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8/6/2019 Hight Risk Pregnancy Concepts
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Termination of pregnancy before 20 weeks
ABORTION
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TYPES OF ABORTIONySpontaneous
yInducedyThreatened
yHabitual
yIncomplete
yCompleteyMissed
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EtiologyEtiology
Fetal factorsFetal factors Placental factorsPlacental factors
Maternal factorsMaternal factors
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Q. Which of this is true about abortion?
A. Inevitable abortion can be saved
B. It occurs when fetus reaches age ofviability
C. Threatened abortion has no cervical
dilation
D. Complete abortion needs D and C
E. No sex during active signs of abortion
F. Bed rest is needed
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ASSESSMENT OF CLIENTS WITH ABORTION
yVaginal bleeding
yPassage of clots or tissueyCramping/contractions
yShock
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INTERVENTIONSyAssess
y
Uterus, bleeding, pads, clots, shockyBed rest and no sex
yAdminister
yIVfluids and Rhogam if necesary
yAssisst with D&C
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Q. A pregnant mother will receive Rhogam,if:
A. Rh negative mother, Rh positive fetus, +Coombs testB. Rh postive mother, Rh positive fetus, -
Coombs test
C. Rh negative mother, Rh positive fetus, -Coombs testD. Rh negative mother, Rh positive fetus, -
Coombs test
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Pregnancy outside uterus
ECTOPIC PREGNANCY
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EtiologyEtiology
Problems in the fallopian tubesProblems in the fallopian tubesUse ofIUDUse ofIUD
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ASSESSMENT OF CLIENTS WITH ECTOPIC
PREGNANCY
yTiming of signsyAbdominal pain
yVaginal spotting
ySigns of rupture
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Diagnostic
CBC
Pregnancy test
UTZ
Culdocentesis
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INTERVENTIONSyAssess
yVS, pain, and rupture, shockyAdminister medications
yPrepare for surgery
yProvide emotional support
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Q. A client is suspected of ectopic
pregnancy. Which one supports the
diagnosis?A. 3rd trimester pregnancy
B. Dark vaginal bleeding
C. Painless vaginal bleeding
D. Sudden/sharp upper abdominal pain
E. Spotting in before 20 weeks
F. Signs and symptoms of shock
G.Blood aspirated on the pelvis (cul-de
sac)
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Thropoblastic proliferation of grapelike vesicles
HYDATIDIFORM MOLE
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Diagnostic
HCG
UTZ
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ASSESSMENT OF CLIENTS WITH H-MOLE
yOnset of signs
yNo growing fetus
yVaginal bleeding
yIncreased fundal height
y
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Q. Which one does not support
the diagnosis ofH-mole?
A. Severe edema of face and hands
B.Abnormal fundal height
C.Absent FH tone
D.Elevate HCG
E. Sudden pain in the lowerabdomen
F. UTZ no fetus
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INTERVENTONSyAssist with uterine evacuation
yTissues for analysis
yMonitor for complications
yMonitor HCG levels
yNo pregnancy for 1 year
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Q. A client with H-mole is for
discharge. Which one is
emphasized on teaching?
A. Use contraception for 1 year
B. Monitor HCG for 6 months until
normal C.Report fever or sore throat
when on methotrexate
D. Supplement methotrexate with
folic acid for prevention and
treatment of choriocarcinoma
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Premature dilation of cervix
INCOMPETENTCERVIX
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Etiology
History of traumatic birth
Anatomical anomaly
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ASSESSMENT OF CLIENTS WITH
INCOMPETENT CERVIX
yCommon 20th
weekyVaginal bleeding
yFetal membranes visible throughthe cervix
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INTERVENTIONSyBed rest and tocolytic agents
yPrepare for cervical cerclage
yReport these after cerclage
ybleeding and contractions
yInfection and bag of water
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Low implantation of placenta
PLACENTAPREVIA
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EtiologyEtiology
Maternal factorsMaternal factors
History of placenta previaHistory of placenta previa
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TYPES OF PLACENTA PREEVIA
y
Total placenta previayPartial placenta previa
yMarginal placenta previa
yLow-lying placenta previa
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Diagnostic
UTZ
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yQ. Partial placenta previa is:
yLow lying placenta
yPlacenta covers some of the vcervical os
yEntire placenta covers the cervical os
yPlacenta covers the cervical os duringdilatation
yPregnancy outside the uterus
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ASSESSMENT OF CLIENTS WITH PLACENTA
PREVIA
yVaginal bleedingyUterus is soft, relax and non-tender
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INTERVENTIONSyMonitorVS and FHT
yBed rest
yPrepare UTZ
yNo IE
yMonitor bleeding
yCS for heavy bleeding
yRhogam is needed
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yQ. Care for a client with placenta previainclude:
yA. IE to measure cervix dialtion
yB. Complete bed rest lying on back
yC. Double set up during internal exam
yD. Monitoring for shock
yE. UTZ to confirm diagnosis
yF. Weight saturated pads
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PREMATURE SEPARATION OF THEPLACENTA
ABRUPTIO PLACENTAE
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EtiologyEtiology
Anatomical anomalyAnatomical anomaly
Underlying disease conditionUnderlying disease condition
Previous CSPrevious CS
Trauma to the abdomenTrauma to the abdomen
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ASSESSMENT OF CLIENTS WITH ABRUPTIO
PLACENTAE
yVaginal bleeding
yUterine rigidity and tenderness
ySevere abdominal pain
yFetal distress
ySigns of complication
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INTERVENTIONSyMonitor
yVS, bleeding, uterus, fundus, pads
yBed rest
yAdminister O2, IVF, BT
yEmergency delivery of the fetus
yRhogam is needed
yProvide emotional support
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yAssessment technique to determineblood loss on a client with abruptio
placentae include the following except:yA. Measure fundal height
yB. Measure abdominal girth
yC. Check VS and Hgb and Hct
yD. Monitor for saturated pads
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ACUTE HYPERTENSIVE STATE THATDEVELOPS AFTER THE 20TH WEEK OF
GESTATION
PREGNANY-INDUCED HYPERTENSION
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EtiologyEtiology
Risk factorsRisk factors
Genetic
Genetic
PrimigravidaPrimigravida
AgeAge
Underlying disease/conditionUnderlying disease/condition
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Diagnostic
UA
CBC
Renal Function
Liver Function
Roll over test
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PREGNANCY-INDUCED HYPERTENSION (PIH)
yMILD
ySEVERE
yClassic signs of PIH
yProteinuriayEdema
yHypertension
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ASSESSMENTMILD SEVERE
yP
yE
yH
yP
yE
yH
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Q. Mild PIH is: SATAQ. Mild PIH is: SATA
A.A.BP of at least 160/110BP of at least 160/110B.B.ProteinuriaProteinuria is more than 5 g/dl in 24is more than 5 g/dl in 24hour urine collectionhour urine collection
C.C.Having increased liver enzymes andHaving increased liver enzymes and
seizuresseizuresD.D.Presence of HELLPPresence of HELLP
E.E.Systole increases to 30, and diastole toSystole increases to 30, and diastole to
1515F.F.SevereSevere epigastricepigastric painpain
G.G.BP 140/90BP 140/90
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Warning signs of Worsening PIH
yWorsening PEH
y Increasing weight gain
yCerebral signs
yRenal signs
yGI signs
yHELLP syndrome
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INTERVENTIONS FOR MILD AND
SEVERE PIHyAssessVS, CNS, edema and weight
yBed rest and limit stimulation
yProvide safety
yModify diet
yAdminister medications
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Q. Before Mg SO4 administration, the
nurse checks:
A.Respiration
B.Uterine contractions
C.Visual acuityD.Platelet count
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Premature rupture ofPremature rupture of
membrane (PROM)membrane (PROM)Rupture of amniotic sac beforeRupture of amniotic sac before
onset of laboronset of labor
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PROM
Diagnostic
Ferning test
Nitrazine test
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InterventionsInterventions
Confirm ruptureConfirm rupture
AssessAssess
Fetal and maternal statusFetal and maternal status
Maintain on bed rest if fetal head isMaintain on bed rest if fetal head is
not engagednot engaged Position if with cordPosition if with cord prolapseprolapse
NSD is possibleNSD is possible
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AssessmentAssessment
Signs of true labor between 20S
igns of true labor between 20weeks to 37 weeks gestationweeks to 37 weeks gestation
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InterventionsInterventions
AssessAssess
VS, bleeding, contractions andVS, bleeding, contractions andFHTFHT
Bed restBed rest
Diagnostic proceduresDiagnostic proceduresUTZ and amniocentesisUTZ and amniocentesis
MedicationsMedications
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Cord ProlapseCord ProlapseDescent of the cord that myDescent of the cord that my
stop placental and fetalstop placental and fetalperfusionperfusion
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EtiologyEtiology
Preterm laborPreterm labor
Rupture of membraneRupture of membrane
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AssessmentAssessment
Feeling the cord within the vaginaFeeling the cord within the vagina
Cord seen or felt on IECord seen or felt on IE
Cord prolapsed maybe occultCord prolapsed maybe occult
DecelerationDeceleration
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InterventionsInterventions
Identify prolapsed cord and provideIdentify prolapsed cord and provide
immediate interventionimmediate intervention
Assess FHR, especially right after theAssess FHR, especially right after therupture of membrane and again in 5rupture of membrane and again in 5--1010
minutesminutes
If cord prolapse is identified, prepare forIf cord prolapse is identified, prepare forCS deliveryCS delivery
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InterventionsInterventions
If client is fully dilated, NSD isIf client is fully dilated, NSD is
possible:possible:
Proper positioningProper positioning
OxygenationOxygenation
Relieve pressure form the cordRelieve pressure form the cord
Prevent drying of the cordPrevent drying of the cord
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Dysfunctional LaborDysfunctional LaborDifficult, painful, prolonged laborDifficult, painful, prolonged labor
due to mechanical factorsdue to mechanical factors
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EtiologyyFetal factors
yUterine factorsyPelvic factors
yPsyche factors
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Assessment
yIrregular uterine contractionsyIneffective uterine contractions
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Uterine RuptureUterine RuptureComplete or incomplete tearing ofComplete or incomplete tearing of
uterine walluterine wall
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EtiologyEtiology
Obstetric interventionsObstetric interventions
Grand
Grand multiparitymultiparity
Fetal factorsFetal factors
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AssessmentAssessment
Abdominal painAbdominal pain
Fetal parts under the skinFetal parts under the skin Fetal distressFetal distress
Signs of shockSigns of shock
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InterventionsInterventions
Assess forAssess for
UterusUterus
Prepare forCS and surgeryPrepare forCS and surgery
Prevent and treat shockPrevent and treat shock
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END
Thank you so much