OB ABNORMALS

Tricia Mae Carmona, RN

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 HIGH RISK PREGNANCY

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 GESTATIONAL DIABETES MELLITUS

RISK FACTORS:
1. Advanced maternal age
2. Obesity
3. Multiple gestation
4. Family history of DM
5. PCOS
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 DIAGNOSTIC TEST:
• a. FBS: b. NFBS:

• 50 g glucose tolerance test

N:
ABN:

• 100 g glucose tolerance test

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 Oral Glucose Challenge Test Values
(Fasting Plasma Glucose Values) for Pregnancy

Confirmation:
TEST TYPE PREGNANT GLUCOSE LEVEL
(mg/dL)
FASTING
1 HOUR
2 HOURS
3 HOURS
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 Complications related to uncontrolled
diabetes:
1.

2.

3.

4.

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 MANAGEMENT:
A. Monitor:

1. Blood glucose

2. Vision changes

3. Infection

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 MANAGEMENT:
B. Diet

1. 1800 – 2400 calorie diet

2. Increased fiber and reduced saturated fats

3. Final snack of the day: Protein + Complex carbohydrate

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 MANAGEMENT:
C. Exercise

D. Insulin
Early:
Late:

1. Type of Insulin:

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 MANAGEMENT:
2. Time and amount:

3. Site:

4. Avoid:

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 PREGNANCY INDUCED HYPERTENSION
1. Vascular

2. Kidney

3. Interstitial

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 CLASSIFICATIONS OF PIH:
GESTATIONAL MILD PRE- SEVERE PRE-ECLAMPSIA ECLAMPSIA
HYPERTENSION ECLAMPSIA

BLOOD
PRESSURE

PROTEINURIA

EDEMA

WEIGHT
GAIN
OTHERS:

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 CLASSIFICATIONS OF PIH:
GESTATIONAL MILD PRE- SEVERE PRE-ECLAMPSIA ECLAMPSIA
HYPERTENSION ECLAMPSIA
PROTEINURIA: +1 / +2

BP: 160/110 mmHg

Extreme Edema

BP: Higher than

160/110
Edema: Upper part of
the body

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 INTERVENTIONS:
1. Nutrition
Protein:
Sodium:
2. Rest
Visitors:
Rooms:
Environment
3. Safety
Institute:
Priority:
Position:

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 MEDICAL INTERVENTIONS:
1. MAGNESIUM SULFATE
Indication: Therapeutic Level:
Given via: WOF:
Antidote:
Assessment: S/Sx of toxicity
1. B
2. U
3. R
4. P

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 MEDICAL INTERVENTIONS:
2. HYDRALAZINE, NIFEDIPINE, LABETALOL

Indication:
Administration:
Assessment:
Maintain:

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 MEDICAL INTERVENTIONS:
3. DIAZEPAM

Indication:
Administration:
Observe for:
Mother:
Infant at birth:

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 RH Incompatibility
Mother:
Fetus:

Procedure that increases exposure to fetal blood:

1.
2.
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 SCREENING:
a. Normal:
b: After 28 weeks:
c. Abnormal:

THERAPEUTIC MANAGEMENT:
1. RhIG
First:
Second:
Administration:

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 BLEEDING DURING
PREGNANCY

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 A. 1ST TRIMESTER
BLEEDING

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 MISCARRIAGE
Causes:
1. Abnormal fetal development
2. Embryonic defects
3. Implantation abnormalities
4. Infection

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 Types of Miscarriage:
SPONTANEOUS

A. THREATENED
Assessment:
1.
2.
Avoid:
1.
2.
3.
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 Types of Miscarriage:
B. Imminent
If no fetal heart beat:

C. Complete

D. Incomplete
WOF:
Management:

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 Types of Miscarriage:
E: MISSED
Management:

F: RECURRENT PREGNANCY LOSS

Causes:
1. Defective ovum or sperm
2. Luteal phase defect
3. Defect in the uterus
4. Autoimmune disease
5. Chorioamnionitis
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 Complications of Miscarriage
1. HEMORRHAGE
Management:
Monitor:
1.
2.
Position if with bleeding:
2. INFECTION
CA:
Health Teaching:
1.
2.
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 Complications of Miscarriage
3. Septic Abortion
If untreated:
Management:
Antibiotics:
D&C:
TT:
4. Isoimmunization

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 ECTOPIC PREGNANCY
Most common site:
CAUSES:
1. Previous infection
2. Congenital malformations
3. Uterine tumor
4. Use of IUD

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 Early diagnosis:
Undiagnosed:

ASSESSMENT: Unruptured
1.
2.
MANIFESTATIONS: Ruptured
1.
2.

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 MEDICAL MANAGEMENT: Unruptured
1.
2.
3.
INTERVENTIONS: Ruptured
1.
2.
SURGICAL MANAGEMENT: Ruptured
1.
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 B. 2ND TRIMESTER
BLEEDING

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 HYDATIDIFORM MOLE
TWO TYPES:
1. Complete

2. Partial

Undiagnosed:
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 MANIFESTATIONS:
1.
2.
3.
4.
After 16 weeks: If unidentified
1.
2.
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 THERAPEUTIC MANAGEMENT:
1.
2.
a.
b.

3.
4. DOC for Choriocarcinoma:

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 INCOMPETENT CERVIX
RISK FACTORS:
1. Advanced maternal age
2. Congenital defects
3. Trauma

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 EARLY MANIFESTATIONS:
1.
2.
3.

SURGERY:
1.
a.
b.

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 C. 3rd TRIMESTER
BLEEDING

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 PLACENTA PREVIA
RISK FACTORS:
1. Increased parity
2. Advanced maternal age
3. Past cesarean births

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 TYPES OF PLACENTA PREVIA DESCRIPTION

implantation in the lower rather than in

the upper portion of the uterus

the placenta edge approaches that of

the cervical os

implantation that occludes a portion of

the cervical os

implantation that totally obstructs the

cervical os

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 MANIFESTATIONS:
1.
2.
INTERVENTIONS:
1. Position:
2. Inspect:
3. Weigh:
4. Avoid:
5. Bleeding:

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 6.
If labor has begun:
If bleeding has stopped:

WOF:
1.
2.

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 ABRUPTIO PLACENTA
RISK FACTORS:
1. Multiparous
2. Advanced maternal age
3. Short umbilical cord
4. PIH
5. Cocaine use

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 MANIFESTATIONS:
1.
2.
3. Bleeding
a. Edge:
b. Center:
Kleihauer-Betke test:
4.

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 MANAGEMENT:
1.
2.
3.
4.
5.
6.

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 PRETERM LABOR
RISK FACTORS:
1. DHN
2. UTI
3. Stress
4. Strenuous activity

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 MANIFESTATIONS:
1.
2.
3.
4.
5.
6.

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 Nursing Management:
1.
2.
Medical Management:
1.
Usual dose:
a.
b.
2. Tocolytic agents
a.
b.
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 If labor cannot be halted…
1. Preferred delivery:

2. Avoid:

3. Use of forceps/episiotomy

4. Umbilical cord cutting

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 POST PARTUM
COMPLICATIONS

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 A. POSTPARTAL
HEMORRHAGE

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 TONE

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 UTERINE ATONY
Risk factors:
1. Distention of the uterus beyond capacity
2. Varied placental site or attachment
3. Inability of the uterus to contract
4. Inadequate blood coagulation
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 THERAPEUTIC MANAGEMENT:
1. Bimanual Massage

2. Blood replacement
3. Encourage patient to void
4. Oxygen administration

SURGICAL MANAGEMENT:
1. Hysterectomy
2. Suturing / Balloon compression
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 MEDICAL MANAGEMENT:

1. Oxytocin

2. Methergine

3. Carboprost tromethamine (Hemabate)

4. Rectal misoprostol

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 TRAUMA

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 LACERATIONS
1. Cervical Lacerations
Site:
Color:

2. Vaginal Lacerations

3. Perineal Lacerations
Cause:

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 UTERINE INVERSION
CAUSES:
1. Traction applied to the umbilical cord
2. Pressure applied in a NON contracted uterus

SIGNS:
1. Large amount of blood gushes from the vagina
2. Fundus is not palpable

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 AVOID:
1.
2.
3.
MANAGEMENT:
1.
2.
3.
4.
5.
• NEXT PREGNANCY:
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 THROMBIN

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 DISSEMINATED INTRAVASCULAR
COAGULATION

Causes:
1.
2.
3.
4.

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 MEDICAL MANAGEMENT:
1. To stop coagulation:
a.
2. To restore blood clotting:
a.
b.
c.

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 TISSUE

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 RETAINED PLACENTAL FRAGMENTS
DETECTION:
1.
2.
ASSESSMENT:
1. Bleeding
a. Large fragment
b. Small fragment

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 SURGICAL MANAGEMENT:
1.
2.

MEDICAL MANAGEMENT:
1.

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 B. MASTITIS

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 MASTITIS
CA:
PORTAL OF ENTRY:
PREVENTIVE MEASURES
1. Proper positioning
2. Washing of hands
3. Proper releasing
4. Exposing nipples to air
5. Using vit E
6. Continue breastfeeding
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 MANIFESTATIONS:
1.
2.
3.
4.
MANAGEMENT:
1.
2.
3.

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 C. POSTPARTUM
PSYCHOLOGICAL
COMPLICATIONS
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 POSTPARTAL POSTPARTAL POSTPARTAL
BLUES DEPRESSION PSYCHOSIS

ONSET

SYMPTOMS

ETIOLOGY

THERAPY

NURSING ROLE

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 POST-TEST

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