Obstetrics Perfusion

Issues
F. Thomas, PhD, RN

Placenta Previa
Implantation of the placenta I the lower uterus

Classifications
Marginal
Partial
Total

In what group is previa more

common!

Classic Sign

Collaborative Management
1. Evaluate the amount of hemorrhage
2. Electronic fetal monitoring to evaluate fetus
3. Fetal gestational age

 Conservative management if
Mothers CV status is stable
Fetus is immature
Reassuring pattern

 What are the advantages to delaying birth?

Home Care Considerations

No evidence of active bleeding
Maintain bed rest at home
Home location is reasonable distance form hospital
Woman and family can verbalize understanding of risks

Inpatient Care
Assessment of bleeding
Signs of preterm labor
Periodic electronic fetal mentoring

Excessive Bleeding
Delivery of fetus
How??

Abruption
Separation of the Placenta before delivery

Causes
Cocaine Use
Maternal HTN
Cigarette smoking
Short umbilical cord
Trauma
PROM
History of previous separation

Manifestations
Bleeding Types
Uterine tenderness
Uterine irritability
Low back or abd. Pain
High uterine resting tone
Other

Major Concerns
Woman feels powerless and frightened
Fetal hypoxia

Assessment
Nature of bleeding
Pain
Maternal and fetal vital signs
Condition of fetus
Contractions
Obstetric history
Length of gestation
Lab data
Ultrsasound

Management
Emergency: need to go to ER and admitted
Focus on CV status of Mother and condition of fetus
Mild condition
Delivery

Interventions
Monitor for hypovolemic shock
Monitor fetus
Promote tissue oxygenation
Collaborate with health care provider for fluid
replacement
Prepare woman for surgery
Emotional support

Critical to remember!

Ectopic Pregnancy
Called disaster of reproduction

Causes
Scarring from pelvic infections
Failed tubal ligation
History of previous ectopic pregnancy
Assisted reproduction
IUDs
40% of EP occur with no identified risk
Delayed or premature ovulation

 Classic
Subtle
Rupture

Manifestations

Diagnosis
Transvaginal Ultrasound
Beta-hCG is at low levels than expected
Gestational sac cannot be seen
Maternal serum progesterone levels
High resolution transvaginal US
Laproscopy

Management
Goal
Improve future fertility and preserve the tube

Medical
If tube is unruptured
Use Methotrexate inhibits cell division

Surgical
Unruptured involves a linear incision (salphingostomy)
Ruptured requires salpingectomy

Nursing
Prevention or early identification of hypovolemic shock
Monitor for S/S of rupture

Pelvic and shoulder pain**

Neck pain
Dizziness
Vag bleeding

Analgesics
Teach SE of Methrotrexate
Emotional support

Hemorrhagic Conditions of Late

Pregnancy
Assessment Data

Planning
Monitor for S/S of hypovolemic shock

Interventions
Monitor for S/S for shock: You know these already!!
Fetal monitoring
Promote tissue Oxygenation
Collaborate with practitioner to replace volume
Prepare for surgery
Emotional Support

 Evaluation