Question

Include definition/pathophysiology, manifestations, immediate interventions, medications (if applicable) and patient teaching for the following:

• Preterm labor
• Incompetent cervix
• Preeclampsia
• Placenta previa
• Placenta abruption
• Placenta acreta
• Substance abuse

Answer 1

1. Preterm labour. :

Definition : Preterm labour is defined as one where the labour starts before 37th completed week(<259 days), counting from the first day of the last menstrual period.

Risk factors : Previous preterm labours, risky lifestyle, multiple gestation, maternal fever,opioid use, bacterial vaginitis, multiple abortions,pyelonephritis,asymtomatic bacteriuria.

Manifestaions: Pelvic pressure, premature effacement of cervix with irritable uterus, vaginal discharge or bleeding.

Immediate interventions : It includes primary care , secondary care, tertiary care..

In primary care it is aimed to reduce the incidence of preterm labour, by reducing the high risk factors(infection). In secondary it includes screening tests for early detection, and prophylactic treatment.(e.g. tocolytics). In tertiary care, it is aimed to reduce the perinatal mortality and morbidity after the diagnosis .(e.g. use of corticosteroids).

Immediate assessment includes: - Monitoring fetal status.

- monitoring the signs of labor: two contractions lasting 30seconds within 15minutes,cervical dialation, less than 4cm,effacement 50% or less.

- Signs of hemorrhage

- Signs of severe preeclampsia

- Rupture of membranes, length of time since rupture

- Emotional status of mother

Medications : Tocolytic therapy, like use of betasympthomimetics,magnesium sulphate,prostaglandin inhibitors, calcium channel blockers,

- Corticosteroid therapy ; includes administration of betamethosone.

Patient education : Educate about the importance of early reporting of temperature elevations.

- Monitor for urinary tract infections

- Arrange for home health visit by the health nurse to supervise maternal and fetal status.

- Provide emotional support

- Monitor vital signs, FHR, contractions, and progression of labor.

- Discuss impact of drug use and lifestyle.

- Maintain bedrest if needed.

- Provide home instruction regarding halting of preterm labor like avoidance of stressful events, maintaining bed rest and increase fluid intake, rest periods in lateral position,avoid nipple stimulation,empty bladder regularly and if contractions occur.

2. Incompetent cervix :

-Definition :Cervical effacement and dialation in early second trimester: expultion of products of conception:recurrent miscarriages each one earlier in pregnancy.

-Risk factors are forceful or excessive dilation and curettage,congenitally short cervix.

Clinical findings: - Painless contractions insecond trimester.

- Preterm birth of nonviable fetus.

- Nursing care includes : - Monitor vital signs

- Educate which activities are restricted and importance of adherence to restrictions.

- Maintain bed rest for 24hours.

- Monitor for rupture of membranes or bleeding

- States will notify health care provider when labor begins

- Medications : a. Concervative : bedrest, adequate hydration, tocolytic therapy to inhibit uterine contractions.

b. Cerclage procedure: during 10 to 14 weeks gestation: suture or ribbon placed beneath cervical mucosa to close cervix.

c. Activity restrictions, cesarean birth or cutting of suture for vaginal birth at term

3. Preeclampsia :

- Definition : Preecclampsia is a multi system disorder of unknown etiology characterised by development of hypertension to the extent of 140/90mmHg or more with proteinuria afetr the 20th week in a previously normotensive and non-proteinuric women.

- Clinical manifestations : a. mild symtoms include blood pressure 140/90mmHg and severe includes 160/110mmHg , blurred vision,epigastric pain, irritability, persistant headache , edema in the extremities, proteinuria and oliguria

- Nursing interventions- a. Hopitalization and bed rest.

b. monitor for seizure activities, maintain fluid balance.

c. monitor FHR nad observe signs of bleeding.

d. offer high protein diet with adequate sodium intake .

e. monitor edema and daily weight

d. assess magnesium levels in the blood every 6 hours.

e. adherence to prenatal recommendations about diet , exercise, rest, regular prenatal checkups.

- Medications : Magnesium sulphate administered intravenously via infusion pump, antihypertensive drugs like hydralazine,nifedipine,methyldopa, labetolol is administered

4. Placenta previa :

- Definition : Placenta previa is defined as implantation of placenta in loer uterine segment.

- Risk factors like cesarean birth, multiple gestations, placenta previa, endometrial scarring.

- Clinical manifestations are painless ,bright red bleeding, hemorrhage inthird trimester , soft uterus in latter part of pregnancy, may have signs of infection.

- Therapeutic interventions :

- Ultrasonography to confirm placenta previa.

- Depend onlocation of placenta , amount of bleeding, status of fetus.

- Avoidance of vaginal examinations.

- Measures to control bleeding and replacement of blood loss

- Home monitoring with repeated ultrasounds for type 1 low lying.

-Ceserean birth if necessary.

Nursing care of women placenta previa:

- Emphasize to other health care provider that vaginal examinations are contraindicated.

- monitor hemoglobin and hematocrit,administer IV therapy and or blood replacement if necessary.

- monitor maternal vital signs using electronic equipment.

- monitor and document amount of bleeding.

- monitor signs of cyanosis, administer oxygen if necessary.

5. Placenta abruption :

- Definition : It is form of antepartum hemorrhage where the bleeding occurs due to premature seperation of nrmally situated placenta.

Clinical manifesttaions: blood may accumulate behind the placenta when it is totally seperated from the uterine wall, abdominal discomfort or vaginal bleeding, shock due to blood loss and hypovolaemia aor due to coagulopathy.

- Immediate interventions are : Induction of labor is done due to low rupture of memberane, ceserean delivery, hypovolaemia should be corrected early.

Nursing interventions:

- Maintain bedrest in lateral recumbent position.

- monitor maternal vital signs using electronic equipment.

- observe for cyanosis.

- administer IV therapy and blood infusion if necessary.

- observe for perineal pads for bleeding.

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