1. Chapter 12 Care of the Obstetric Patient

2. Pre-existing Conditions That Can Complicate Pregnancy
Factors that can contribute to a high-risk pregnancy:
Diabetes mellitus
Heart disease
Substance abuse

3. PREGNANCY COMPLICATIONS
Ectopic Pregnancy

4. Spontaneous Abortion
In a complete abortion, all of the products of conception are expelled.
In an incomplete abortion, some, but not all, of the products of conception are expelled. (For example, the placenta may remain in the uterus.)
In a missed abortion, the fetus dies and the products of conception remain in the uterus.

5. Pregnancy Complications
Incompetent cervix
Unable to remain closed for the duration of the pregnancy
No known cause
Early delivery results
Cervical cerclage procedure
Suture tied around the cervix
Complete bedrest

6. Care of the patient with incompetent cervix
Emotional support
Fear of losing the baby causes anxiety and worry
Report
Abdominal pain
Uterine contractions
Fluid leaking from the vagina

7. Pregnancy complications
Hyperemesis gravidarum
Severe nausea and vomiting
Cause dehydration and weight loss
Normal “morning sickness stops by the 12th week
Continues into the second trimester
Often requires hospitalization for enteral nutrition

8. Pregnancy complications
Gestational diabetes
Pregnancy induced
Usually develops during the second trimester
No history of diabetes
Increases risk of development of type II later
Risks
Large babies cause difficult delivery

9. Preeclampsia/Eclampsia
PREGNANCY COMPLICATIONS
Preeclampsia/Eclampsia
Gestational Hypertension
bp greater than 140/90
Develops after 20th week of gestation
Can lead to death of mother and baby
Md orders
Bed rest
antihypertensive meds
hospitalization

10. Gestational hypertension
Report to the nurse right away if a preeclampsia/eclampsia patient:
Complains of blurred vision
Is irritable or seems especially tense
Complains of severe heartburn
Has decreased urinary output
Has puffy or swollen face and hands

11. PREGNANCY COMPLICATIONS
Placenta

12. PREGNANCY COMPLICATIONS
Placenta Previa

13. PREGNANCY COMPLICATIONS
Abruptio Placentae

14. Pregnancy Complications
Pre-term labor
Occurs between 20th and 37th week
Danger due to baby’s lungs are not full developed
Reason if often not known
Risks
Previous preterm labor
Multiple pregnancy
Uterine or cervical problems
Age of mother (less than 16 or older than 40)

15. Tell the nurse
c/o low back pain or abdominal pain
Urinary urgency
Fluid leaking from the vagina
May signify labor is starting

16. Premature rupture of membranes (PROM)
Occurs prior to due date
Before labor begins
Md may make labor begin if the mother does not go into labor within 24 hours
Mother and baby become at risk for infection

17. Pre-term premature rupture of membranes (pre-term PROM)
Prior to 37th week of pregnancy
Baby’s lungs are not fully developed MD
medication to maintain pregnancy to get past 37th week.
Bedrest
Help with ADL’s

18. Multiple Gestation Twins (the most common) Triplets Quadruplets
Quintuplets
Multiple gestation can sometimes cause a pregnancy to be “high-risk”

19. Monozygotic
One egg is fertilized
Share a placenta
Always same gender
Dizygotic
Two eggs are fertilized
Each baby has own placenta
May be the same gender or different

20. Divided into 4 categories
INFERTILITY
Divided into 4 categories
Problems with the man's reproductive system.
Problems with the woman's fallopian tubes.
Problems with the woman's uterus and/or cervix.
Problems with ovulation.

21. LABOR AND DELIVERY Vaginal birth
Mother is not high risk or there are no problems with the pregnancy
Cesarean section birth
Complications that cause stress on mother or baby

22. Responsibilities of the PCT
Vary from facility to facility
May include Basic care and advanced care skills
routine vital signs
assisting with ambulation
Toilteing
preparation of sterile supplies
collection of blood samples from umbilical cord
clean the patient after delivery

23. Labor and Delivery- process
Oxytocin is released by the pituitary gland causing the uterus to contract in the upper muscular portion
Contractions push the baby downward against the cervix
Pressure of the baby on the cervix causes it to dilate (the opening becomes larger)
When the cervix is fully dilated the baby passes into the birth canal (vagina)
The placenta is delivered

24. Delivery is done by the primary health care provider
Obstetrician
MD who specializes in obstetrics and gynecology in addition to medical school
Certified nurse midwife
RN who completes 1-2 years of additional graduate training
Cannot perform c-sections

25. Signs of Labor Lightening Baby begins to move down into the pelvis
Abdomen changes appearance “dropped”
Usually indicates labor in 2 weeks

26. Signs of Labor Bloody show
Blood tinged vaginal discharge that is mixed with mucous
Mucous plug blocks opening to cervix during pregnancy
Cervix softens and begins to efface (become thinner

27. Signs of Labor Braxton-Hicks contractions
Irregular contractions that occur with more freauency as labor approaches
Irregular frequency and intensity

28. primipara-=a women delivering her first baby
Multipara= a women who has delivered a baby
First stage of labor differs for each

29. First Stage of Labor Divided into three stages: Early latent phase
Mild discomfort, backache
5-8 minutes apart for seconds

30. First stage of Labor Mid/active phase
Contractions become more frequent
Discomfort increases
Monitoring of contractions and FHR
Transitional phase
Most intense contractions every 2-3 minutes for as long as 80 seconds
Cervix dilates from 7-10 cm
Crowning

31. Second Stage of Labor Cervix is completely dilated Pushing stage
Baby is delivered

32. Third Stage of Labor The placenta is delivered
On average, delivery of the placenta takes between 5 and 20 minutes
Nursing assistant’s responsibilities:
Cleaning the perineal area
Applying an ice pack and a perineal pad
Changing soiled linens
Monitoring vital signs every 15 minutes

33. Fourth Stage of Labor
Begins with the delivery of the placenta and ends when the woman’s condition has been stabilized
Vital signs continue to be monitored
Nursing assistant will assist the patient with urination

34. Cesarean Delivery
Delivery of the baby through a surgical incision made in the mother’s abdomen
Necessary when a vaginal delivery is not possible or safe for the mother or baby
Recovery time following a cesarean delivery is generally longer than the recovery time following a vaginal delivery

35. Possible Reasons for a Cesarean Delivery
Anatomical difficulties
Cephalopelvic disproportion (CPD)
Baby’s head is too large to pass through the pelvis
Abnormal fetal presentation
Breech=legs or buttocks first
Shoulder=may be repositioned by the MD
Previous cesarean delivery
Emergency procedure (if complication develops during pregnancy, labor, or delivery)

36. Abnormal Fetal Presentation

37. Nursing Assistant’s Role During Cesarean Delivery
Serve as a scrub person
Perform a surgical scrub, put on a sterile gown and gloves, and work within a sterile field
Learn the steps of the cesarean section procedure, the names of the instruments used, and how to properly pass the instruments and other supplies to the doctor
See Box 12-1

38. VBAC Vaginal birth after cesarean
Possible if no complications during the pregnancy
Uterine scar is located in lower portion of the uterus
Previous pregnancy did not have a life threatening problem

39. Postpartum Complications
Hemorrhage
Greatest first hour after delivery
Can occur 24 hours and up to 6 weeks after delivery

40. Postpartum Complications
Puerperal infection
An infection that develops after childbirth
Affects structrues of the reproductive tract
Other structures could be affected
Urinary tract
Wound
breast

41. Postpartum Complications
Thrombophlebitis
Most common cardiovascular problem
Clots form in deep veins of the legs or pelvis
If break loose cause pulmonary embolism and respiratory/cardiac arrest.

42. Question
When caring for a patient with incompetent cervix, you should report to the nurse right away which of the following observations?
The patient has abdominal pain
The patient has uterine contractions
There is fluid leaking from the vagina
All of the above

43. Answer D. All of the above
All may be signs of an impending spontaneous abortion.

44. Question Tell whether the following statement is true or false.
Usually, a woman with PROM will go into labor within 24 hours, but the doctor may choose to administer medications that make labor begin sooner to lower the risk for infection.
True
False

45. Answer
A. True
PROM puts the mother and the fetus at risk for infection.

46. Question
How many phases are in the first stage of labor? 4 3 6 2

47. Answer
B. 3
The three phases of the first stage of labor are: early latent, mid/active, and transitional.

48. Question What are some postpartum complications? Hemorrhage
Puerperal infection
Thrombophlebitis
All of the above

49. Answer D. All of the above
The postpartum period is the 6-week period of time following the birth. The most common postpartum complications include hemorrhage, infection, and thrombophlebitis.