Obstetric and Gynecological Nursing - The Carter Center

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• May be obvious or extremely difficult to identify, and photocopy or the introduction of dyes may be required. Treatment The treatment of all fistulae, except small fistulae which have formed recently following child birth or operation, is surgical. Some recently formed vesico vaginal fistulae will heal if the bladder is drained continuously for 21 to 28 days and some recto vaginal fistulae will heal if a low residue diet is given for the some period. Most fistulae require operation. The principles involved are; A. the fibrosed edges of the fistulous tract must be excised so that well vascularized viable tissue may be brought in to apposition B. the apposition must be effected with out tension on the apposed edges C. The tissues must not be placed under tension for at least 3 weeks (this principle implies constant bladder drainage in cases of vesicovaginal fistulae) D. The best results are obtained if fistulae are treated in special units, where experience in the operative technique and, more important, the meticulous postoperative management of the case can be offered. 272
12.6 Prolaps of the Uterus A descent of the uterus and always it is with parts of upper vagina with it. Three degrees are recognonized. - First degree prolapse diagnosed when there is slight descent of the uterus but the cervix remains with in the vagina. - Second degree prolapse indicates that the cervix projects beyond the vulva when the patient strains. Third degree prolapse or complete procidential, the inside uterus has prolapsed out side the vulva and most it not all of the vagina is averted. • Imperfect development of the supportive tissue • stretching of the supportive tissues at child birth • Atrophy of the supporting tissue Sign and Symptoms - A feeling of something falling out - Dragging pains in the pelvis - Some protrusion at the vulva - Difficulty or discomfort in micturation or defecation Diagnosis - Types and degree of prolapse can be determined by • Observing the vulva when the patient is straining or coughing 273
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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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35% with in the first few hours aft
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- The volume of urine and the album
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Type 1 placenta praevia - The major
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Diagnosis - Using ultrasonic scanni
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Complications • Post partam haemo
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If the blood loss is revealed; More
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- Rarely, Rhesus- isoimmunization -
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The mother should rest in bed. An u
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The first encounter may not result
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The degree of haemolysis and the nu
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Transmission of infection to the fe
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Post natal care Separation of the b
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giving several short pushes during
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- Maternal hyperglycemia should be
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Review Questions 1. List the differ
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All ill fitting part is associated
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On auscultation The fetal heart bea
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cord prolapse). - Sedation often ne
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up gently delivery slowly taking 2
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Diagnosis On palpation - the head i
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Complications Maternal Fetal - Obst
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make sure no cord prolapsed and to
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If diagnosed during the first stage
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Management Encourage the mother to
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7.2.1 Atonic Postpartum Hemorrhage
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Cause - Delivery through partially
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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
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
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Page 265 and 266: procedure is extremely rare in cont
Page 267 and 268: - The head must be engaged. - The w
Page 269 and 270: CHAPTER ELEVEN CONGENITAL ANOMALIES
Page 271 and 272: A single remiuterus results when on
Page 273 and 274: E. Persistence of male (Wolffcan) d
Page 275 and 276: CHAPTER TWELVE INFECTION OF THE FEM
Page 277 and 278: Sign Major Minor Cervical motion Ab
Page 279 and 280: - Gentamycin iv or in loading dose
Page 281 and 282: In those persons with recurrent les
Page 283 and 284: Presentation Sign and symptom A wom
Page 285 and 286: Risk Factor Studies have indicates
Page 287: ecto vaginal fistula. Other types m
Page 291 and 292: - If no symptoms are present and th
Page 293 and 294: Forced inversion caused by excessiv
Page 295 and 296: therapy may be initiated to prevent
Page 297 and 298: Local disorders of the genital trac
Page 299 and 300: . Missed abortion This is the term
Page 301 and 302: The membranes may have ruptured and
Page 303 and 304: operation. Many mothers do not make
Page 305 and 306: I. Septic abortion Infection may oc
Page 307 and 308: Dysmenorrhea Definition-Dysmenorrhe
Page 309 and 310: esult from tension, anxiety (stress
Page 311 and 312: Implantation may occur in the fimbr
Page 313 and 314: the rupture is on the mesenteric si
Page 315 and 316: Diagnosis - The presence of interna
Page 317 and 318: Causes of infertility Female - Vagi
Page 319 and 320: Benign A. Fibrocystic breast diseas
Page 321 and 322: - Pain in the breast - Blood staine
Page 323 and 324: Treatment - Oestrogen - Progesteron
Page 325 and 326: E. Gently squeeze the nipple of eac
Page 327 and 328: - Poor uterine contraction - Subinv
Page 329 and 330: cervical canal and are multiple. Th
Page 331 and 332: Vulval Cysts Bartholin’s cyst- It
Page 333 and 334: GLOSSARY Abortion Termination of pr
Page 335 and 336: Intra uterine growth retardation Fe
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