Obstetric and Gynecological Nursing - The Carter Center

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- Intrauterine death which is prolonged - Amniotic fluid embolism - Pre- eclampsia, eclampsia - Intra uterine infection - Hepatitis Management of hypofibrinogenaemia (DIC) The best treatment is - Fresh blood transfusion - Fibrinogen or triple strength plasma transfusion - Give oxygen and resuscitate with IV dirp - Drugs as prescribed E.g Morphine for pain - IV syntocinic if uterus is lax The patient will respond quickly to this treatment if given quickly. Advice Hospital delivery for the next time and warm her to explain to doctor or nurse. It is important to be able to differentiate between a tonic and traumatic psot part hemorrhage. Atonic Uterus is lax or soft Bleeding starts after a few minutes of birth Blood is dark red in colour Traumatic Uterus is contracted firmly Bleeding starts immediately after delivery and continues Blood is bright red in colour 198
Management of Severe PPH in a Health Center 1. Massage the uterus to stimulate contraction and expel the placenta if possible 2. Stay with your patient and shout for help 3. Give ergometrine 0.5 ml I.V and put up a drip 4. Empty bladder 5. If placenta is already expelled, expel clots if not try to expel it with the contraction caused by ergometrine. If not and she is still bleeding severely in order to save the patient’s life manual removal is done. 6. If still the uterus is lax as a last reason, bimanual compression method is done. Consequences of PPH 1) Shock and collapse- death 2) Puerperal anemia – weakness & low resistance to infection 3) Fear of the further pregnancy 4) Sheehan’s syndrome- due to anterior pituitary necrosis 5) Infection Prevention of PPH Good antenatal care - Careful history taking to find out if she had PPH in previous delivery. 199
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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
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1. Separation of the placenta Mecha
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3. Controlled cord traction with ou
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Advantage: It allows the placenta t
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Inspect the umbilical cord a) Check
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Ergometrine Route Time to act Durat
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The guiding principles is to watch
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B. Delayed cord clamping The cord c
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- Method of delivery- spontaneous o
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4.4. Episiotomy Definition: The mak
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4. Lateral: The incision is begun o
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Layers to be repaired 1. Vaginal wo
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CHAPTER FIVE THE NORMAL PUERPERIUM
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Lochia- discharge from the uterus d
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5.2 Management of the Puerperium An
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answer her questions and through ou
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CHAPTER SIX ABNORMAL PREGNANCY At t
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One fetus may be died and be retain
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Management of Pregnancy - Early dia
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are labeled as ‘ Twin one ‘ and
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a) Both twins presenting by the ver
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- The urine will smell of acetone,
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The liver is affected in sever case
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Moderate - Preeclampsia is usually
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Management during labour The nurse/
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Page 165 and 166: - The volume of urine and the album
Page 167 and 168: Type 1 placenta praevia - The major
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: Cause - Delivery through partially
Page 217 and 218: Cause in 1 st stage 1) In-efficient
Page 219 and 220: 4 Reduced pelvic out let. A forceps
Page 221 and 222: - If the fetus is not alive and the
Page 223 and 224: Methods of determining C.P.D. 1. De
Page 225 and 226: 3 Placenta percrata- through muscle
Page 227 and 228: 2. Tonic contraction and Bandl’s
Page 229 and 230: Condition of the baby - Usually sti
Page 231 and 232: 3. Control head, keep it flexed, so
Page 233 and 234: Review Questions 1. What are the co
Page 235 and 236: More severe infection may consist o
Page 237 and 238: Prevention The best method of treat
Page 239 and 240: Managing Puerperal sepsis 1. Isolat
Page 241 and 242: 8.5 Subinvolution Sub involution is
Page 243 and 244: CHAPTER NINE INDUCTION OF LABOUR At
Page 245 and 246: Table 6 .Bishops Score System Induc
Page 247 and 248: - Fluid balance chart - Urine test
Page 249 and 250: Nipple stimulation, which releases
Page 251 and 252: Conditions in which trial of scar i
Page 253 and 254: CHAPTER TEN OBSTETRIC OPERATIONS At
Page 255 and 256: Indication for forceps delivery - F
Page 257 and 258: In the infant: Bruising: Severe bru
Page 259 and 260: 10.2 Caesarean Section Caesarean se
Page 261 and 262: Possible indications include: - The
Page 263 and 264: 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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