Exam 2 level 3 nursing scf
Preterm rupture of Membranes (PROM) - rupture of membranes after 37th wk gestation but
before onset of labor
Preterm Premature Rupture of Membranes (PPROM) - rupture of membranes before the 37th wk
gestation (worse outcomes)
possible causes of PPROM - infection (UTI)
amniocentesis
placental abruption
hydramnios
maternal smoking
multiple gestation
assessment of rupture of membranes - time (must delivery baby w/in 24hrs)
amount
odor
color (cloudy=infection, green=fetal distress)
signs of infection
gestational age
hydration status
FHR (fetal tachy=infection)
clinical therapy for PROM - NO vaginal exam (changes environment)
sterile speculum exam (to sample fluid)
Nitrazine test
ferning test
,nitrazine test - Color will indicate whether amniotic fluid is present
Yellow = urine. Blue = Amniotic fluid
(sperm will change color too)
Ferning test - positive= indicates rupture of membranes
crystallization of amniotic fluid
indigo carmine test - green=urine
blue=amniotic fluid
hospital management of viable fetus w/ ROM - fetal lung maturity studies near 34 wks
labwork
NST qshift
biophysical profile q24hrs
Home management of viable fetus with ROM - monitor temp
record fetal movement (q4days)
pelvic rest (no sex)
twice wk NST/cbc
weekly ultrasound/cervical visual
prophylactic antibiotics
s/s of preterm labor - contractions q10min or less
mild menstrual like cramps in lower abs
with or without diarrhea
pelvic pressure
low dull back ache
,Rupture of membranes
change in vaginal discharge
risk factors for placental abruption - previous history
alcohol
domestic violence
white and black women
preterm labor - contractions and cervical dilation that occurs btw 20 and 37 wks gestation
partial placental abruption - the placenta partially detaches from the endometrium
may go undetected
baby will have decells (placental insufficiency)
marginal placental abruption - one side of the placenta detaches from endometrium
complete placental abruption - the whole placenta detaches
super painful
dark brown bleeding
low/no fetal heartbeat
rigid abdomen
maternal risks for placental abruption - hemorrhagic shock
DIC (disseminated intravascular coagulation)
renal failure
DIC (disseminated intravascular coagulation) - clotting factor bottoms out
body cant stop bleeding from every open wound/openings
, clinical therapy for placetal abruption - evaluate coag tests- fibrinogen levels, platelet count, PT &
PTT
maintain cardio status with iv fluids/blood
FHR monitoring
either induce labor or C section (if baby is alive)
(DIC treatment may only be hysterectomy)
normal platelet count - 150K-450K
Normal PT (prothrombin time) - 10-13 secs
normal aPTT - 25-35 seconds
hypovolemia with placental abruption - life threatening
treat with whole blood
lactated ringers
placental previa - improper implantation of placenta, nearing/covering the cervix
low lying placental previa - placenta attaches in lower 1/3rd of uterus, just near cervical opening
marginal placental previa - one part of placenta is over cervix
complete placental previa - placenta is completely blocking opening of cervix
only delivery option - c section
s/s of placental previa - normal FHR
painless
Preterm rupture of Membranes (PROM) - rupture of membranes after 37th wk gestation but
before onset of labor
Preterm Premature Rupture of Membranes (PPROM) - rupture of membranes before the 37th wk
gestation (worse outcomes)
possible causes of PPROM - infection (UTI)
amniocentesis
placental abruption
hydramnios
maternal smoking
multiple gestation
assessment of rupture of membranes - time (must delivery baby w/in 24hrs)
amount
odor
color (cloudy=infection, green=fetal distress)
signs of infection
gestational age
hydration status
FHR (fetal tachy=infection)
clinical therapy for PROM - NO vaginal exam (changes environment)
sterile speculum exam (to sample fluid)
Nitrazine test
ferning test
,nitrazine test - Color will indicate whether amniotic fluid is present
Yellow = urine. Blue = Amniotic fluid
(sperm will change color too)
Ferning test - positive= indicates rupture of membranes
crystallization of amniotic fluid
indigo carmine test - green=urine
blue=amniotic fluid
hospital management of viable fetus w/ ROM - fetal lung maturity studies near 34 wks
labwork
NST qshift
biophysical profile q24hrs
Home management of viable fetus with ROM - monitor temp
record fetal movement (q4days)
pelvic rest (no sex)
twice wk NST/cbc
weekly ultrasound/cervical visual
prophylactic antibiotics
s/s of preterm labor - contractions q10min or less
mild menstrual like cramps in lower abs
with or without diarrhea
pelvic pressure
low dull back ache
,Rupture of membranes
change in vaginal discharge
risk factors for placental abruption - previous history
alcohol
domestic violence
white and black women
preterm labor - contractions and cervical dilation that occurs btw 20 and 37 wks gestation
partial placental abruption - the placenta partially detaches from the endometrium
may go undetected
baby will have decells (placental insufficiency)
marginal placental abruption - one side of the placenta detaches from endometrium
complete placental abruption - the whole placenta detaches
super painful
dark brown bleeding
low/no fetal heartbeat
rigid abdomen
maternal risks for placental abruption - hemorrhagic shock
DIC (disseminated intravascular coagulation)
renal failure
DIC (disseminated intravascular coagulation) - clotting factor bottoms out
body cant stop bleeding from every open wound/openings
, clinical therapy for placetal abruption - evaluate coag tests- fibrinogen levels, platelet count, PT &
PTT
maintain cardio status with iv fluids/blood
FHR monitoring
either induce labor or C section (if baby is alive)
(DIC treatment may only be hysterectomy)
normal platelet count - 150K-450K
Normal PT (prothrombin time) - 10-13 secs
normal aPTT - 25-35 seconds
hypovolemia with placental abruption - life threatening
treat with whole blood
lactated ringers
placental previa - improper implantation of placenta, nearing/covering the cervix
low lying placental previa - placenta attaches in lower 1/3rd of uterus, just near cervical opening
marginal placental previa - one part of placenta is over cervix
complete placental previa - placenta is completely blocking opening of cervix
only delivery option - c section
s/s of placental previa - normal FHR
painless
