Obstetric and Gynecological Nursing - The Carter Center

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Effect on the fetus Fetal mortality and morbidity are increased as a result of severe vaginal bleeding in pregnancy. Still birth or perinatal or neonatal death may occurre Premature placental separation and consequent hypoxia may result in the birth of a child who is mentally and physically handiclapped. Effect on the mother If bleeding is severe, it may be accompanied by shock, disseminated interavascular coagulation and renal failure. The mother may die or be left with permanent ill- health. Types of ante partum hemorrhage Vaginal bleeding in late pregnancy is confined to placental separation due to placenta praevia or placental abruption. 6.4.1 Placenta praevia The placenta is partially or wholly implanted in the lower uterine segment on either the anterior or posterior wall. The lower uterine segment grows and stretches progressively often the 12 th week of pregnancy. In late weeks this may cause the placenta to separate and sever bleeding can occur. Incidence- placenta pracvia occurs in 0.5% of all pregnancies. 150
Type 1 placenta praevia - The majority of the placenta is in the upper uterine segment - Vaginal delivery is possible - Blood loss is usually mild - The mother and the fetus remains in good condition Type 2 placenta praevia - The placenta is partially located in the lower uterine segment near the internal - cervical os (marginal placenta pravia). - Vaginal delivery is possible particularly if the placenta is implanted anteriorly - Blood loss is usually moderate - Fetal hypoxia is more likely to be present Type 3 placenta pracvia - The placenta is located centrally over the internal cervical • Bleeding is likely to be sever particularly when the lower segment stretches and - the cervix begins to efface and dilate in late pregnancy • Vaginal delivery is in appropriate. Type 4 placenta praevia - The placenta is located centrally over the internal cervical os and sever haemorrhage is very likely 151
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LECTURE NOTES For Nursing Students
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Preface This lecture note offers nu
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Acknowledgement My deepest apprecia
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2.3.5 Fallopian tube or uterne tube
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CHAPTER SIX : ABNORMAL PREGNANCY 12
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8.5 Subinvolution 225 Review Questi
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LIST OF FIGURES Figuer 1. Normal Fe
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ABBRIVATIONS ACTH Adreno cortico tr
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CHAPTER ONE INTRODUCTION Care of ch
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Hemorrhage, sepsis (infection), tox
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CHAPTER TWO ANATOMY OF FEMALE PELVI
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sacrum is concave and is referred t
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diamond in shape. The obstretrical
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Table 2 .Features of the four types
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The Fetal Skull The fetal head is t
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Regions of the Skull A. The occiput
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. Suboccipitofrontal 10cm from belo
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Figure 6 . Female external genitali
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Position:- In the non-pregnant fema
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• Round ligament - Ligaments form
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• provides a site for fertilizati
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maturation of reproductive organs a
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Thispain, called mitlelschmerz may
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2.5. The Breast Anatomy The female
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Amplulla: the widened-out portion o
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Review Questions 1. List different
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the ampullar portion. The functiona
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Blastocyst Trophoblast Inner cell m
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penetrate. Viruses, however, can cr
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Figure 10 . The fetal circulation (
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Appearance of the Placenta at Term
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Identification On inspection, the p
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Placenta infarction Placental infar
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Oarl cavity feels salivation Gums-
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• Creatinine and BUN decrease bec
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- Increase in the lower extermities
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- Lower part cervix and isthmus cha
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6. Fainting: - In early pregnancy f
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women feels it at 18-20 weeks the m
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Multipara a woman who has given bir
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The Obstetric History 1. Past Obste
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Breast Examination Asses the size,
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1.2 Fundal Palpation Purpose- To kn
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3. Deep pelvic Palpation: (3 rd Leo
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Auscultation: Check Fetal heart, ra
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• Rest at least 10 hrs at night a
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CHAPTER FOUR NORMAL LABOUR At the e
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- Labour is said to be established
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To assess progress of labour - Stat
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Relief of pain & promotion of comfo
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Uterine contraction - Frequency per
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advanced labour women may be assess
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Method - by abdominal palpation ide
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Eg. Partograph Name _______________
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- Caput - Sutures and Fontanelles.
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Echanism of Labour in a Normal Vert
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ERGOMETRINE: 0.5mgs. in a syringe w
Page 115 and 116: 1. Separation of the placenta Mecha
Page 117 and 118: 3. Controlled cord traction with ou
Page 119 and 120: Advantage: It allows the placenta t
Page 121 and 122: Inspect the umbilical cord a) Check
Page 123 and 124: Ergometrine Route Time to act Durat
Page 125 and 126: The guiding principles is to watch
Page 127 and 128: B. Delayed cord clamping The cord c
Page 129 and 130: - Method of delivery- spontaneous o
Page 131 and 132: 4.4. Episiotomy Definition: The mak
Page 133 and 134: 4. Lateral: The incision is begun o
Page 135 and 136: Layers to be repaired 1. Vaginal wo
Page 137 and 138: CHAPTER FIVE THE NORMAL PUERPERIUM
Page 139 and 140: Lochia- discharge from the uterus d
Page 141 and 142: 5.2 Management of the Puerperium An
Page 143 and 144: answer her questions and through ou
Page 145 and 146: CHAPTER SIX ABNORMAL PREGNANCY At t
Page 147 and 148: One fetus may be died and be retain
Page 149 and 150: Management of Pregnancy - Early dia
Page 151 and 152: are labeled as ‘ Twin one ‘ and
Page 153 and 154: a) Both twins presenting by the ver
Page 155 and 156: - The urine will smell of acetone,
Page 157 and 158: The liver is affected in sever case
Page 159 and 160: Moderate - Preeclampsia is usually
Page 161 and 162: Management during labour The nurse/
Page 163 and 164: 35% with in the first few hours aft
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Page 169 and 170: Diagnosis - Using ultrasonic scanni
Page 171 and 172: Complications • Post partam haemo
Page 173 and 174: If the blood loss is revealed; More
Page 175 and 176: - Rarely, Rhesus- isoimmunization -
Page 177 and 178: The mother should rest in bed. An u
Page 179 and 180: The first encounter may not result
Page 181 and 182: The degree of haemolysis and the nu
Page 183 and 184: Transmission of infection to the fe
Page 185 and 186: Post natal care Separation of the b
Page 187 and 188: giving several short pushes during
Page 189 and 190: - Maternal hyperglycemia should be
Page 191 and 192: Review Questions 1. List the differ
Page 193 and 194: All ill fitting part is associated
Page 195 and 196: On auscultation The fetal heart bea
Page 197 and 198: cord prolapse). - Sedation often ne
Page 199 and 200: up gently delivery slowly taking 2
Page 201 and 202: Diagnosis On palpation - the head i
Page 203 and 204: Complications Maternal Fetal - Obst
Page 205 and 206: make sure no cord prolapsed and to
Page 207 and 208: If diagnosed during the first stage
Page 209 and 210: Management Encourage the mother to
Page 211 and 212: 7.2.1 Atonic Postpartum Hemorrhage
Page 213 and 214: Cause - Delivery through partially
Page 215 and 216: Management of Severe PPH in a Healt
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Cause in 1 st stage 1) In-efficient
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4 Reduced pelvic out let. A forceps
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- If the fetus is not alive and the
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Methods of determining C.P.D. 1. De
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3 Placenta percrata- through muscle
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2. Tonic contraction and Bandl’s
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Condition of the baby - Usually sti
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3. Control head, keep it flexed, so
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Review Questions 1. What are the co
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More severe infection may consist o
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Prevention The best method of treat
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Managing Puerperal sepsis 1. Isolat
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8.5 Subinvolution Sub involution is
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CHAPTER NINE INDUCTION OF LABOUR At
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Table 6 .Bishops Score System Induc
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- Fluid balance chart - Urine test
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Nipple stimulation, which releases
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Conditions in which trial of scar i
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CHAPTER TEN OBSTETRIC OPERATIONS At
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Indication for forceps delivery - F
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In the infant: Bruising: Severe bru
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10.2 Caesarean Section Caesarean se
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Possible indications include: - The
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types of decapitating hooks and kni
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procedure is extremely rare in cont
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- The head must be engaged. - The w
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CHAPTER ELEVEN CONGENITAL ANOMALIES
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A single remiuterus results when on
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E. Persistence of male (Wolffcan) d
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CHAPTER TWELVE INFECTION OF THE FEM
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Sign Major Minor Cervical motion Ab
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- Gentamycin iv or in loading dose
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In those persons with recurrent les
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Presentation Sign and symptom A wom
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Risk Factor Studies have indicates
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ecto vaginal fistula. Other types m
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12.6 Prolaps of the Uterus A descen
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- If no symptoms are present and th
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Forced inversion caused by excessiv
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therapy may be initiated to prevent
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Local disorders of the genital trac
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. Missed abortion This is the term
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The membranes may have ruptured and
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operation. Many mothers do not make
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I. Septic abortion Infection may oc
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Dysmenorrhea Definition-Dysmenorrhe
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esult from tension, anxiety (stress
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Implantation may occur in the fimbr
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the rupture is on the mesenteric si
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Diagnosis - The presence of interna
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Causes of infertility Female - Vagi
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Benign A. Fibrocystic breast diseas
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- Pain in the breast - Blood staine
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Treatment - Oestrogen - Progesteron
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E. Gently squeeze the nipple of eac
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- Poor uterine contraction - Subinv
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cervical canal and are multiple. Th
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Vulval Cysts Bartholin’s cyst- It
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GLOSSARY Abortion Termination of pr
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Intra uterine growth retardation Fe
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Obstetric and Gynecological Nursing - The Carter Center

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