• BLEEDING IN PREGNANCY • Pregnancy do not

• FIRST TRIMESTER progress beyond

• ABORTION – any interruption in pregnancy before 12th week causing
the age of viability the tube to rupture
• Spontaneous
 Occurs from natural causes o Surgical mgt
• Blighted ovum  Salphingectomy w/ BT for
• Trauma ruptured
• Infection  Salphingotomy if not ruptured
• Hormonal • SECOND TRIMESTER
• Hydatidiform Mole (H-Mole) or Gestational
• a.1. Threatened Trophoblastic Dse
• s/s: bright red vaginal bleeding, mod amt o a dev’tal anomally of placenta resulting
• Mgt: to degeneration & proliferation of
• CBR for 24-48° chorionic villi
• Coitus is restricted for 2 wks o Precursor to choriocarsinoma
• Endocrine/hormonal therapy
• Advise pt to save all pads, clots & expelled tissues o S/S:
 Uterine expansion faster than
• a.2. Imminent/ Inevitable the normal
• s/s:  Nausea & vomiting
o bright red vaginal bleeding, mod amt  No FHT
o Uterine contractions & cervical dilatation  (+) pregnancy test
o Loss of products of conception  Signs of toxemia
o Types:  Vaginal bleeding
 Complete
 Incomplete – D&C
o Mgt:
• a.3. Missed  Suction curretage
• Fetus dies in utero but is not expelled  Actinomycin D or
o Has to be expelled w/in 2wks after dx Methotrexate
 Post-evacuation monitoring of
• b. Induced HCG
o b.1. therapeutic  TAHBSO
o b.2. illegal
• PUERPERIUM/POSTPARTUM
• Ectopic Pregnancy – gestation outside the uterus • 6-week period after delivery
o Types:
• Cervical – due to too slow movt of sperm or too • INVOLUTION
fast movt of ova • return of reproductive organs to their pre-
• Abdominal – outside the female reproductive pregnancy state
organs • PRINCIPLES OF POSTPARTUM CARE
• Ovarian • Promote healing & return to normal of the different
• Tubal – most common; usually due to adhesions parts of the body
or scarring from PID • Vascular changes
• The 30-50% ↑ in bld vol is reabsorbed into general
o Tubal circulation w/in 5-10 mins
 Ampullar - • ↑ WBC
• s/s: • Risk for thrombo-embolism
o Spotting • Early ambulation – after 4-8° postpartum
o Stabbing  d. 3 – 4 wks postpartum – all
excruciati bld values return to normal
ng pain in • PRINCIPLES OF POSTPARTUM CARE
lower • Genital changes
quadrant • Uterine involution – measured by fingerbreaths
o Rigid (=1cm)
abdomen • Knee-chest position – for return of uterus in its
o Cullen’s normal anteflexed position
sign • Afterpains – strong uterine contractions felt
o Signs of • Nsg mgt: analgesic
shock • PRINCIPLES OF POSTPARTUM CARE
o fever • Lochia – uterine discharge consisting of bld,
 Interstitial decidua, WBC, mucus
• Interstitial portion – • Rubra – 1st 3 days; red, mod in amt
has large bld
vessels • Serosa – next 4-9 days; pink or brownish & ↓ amt
• Alba – from 10th day up to 3-6 wks; colorless,
minimal amt
• PRINCIPLES OF POSTPARTUM CARE
• Pain in perineal region
 Relieved by:
• Sim’s position
• Perineal heat lamp
• Warm Sitz bath BID
• Topical or oral analgesics
• PRINCIPLES OF POSTPARTUM CARE
• Sexual activity – 3-4 wks postpartum if bleeding
has stopped & episiorrhaphy has healed.
• Menstruation
• Breastfeeding – 3-4 mons
• Not breastfeeding – w/in 8 wks
• Postpartum check-up – 6th wk
• PRINCIPLES OF POSTPARTUM CARE
• Urinary changes
• Diuresis – w/in 12°
• Frequent urination in small amts
• GI changes – delayed bowel evacuation due to:
• ↓ muscle tone
• Lack of food + enema during labor
• Dehydration
• Fear of pain from perineal tenderness
• PRINCIPLES OF POSTPARTUM CARE
• VS
• T° may ↑
• Bradycardia – common for 6-8 days postpartum
• RR – no change
• Weight
• 10-12 lbs immediate wt loss
• Further wt loss – next days
• PRINCIPLES OF POSTPARTUM CARE
• Provide emotional support
• Taking In Phase
• 1st 1-2 days. Mother is passive & dependent on
others; keeps on verbalizing about recent delivery.
• Taking Hold Phase
• After she has rested and recovered from stress of
delivery, the new mother begins to initiate & take
axn, has energy for the infant. Lasts 2 days to
several weeks.
• Letting Go Phase
• Family relationships are adjusted to accommodate
the infant. Give up the fantasy child and gets to
know the real child.

• PRINCIPLES OF POSTPARTUM CARE

• Prevent postpartum complications
• PRINCIPLES OF POSTPARTUM CARE
• Establish successful lactation
• Advantages of breastfeeding
• For the mother
• Economical
• Rapid involution
• Less incidence of breast Ca
• For the baby
• Bonding
• Contains antibodies
• Less incidence of GI dses
• Always available
• Right temperature
6. Inversion of the Uterus – uterus is turned inside 2. Advise to rest during the last 3 mons
out 3. Advise to refrain from coitus during the last
Clinical manifestation 2 mons bec cervix may dilate prematurely
1. Sudden gush of blood 9. Hydramnios – excessive amniotic fluid prod’n
2. Unpalpable fundus usually up to 2000ml
3. Signs of shock - suggests difficulty w/ fetus’ ability to
Management swallow or absorb excessive urine prod’n
1. Never attempt to replace the inversion w/o (anencephalic, TEF, intestinal obstruction)
good pelvic relaxation Clinical manifestations
2. Never attempt to remove the placenta if it is 1. Rapid enlargement of the uterus
still attached 2. FHT is difficult to auscultate
3. Administer tocolytic agent or anesthesia
3. Shortness of breath
4. BT 4. Lower extremities varicosities &
7. Prolapse of the Umbilical Cord – a loop of
hemorrhoids
umbilical cord slips down in front of the presenting Nsg Care Mgt
fetal part
1. Bedrest to help inc utero-placental circ
Clinical manifestations 2. Educate women to report signs of ruptured
1. Fetal distress
membrane
2. Cord is felt as presenting part during vaginal 3. 3. Advise to ↑ fiber diet to avoid
examination or visible in the vulva
constipation
3. Deceleration 4. 4. Suggest for stool softeners
Management
5. 5. Assess VS & lower extremities edema q
1. Manual elevation of the fetal head 4°
2. Trendelenberg position
3. O2 @ 10L/min via mask 6. 10. Dystocia – difficulty in labor & delivery
4. Tocolytic agent most commonly due to CPD or large baby
5. 5. Do not push back exposed cord 7. 11. Malpresentation
6. 6. Cover exposed cord w/ saline compress 8. a. Occipitoposterior Position –
7. 8. Multiple Pregnancy – twinning mostly the occiput is directed diagonally &
occur 1 in q 99 posteriorly rather than anteriorly
8. - considered complication of 9. b. Breech Presentation
pregnancy bec the woman’s body must 10. Complete feet &
adjust to the effects of more than 1 fetus legs are flexed on thighs; thighs
9. Types: 11. are
10. a. monozygote – identical, same flexed on abd; buttocks & feet are
sex, same features the presenting part
11. - 1 ovum + 1 spermatozoa 12. Frank legs are
12. b. dizygote – each has its own extended & lie against the abd
placenta, cord, amnion 13. & chest;
13. - 2 ova + 2 spermatozoa feet are @ the level of
(possibly not from same sex partners) shoulder, buttocks are the
Risk Factors presenting part
1. Genetic 14. Double footling Legs are unflexed
2. Age: the higher the age, the greater the & extended; feet are
tendency 15. the
3. Parity: the higher the parity, the greater the presenting part
tendency 16. Single footling One leg is
Clinical Manifestations unflexed & extended; 1 foot
1. ↑ size of uterus @ faster rate than usual 17. is the
2. Multiple gestational sac @ USD presenting part
3. Elevated alpha-fetoprotein 18. c. Face Presentation (chin/mentum) – rare
4. Flurries of axns @ different portion of the abd 19. - presenting part is too large for the
during quickening canal for the birth to proceed
5. 2 sets of FHT 20. 12. Forceps Delivery – method of
6. Marked wt inc not associated w/ PIH
delivering infants through the use of forceps
7. Difficulty in sleeping bec of greater discomfort by
extraction
many fetal activities
21. - 2 double-crossed, spoonlike
8. Extreme fatigue & backache
articulated blades that are used to assist in
Nsg care Mgt
delivery of fetal head
1. Eat small 6 meals to compensate nutrition
 22. - may cause damage on the facial
nerve of the baby
23. 13. Vacuum Delivery – method of
delivering an infant using a vacuum applied
over the scalp of the baby
24. - may cause caput succedaneum
25. 14. Cesarean Section – incision is done on
the abd of the pregnant woman to deliver
the fetus primarily bec of CPD.
26. 3 types
27. a. Low Segment CS – method os
choice since lower segment is thinner, fewer
bld vessels, passive during labor
28. b. Classical CS – indicated for
transverse lie, placenta previa, adhesion of
tissues
29. c. Pffannenstiel or bikini
POSTPARTUM COMPLICATIONS
1. HEMORRHAGE - 1-3 hrs postpartum is the
most critical stage
Causes:
a. Laceration
b. Placental retention
c. Uterine rupture
d. Uterine inversion
e. Uterine atony
2. INFECTIONS
a. Endometritis – endometriosis is the
growth of endometrial tissue outside the uterus.
When infected, it is called endometritis.
clinical manifestations
foul smelling vaginal discharge
fever & chills
profuse bleeding
b. Episiotomy Infection