Termination of pregnancy before 20

weeks
TYPES OF ABORTION
Spontaneous Incomplete
Induced Complete
Threatened Missed
Habitual
Etiology

 Fetal factors
 Placental factors
 Maternal factors
 Q. Which of this is true about abortion?
A. Inevitable abortion can be saved
B. It occurs when fetus reaches age of viability
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
ASSESSMENT OF CLIENTS WITH ABORTION
Vaginal bleeding
Passage of clots or tissue
Cramping/contractions
Shock
INTERVENTIONS
Assess
Uterus, bleeding, pads, clots, shock
Bed rest and no sex
Administer
IV fluids and Rhogam if necesary
Assisst with D&C
Q. A pregnant mother will receive Rhogam,
if:
A. Rh negative mother, Rh positive fetus, +
Coomb’s test
B. Rh postive mother, Rh positive fetus, -
Coomb’s test
C. Rh negative mother, Rh positive fetus, -
Coomb’s test
D. Rh negative mother, Rh positive fetus, -
Coomb’s test
Pregnancy outside uterus
Etiology

 Problems in the fallopian tubes

 Use of IUD
ASSESSMENT OF CLIENTS WITH ECTOPIC
PREGNANCY

Timing of signs
Abdominal pain
Vaginal spotting
Signs of rupture
Diagnostic

• CBC
• Pregnancy test
• UTZ
• Culdocentesis
INTERVENTIONS
Assess
VS, pain, and rupture, shock
Administer medications
Prepare for surgery
Provide emotional support
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)
Thropoblastic proliferation of grapelike
vesicles
Etiology

 Unknown
 Gene
 Nutritional deficiency
Diagnostic

• HCG
• UTZ
ASSESSMENT OF CLIENTS WITH H-MOLE
Onset of signs
No growing fetus
Vaginal bleeding
Increased fundal height

• Q. Which one does not support
the diagnosis of H-mole?
A. Severe edema of face and hands
B. Abnormal fundal height
C. Absent FH tone
D. Elevate HCG
E. Sudden pain in the lower
abdomen
F. UTZ no fetus
INTERVENTONS
Assist with uterine evacuation
Tissues for analysis
Monitor for complications
Monitor HCG levels
No pregnancy for 1 year
• 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
Premature dilation of cervix
Etiology

• History of traumatic birth

• Anatomical anomaly
ASSESSMENT OF CLIENTS WITH
INCOMPETENT CERVIX

Common 20th week

Vaginal bleeding
Fetal membranes visible through
the cervix
INTERVENTIONS
Bed rest and tocolytic agents
Prepare for cervical cerclage
Report these after cerclage
bleeding and contractions
Infection and bag of water
Low implantation of placenta
Etiology

 Maternal factors
 History of placenta previa
TYPES OF PLACENTA PREEVIA

Total placenta previa

Partial placenta previa
Marginal placenta previa
Low-lying placenta previa
• Diagnostic
• UTZ
Q. Partial placenta previa is:
Low lying placenta
Placenta covers some of the vcervical os
Entire placenta covers the cervical os
Placenta covers the cervical os during
dilatation
Pregnancy outside the uterus
ASSESSMENT OF CLIENTS WITH PLACENTA
PREVIA

Vaginal bleeding
Uterus is soft, relax and non-
tender
INTERVENTIONS
Monitor VS and FHT
Bed rest
Prepare UTZ
No IE
Monitor bleeding
CS for heavy bleeding
Rhogam is needed
Q. Care for a client with placenta previa
include:
A. IE to measure cervix dialtion
B. Complete bed rest lying on back
C. Double set up during internal exam
D. Monitoring for shock
E. UTZ to confirm diagnosis
F. Weight saturated pads
PREMATURE SEPARATION OF THE
PLACENTA
Etiology

 Anatomical anomaly
 Underlying disease condition
 Previous CS
 Trauma to the abdomen
ASSESSMENT OF CLIENTS WITH ABRUPTIO
PLACENTAE
Vaginal bleeding
Uterine rigidity and tenderness
Severe abdominal pain
Fetal distress
Signs of complication
INTERVENTIONS
Monitor
VS, bleeding, uterus, fundus, pads
Bed rest
Administer O2, IVF, BT
Emergency delivery of the fetus
Rhogam is needed
Provide emotional support
Assessment technique to determine
blood loss on a client with abruptio
placentae include the following except:
A. Measure fundal height
B. Measure abdominal girth
C. Check VS and Hgb and Hct
D. Monitor for saturated pads
ACUTE HYPERTENSIVE STATE THAT DEVELOPS
AFTER THE 20TH WEEK OF GESTATION
Etiology

 Risk factors
 Genetic
 Primigravida
 Age
 Underlying disease/condition
Diagnostic
• UA
• CBC
• Renal Function
• Liver Function
• Roll over test
PREGNANCY-INDUCED HYPERTENSION (PIH)
MILD
SEVERE

Classic signs of PIH

Proteinuria
Edema
Hypertension
ASSESSMENT
MILD SEVERE

P P
E E
H H
 Q. Mild PIH is: SATA
A. BP of at least 160/110
B. Proteinuria is more than 5 g/dl in 24 hour
urine collection
C. Having increased liver enzymes and seizures
D.Presence of HELLP
E. Systole increases to 30, and diastole to 15
F. Severe epigastric pain
G.BP 140/90
Warning signs of Worsening PIH
Worsening PEH
Increasing weight gain
Cerebral signs
Renal signs
GI signs
HELLP syndrome
INTERVENTIONS FOR MILD AND
SEVERE PIH
Assess VS, CNS, edema and weight
Bed rest and limit stimulation
Provide safety
Modify diet
Administer medications
 A client with PIH is placed on:
A. Non-stimulating room
B. Supine position
C. Restricted potassium intake
D. Liberal fluid intake
E. Moderate to high CHON intake
F. Well lit room
 Q. Before Mg SO4 administration, the
nurse checks:
A.Respiration
B. Uterine contractions
C. Visual acuity
D.Platelet count
Premature rupture of
membrane (PROM)
Rupture of amniotic sac before
onset of labor
Assessment

 Amniotic fluid gushing

 Pooling of amniotic fluid
 Signs of infection
PROM

• Diagnostic
• Ferning test
• Nitrazine test
Interventions

 Confirm rupture
 Assess
 Fetal and maternal status
 Maintain on bed rest if fetal head is not
engaged
 Position if with cord prolapse
 NSD is possible
 Preterm labor
LABOR THAT BEGINS AFTER 20
weeks’ gestation and before 37
weeks’ gestation
Etiology

 PROM
 Abruptio placentae
 PIH
 Placenta previa
 Incompetent cervix
 Trauma
 Intrauterine infection
Assessment

 Signs of true labor between 20

weeks to 37 weeks gestation
Interventions

 Assess
 VS, bleeding, contractions and
FHT
 Bed rest
 Diagnostic procedures
 UTZ and amniocentesis
 Medications
 Cord Prolapse
Descent of the cord that my
stop placental and fetal
perfusion
Etiology

 Preterm labor
 Rupture of membrane
Assessment

 Feeling the cord within the vagina

 Cord seen or felt on IE
 Cord prolapsed maybe occult
 Deceleration
Interventions

 Identify prolapsed cord and provide

immediate intervention
 Assess FHR, especially right after the
rupture of membrane and again in 5-10
minutes
 If cord prolapse is identified, prepare for
CS delivery
Interventions

 If client is fully dilated, NSD is

possible:
 Proper positioning
 Oxygenation
 Relieve pressure form the cord
 Prevent drying of the cord
Dysfunctional Labor
Difficult, painful, prolonged labor
due to mechanical factors
Etiology
Fetal factors
Uterine factors
Pelvic factors
Psyche factors
Assessment

Irregular uterine contractions

Ineffective uterine contractions
Interventions
Assess
Contractions and FHT
Prevent fatigue
Assess complications of labor
Bladder, CPD, large baby
 Uterine Rupture
Complete or incomplete tearing of
uterine wall
Etiology

 Obstetric interventions
 Grand multiparity
 Fetal factors
Assessment

 Abdominal pain
 Fetal parts under the skin
 Fetal distress
 Signs of shock
Interventions

 Assess for
 Uterus
 Prepare for CS and surgery
 Prevent and treat shock
END…

Thank you so much…