Maternity Exam 2 Study Guide

high risk pregnancy factors adolescents (18yo); older adults (35yo), CVD, HTN, CAD, diabetes, CKD, ESRD, hx. of high risk pregnancy, preeclampsia, eclampsia, obesity, maternal abnormalities which class of heart disease is pregnancy not reccommended? Class IV signs of heart disease in pregnant women palpitations, SOB, lightheadedness, dizziness, weakness, chest pain, nausea, vomiting, edema, proteinuria When to call provider after weight gain during pregnancy? 5lbs in 1 week cardiac output during pregnancy increases 30-50% Ventricular septal defect (VSD) large hole between two ventricles lets venous blood pass from the right to the left ventricle atrial septal defect (ASD) a hole in the atrial septum that causes blood in the RA and LA to mix peripartum heart disease heart disease that occurs with pregnancy; usually right before pregnancy signs of LSHF in pregnancy (LUNGS) orthopnea; paroxsymal nocturnal dyspnea (PND) signs of RSHF in pregnancy (Rest of body) distended liver & spleen; ascites; peripheral edema cardiovascular assessment during pregnancy - Assess activity/exercise level - presence of cough, edema - Assess vitals - Assess liver size (RSHF) - ECG/ECHO - Assess fetal size, FHR - labs, urinalysis (proteinuria) size of babies born to mom's with cardiac issues are typically... small for gestational age education for pregnant women with cardiac issues - healthy diet (DASH) - healthy lifestyle - avoid alcohol, smoking - exercise daily at functional pace, light - medications (typically labetalol for HTN) medication given to pregnant women with HTN labetalol Labetalol blocks stimulation of beta1 and beta2 adrenergic receptor sites which decreases HTN PO (typically), IV MAX DOSE 300mg Contraindicated: asthma, CHF, CVD, ESRD indications for labetalol used to decrease hypertension during pregnancy contraindications for labetalol asthma, CVD, CHF, ESRD Nifedipine (Procardia) Calcium Channel Blocker MOA: blocks calcium transport resulting in inhibition of contraction causing systemic vasodilatation used to decrease HTN in pregnancy when labetalol cannot be used PO ONLY SE: tachycardia, HA Nursing interventions for high-risk cardiac pregnancy during antepartum - promote rest - promote healthy nutrition - avoid infection - education on medications nursing interventions for high-risk cardiac pregnancy during intrapartum - reposition to promote adequate blood flow » avoid lying directly on back - if epidural: Monitor BP closely - concern for FVO w/ fluids, monitor for edema, SOB, crackles - Monitor for pain/stress - Monitor FHR more frequently to ensure adequate oxygen nursing interventions for high-risk cardiac pregnancy during postpartum - Assess for heart failure - Assess medications » Anticoagulants for DVT prophylaxis » Digoxin therapy to get NSR » Oxytocin may cause hypotension - Assess psyche - Assess for bleeding - SCDs signs of thrombophlebitis Unilateral redness, warmth, swelling, discoloration most common anemia during pregnancy iron deficiency how many mg of iron is needed during pregnancy for iron deficiency anema 65mg education of iron-deficiency anemia during pregnancy - take iron supplement with vitamin C (65mg) - avoid fortified foods & drinks - increase protein intake (red meats) - increase foods containing iron - increase fluids & fiber (iron causes constipation) - increase movement (reduce risk of constipation) symptoms of iron-deficiency anemia extreme fatigue, pallor, cold intolerance, low Hgb, Pica pica an abnormal craving or appetite for nonfood substances, such as dirt, paint, or clay that lasts for at least 1 month folic acid deficiency B-vitamin deficiency which can lead to neural tube defects in fetus, linked to miscarriage how much folic acid do pregnant women need daily? 400 mcg sickle cell anemia genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape, which inhibits oxygen and nutrient transport to baby thalassemia autosomal recessively inherited blood disorders that lead to poor hbg formation & severe anemia Von willebrand disease inherited autosomal disorder, normal platelet count but bleeding is prolonged from clotting factors being reduced von willebrand treatment replacement of missing coagulation factors by infusions or cryoprecipitate or FFP may be necessary prior to labor to prevent excessive bleeding hemophilia B occurs only in males, but females are carriers and have reduced level of Factor IX that cause hemorrhage in labor or spontaneous miscarry treatment of hemophilia b give factor of FFP idiopathic thrombocytopenic purpura (ITP) decreased number of platelets (can be as low as 20,000), not inherited, can occur at any time in life, cause is unknown, can occur shortly after viral infection or URI. treatment of ITP 1-3 months of oral prednisone, platelet transfusion symptoms of pyelonephritis pain, tenderness, fever, malaise, vomiting, nausea how to prevent UTI - wipe front to back - void after sex - void when you have to, don't hold it - cotton over nylon - proper pericare Chronic renal disease during pregnancy - GFR, BUN increases, serum Crt normal or high (2.0mg/dL pt suggested to not get pregnant) - kidneys may not produce erythropoietin - typically Crt decreases during pregnancy - typically have HTN - may need dialysis - usually taking corticosteroids long-term treatment for nasopharyngitis during pregnancy - rest, sleep - acetaminophen - humidifier - warm or cool compresses treatment for influenza during pregnancy - vaccines - acetaminophen treatment for COVID-19 during pregnancy vaccine treatment for pneumonia during pregnancy - antibiotics - oxygen appendicitis symptoms nausea, sharp peristaltic LRQ pain risks of appendicitis during pregnancy if it ruptures risk increases fecal material can escape into fallopian tubes to the fetus test for appendicitis McBurney's treatment for GERD during pregnancy - protonix, TUMS - small meals throughout the day - remain upright after meals - limit spicy foods - limit carbonation treatment of seizure disorders during pregnancy - measure therapeutic drug levels and admin the minimum drug needed to achieve therapeutic effects - labs monthly until closer to due date myasthenia gravis autoimmune disorders characterized by the presence of an IgG antibody against acetylcholine receptors in striated muscle - not recommended to get pregnant scoliosis an abnormal curvature of the spine normally diagnosed at 12-14yo, if left uncorrected can interfere with childbirth, especially at the pelvic inlet challenges with scoliosis during pregnancy epidural anesthesia diabetes during pregnacy - decreased control of glucose regulation - effect fetal size (macrosomia) - infant likely to experience hypoglycemia - increase incidence of congenital anomalies - increased risk for infection (glucose in urine) - screening during pregnancy (GTT) - monitoring during pregnancy treatment of diabetes during pregnancy - insulin needs & dosage adjustments - FBS monitoring - insulin pump therapy - test for placental functioning & fetal well-being (FHR) - postpartum management of blood glucose - fetal kick count tests for fetal well being Non-stress test, biophysical profile, kick counts, ultrasound, contraction stress test macrosomia large-bodied baby commonly seen in diabetic pregnancies what happens to glucose levels in gestational diabetics postpartum glucose should return to normal, may be higher for a short-period postpartum because placenta is the cause of diabetes risks of macrosomia to mother - Shoulder dystocia - Lacerations, tearing - polyhydramnios - cephalopelvic disproportion - cord prolapse most common pregnancy complications - ectopic pregnancy - HTN - thromboembolism - hemorrhage - infection spontaneous miscarriage loss of pregnancy during the first 20 weeks of gestation pregnancy complications during the 1st trimester - spontaneous miscarriage - ectopic pregnancy Threatened spontaneous abortion s/s: scant bright red spotting, slight cramping - monitor FHR - check hCG level why do spontaneous abortions typically happen? genetic abnormalities, mom's body has decided it is not sustainable of life imminent spontaneous abortion uterine contractions and cervical dilation occur complete spontaneous abortion entire products of conception are expelled (fetus, membranes, placenta) missed spontaneous abortion fetus dies in utero but was not expelled incomplete spontaneous abortion pregnancy loss with products of conception remaining in the uterus treatment for ectopic pregnancy surgery or methotrexate ectopic pregnancy implantation of a fertilized egg in a place other than the uterus treatment for spontaneous abortion - Preventing complications such as hypovolemic shock and infection - Providing emotional support for grieving - possible anti-anxiety & anti-depressives - support groups Signs of spontaneous abortion Backache, abd tenderness, dilation of cervix, fever, signs and symptoms of hemorhage such as hypotension and tachycardia pregnancy complications during 2nd trimester gestational trophoblastic disease (hydatidiform mole), cervical insufficiency, disseminated intravascular coagulation (DIC) gestational trophoblastic disease abnormal proliferation and then degeneration of trophoblastic villi, embryo fails to develop and a large cluster of cells form which can metastasize into a malignancy "hydatidiform mole; molar pregnancy" Risk factors: hx cancer, young adolescents (15yo), older moms (35yo), low animal fat intake, asian descent dx: ultrasound shows mass of cells s/s: bleeding, discharge, hCG is high Treatment of molar pregnancy - surgical D&C - hCG testing for 3 months after - methotrexate methotrexate precautions - chemo precautions - separate bathrooms, double flush for 3 days - suggested to not breastfeed for 3 days - avoid urine, blood, or vaginal secretions - withhold from sexual activity for 3 days - precautions when handling cervical insufficiency (premature cervical dilation) cervix dilates prematurely and therefore cannot retain the fetus to term; normally occurs after 20 weeks s/s: bleeding, painless, pelvic pressure treatment of cervical insufficiency - strict bedrest to prevent bleeding & continued dilation - suture/ribbon tie mom's cervix to stay close, take out between 36-37 weeks disseminated intravascular coagulation (DIC) acquired disorder of blood clotting in which fibrinogen level falls to below effective limits = mom cannot keep pregnancy and may lead to still birth or placental separation treatment for DIC - possible D&C - ethical dilemma (possible birthing) - check fibrinogen levels - check PT/INR - check platelets - give subcut heparin - possible blood transfusion - possible fibrinogen, other clotting factors pregnancy complications during 3rd trimester - placenta previa - abruptio placentae - preterm labor placenta previa placenta is implanted abnormally in the lower part of the uterus, most common cause of painless bleeding in the 3rd trimester - a small section of the placenta that tears away from the uterus - restricts growth of fetus - dx by ultrasound - typically around 30 weeks (not able to stretch and dilate cervix to accommodate) - mom at risk for hemorrhage signs of placenta previa Sudden painless bleeding, bright red in color usually seen in 3 trimester nursing interventions for placenta previa - vitals (BP decrease) - bed rest - labs (H&H) - cross & type, cross & screen (possible transfusion if hbg 7) - fetal monitoring (HR, variability) - monitor blood loss - monitor urine output - IV fluids - give betamethasone for fetal lung maturity - prepare for delivering baby abruptio placentae premature separation of placenta from the uterine wall, begins separating and bleeding occurs - most frequent case of perinatal death - medical emergency! - prone to clotting - prone to hemorrhaging Signs of abruptio placentae - bright red gushing blood - sharp/stabbing abdominal pain - rigid, board-like abdomen - blood pooling in abdomen - hypotension - hypovolemia shock - abdomen tender on palpation risk factors for placenta previa multiparity, older adult (35yo), multiple gestations, male fetus risk factors for abruptio placentae trauma, stimulants (cocaine), smoking tobacco, high caffeine intake, older adult (35yo), short umbilical cord, HTN, high parity (3-4), infection (UTI, pyelonephritis) nursing interventions for abruptio placentae • Monitor maternal and fetal status • Maintain bed rest; administer oxygen • IV fluids, lab work (CBC, type & cross match, clotting) • Prepare for delivery of fetus as quickly as possible; vaginal delivery preferred but, because of emergency, cesarean section may be done • Assess client for drug use · Vitals · Ultrasound to see abruption exam never done for patients with placenta previa or abruptio placentae cervical exam preterm labor labor that occurs after 20 weeks but before completion of 37 weeks gestation, responsible for 75% of neonatal deaths most common implantation for ectopic pregnancy fallopian tubes risk factors to preterm labor - trauma - age (adolescent, older) - smoking hx - drinking hx - stimulant use (cocaine) - infection - periodontal disease - dehydration - chorioamnionitis - blacks - lack of prenatal care when is labor no longer able to be haulted? 50% effaced or 3-4cm dilated treatment for preterm labor - bedrest - tocolytics (terbutaline, MAX 48hours) - betamethasone (fetal lung maturity, ideally 24hr before birth) - monitor fetal wellbeing max use for terbutaline 48hours ideal time to admin betamethasone during pregnancy 24hr prior to birth nursing interventions for preterm labor • Monitor fetal status and contractions • Treat underlying cause • Administer tocolytics • Admin betamethasone (steroids) to improve fetal lung maturity · Monitor for hemorrhage · Monitor for prolapse umbilical cord · promote delayed cord clamping · promote breastfeeding · monitor for infection, R/O w/ UC&S · avoid cervical exam · may give prophylactic GBS abx signs of preterm labor - persistent, dull, low backache - vaginal spotting - pelvic pressure /abdominal tightening - menstrual-like cramping - increased vaginal discharge - uterine contractions - intestinal cramping gestational hypertension potentially life-threatening condition of high blood pressure (140/90 mmHg); usually develops after the 20th week of pregnancy education for gestational HTN - maintain healthy lifestyle - proper nutrition & eating habits - less sodium - monitor BP - stress reduction - usually dietary & lifestyle managed risks for gestational HTN - blacks - obesity - 5 parity - underlying heart disease - diabetes - renal diseases preeclampsia without severe features BP 140/90 on two separate occasions at least 4hr apart - Proteinuria (1+ on a ruine dip or 300mg in 24-hr urine - 0.3 on urine protein-creatinine ratio) - edema nursing interventions for preeclampsia without severe features - monitor BP - admin medications (aspirin 81mg) - urinalysis - monitor daily weights - reduce sodium - provide emotional support - manage stress preeclampsia with severe features - BP 160/110 or higher - platelet count 100,000 - Proteinuria - elevated liver enzymes (2x) - serum creatinine 1.1 mg/dL - pulmonary edema - new-onset severe HA unrelieved w/ meds - visual disturbances - dizziness - SOB - pitting edema - minimal urine output - hypotension medications to prevent eclampsia mag sulfate, hydralazine, labetalol, nifedipine treatment for preeclampsia with severe features - labetalol at baseline - hydralazine for acute HTN - mag sulfate to prevent seizures - nutritious diet Nursing interventions for preeclampsia with severe features - continuous 5-15min BP checks - emotional support - seizure precautions - IV, ideally 2 access points - BMP check (check mag level) - oxygen, suction, ambu at bedside - monitor BP - monitor FHR - admin medications (labetalol, hydralazine, mag sulfate, nifedipine) nursing interventions for mag sulfate - loading dose then continuous drip to prevent seizure - DTR checks - check RR - monitor HR, BP of mom & baby - place foley (Strict I&Os) - continuous BP checks (q5-15min) - emotional support - seizure precautions - oxygen, suction, ambu at bedside - check IV site & patency - 2 RN check eclampsia most severe classification of pregnancy-related HTN, pt has passed into stage when cerebral edema is so acute a tonic-clonic seizure or coma has occurred - fetal prognosis is poor due to hypoxia during seizure leading to fetal acidosis - premature separation of the placenta from extreme vasospasm may occur, the fetal prognosis becomes even graver signs of eclampsia High blood pressure, cerebral edema, tonic-clonic seizure, renal dysfunction, proteinuria, and in severe cases, coma. nursing interventions for eclampsia seizure during pregnancy - turn on side - nothing in mouth - time seizure start to finish - check airway - ensure safety - check for incontinence - possible Ativan & diazepam for rescue med - monitor FHR » typically decel - get baby out ASAP postpartum eclampsia Eclampsia that occurs after a woman has delivered a newborn; can occur up to 6 weeks after the birth. HELLP syndrome hemolysis leads to anemia, elevated liver enzymes leads to epigastric pain, low platelets lead to abnormal bleeding/clotting s/s: proteinuria; edema; HTN; nausea; epigastric pain; general malaise; RUQ tenderness labs reveal: hemolysis of RBCs, thrombocytopenia, elevated liver enzymes = hemorrhage/necrosis of liver treatment for HELLP syndrome immediate delivery; transfusion of FFP or platelets, possible IV glucose (if hypoglycemia) single-ovum twins one placenta, one chorion, two amnions, two umbilical cords, always the same sex identical twins begins with a single ovum and spermatozoon, in the process of fusion or in one of the first cell divisions, the zygote divides into identical individuals fraternal twins twins resulting from the fertilization of two separate ova by two separate spermatozoon double-ova twins two placenta, two chorions, two amnions, two umbilical cords; may be same or opposite sex polyhydramnios excessive amniotic fluid (up to 2000ml) - can cause fetal malpresentation - fetus could turn in utero - can lead to premature rupture of membranes risk factors for polyhydramnios - Diabetes - Multiple gestation - Congenital anomalies - tracheo-esophageal fistula - fetus urinating too much (kidney problem) risks from premature rupture of membranes infection, prolapsed cord, preterm labor, uterine atony, hemorrhage nursing interventions for polyhydramnios - dx on ultrasound - monitor FHR (more difficult to hear) - monitor for SOB - monitor for varicosities & hemorrhoids - monitor daily weights - assess edema - monitor vitals oligohydramnios too little amniotic fluid usually causes by a bladder or renal disorder in the fetus interfering with voiding; can occur from severe growth restrictions - suspected during pregnancy when the uterus fails to meet its expected growth rate - dx by ultrasound - infants need careful inspection at birth to r/o kidney disease & compromised lung development Risks for oligohydramnios - poor nutrition - fetal kidney issues - underdeveloped lungs - mom has smaller belly oligohydramnios effects on fetus - weakened muscles at birth - underdeveloped lungs difficulty breathing after birth - distorted features of face treatment for oligohydramnios amnioinfusion Amnioinfusion introduction of a solution into the amniotic sac; an isotonic solution is most commonly used to relieve fetal distress postterm pregnancy gestation of the fetus that extends beyond 42 weeks risks for postterm infants - meconium aspiration is more likely to occur as fetal intestinal contents are more likely to reach the rectum - macrosomia - variable deceleration in FHR from cord compression - placental insufficiency/weakened nursing interventions for postterm pregnancy - if labor has not begun by 41 week, a nonstress test, & biophysical profile may be done to document the state of placental perfusion and the amount of amniotic fluid present - prostaglandin gel or misoprostol applied to vagina to initiate cervical ripening followed by oxytocin IV - continuous monitor of FHR & contractions Rh isoimmunization Rh immune globulin should be given within 72 hours for R-negative women who deliver an Rh-positive infant; within 24hr of a procedure why do we give Rhogam? provides passive antibodies and prevents development of naturally occurring maternal antibodies which would attack baby's blood what age cohort is at highest risk for intimate partner violence? pregnant adolescents why are adolescents considered high-risk pregnancy? - body not fully matured - immature - poor nutrition - job? - home life - insurance? nursing interventions for adolescent pregnancy -eliminate barriers to health care -apply teach/learn principles -counseling: Nutrition, self-care, stress reduction, attachment to the fetus, infant care, breastfeeding -promote family support -provide support during labor -provide Referrals make sure gaining weight, getting education, prenatal classes, at risk for domestic abuse, substance abuse considerations for 40+yo pregnancy - concern for down syndrome & cancers - more common to have molar baby - may have chromosomal abnormalities - more susceptible to hemorrhoids, varicosities - more likely to have underlying diseases considerations for physically or cognitively challenged pregnancy - ethical & legal considerations - Assess if pt has emergency contact persons, suppliers of transportation, individual considerations such as mobility, elimination, and possible autonomic responses - careful planning precipitous labor very quick labor that lasts 3 hours or less from onset of contractions to time of delivery risks for precipitous labor history of precipitous labor, grand multipara, possible history of recent drug use (cocaine) considerations for pregnant substance abuser - typically precipitous birth - little to no prenatal care - baby make have to withdraw after birth - more at risk for hemorrhage - high risk for baby management of trauma during pregnancy –Dependent on trauma Make sure mom is stable! –Oxygen –CPR if needed (turned to left) Baby is stable –Rolled towel under R side to relive uterine pressure on vena cava - turn to left side –IV fluid correction –Ephedrine to restore BP and has minimal peripheral vasoconstrictive effects fetal health falls into jeopardy when? uteroplacental function is impaired A patient who is severely hearing impaired is concerned that they will not wake at night when their newborn cries. Which of the following would you suggest? Sleeping with their arm or leg on the crib so they can feel the vibration of the infant's crying or buying a sound-sensitive device that will flash a bright light when a loud noise is detected 3 MULTIPLE CHOICE OPTIONS A 15-year-old patient is 6 months pregnant when first coming for prenatal care. The patient states that, “I had no idea I was pregnant”. What is the most probable rationale for the patient’s statement? denial of pregnancy 3 MULTIPLE CHOICE OPTIONS The most important reason that all pregnant patients should be assessed for the possibility of substance abuse is that: appropriate care may be rendered to the infant after delivery 3 MULTIPLE CHOICE OPTIONS A pregnant patient at 37 weeks’ gestation comes into the emergency room with heavy bleeding and begins to show signs of hypovolemic shock. As an intervention, you would: withhold oral fluid 3 MULTIPLE CHOICE OPTIONS A patient whose membranes ruptured is discharged to home care. Which of the following points would you most likely include in their teaching plan? having the patient monitor their temp twice a day 3 MULTIPLE CHOICE OPTIONS After reporting to the unit, you are assigned to the following patients. Which of the patients should be evaluated first? A patient at 5 weeks’ gestation with suspected ectopic pregnancy complaining of shoulder and abdominal pain 3 MULTIPLE CHOICE OPTIONS Which statement by a patient who is 8 weeks pregnant and has cardiac disease would you most likely follow up closely? "I have gained 4 lb during the last week, but I'm not eating more than before." 3 MULTIPLE CHOICE OPTIONS What is the most accurate statement regarding exercise and nutrition during pregnancy for a patient with diabetes? Ideally, dietary calorie intake should be approximately 20% from protein, 40% to 50% from carbohydrates, and up to 30% from fats. 3 MULTIPLE CHOICE OPTIONS the 4 P's of labor Passage, Passenger, Powers, Psyche complications of power during labor - ineffective uterine force - hypo/hyper contractions - dysfunctional labor and associated stages of labor complications of passenger during labor •Umbilical cord prolapse •Multiple gestation •Problems with fetal position, presentation, or size complications of passage during labor •Inlet contraction •Outlet contraction •Trial labor •External cephalic version •Forceps birth •Vacuum extraction Assessments for complications of labor? •Recognition of hypertonic and hypotonic contractions •Mapping of lengths of phases and stages of normal labor •Recognition of abnormal fetal response to uterine contractions •Recognition of abnormal position of fetus or fetal heart sounds •Accurate assessment of pelvic inlet, outlet, and midpelvis normal contraction pattern contractions every 2-3 min lasting 45-60 seconds FHR 110-160/min hypertonic contractions Uterine contractions that are too long or too frequent, have too short a resting interval, or have an inadequate relaxation period to allow optimal uteroplacental exchange. Symptoms: painful May need sedation hypotonic contractions weak, inefficient, or completely absent contractions Symptoms: limited pain Oxytocin used to help control contractions nursing interventions for complications of labor - reposition mom, let her rest and hangout in bed, possibly give oxygen, monitor vital changes - likely will end up doing a c-section if decelerations persist - if its long in the first stage we go to c-section common causes of dysfunctional labor - Primigravida status - Cephalopelvic disproportion - Posterior rather than anterior fetal position - extension rather than flexion of the fetal head - Uterine atony, as with a multiple pregnancy, polyhydramnios, or macrosomia - A nonripe cervix - Presence of a full rectum or urinary bladder that impedes fetal descent - exhaustion of prolonged labor - Inappropriate use of analgesia (excessive or too early administration) most common phase where hypertonic contractions occur latent most common phase where hypotonic contractions occur active Nursing interventions for dysfunctional 1st or 2nd stage of labor - adequate hydration - pain relief - make comfortable - exercises to bring baby down the birth canal - decrease stimulation - possible augmentation of labor w/ oxytocin, c-section, or amniotomy when to not give oxytocin - hypertonic contractions - HTN - breech or longitudinal presentation of baby (likely c-section) - cephalopelvic disproportion (c-section) precipitate labor a very rapid labor and delivery - cervical dilation occurs at a rate of 5cm or more per hour in primipara or 10cm or more per hour in multipara - occurs when uterine contractions are so strong a parent gives birth with only a few, rapidly occurring contractions (3 hours) Risks of precipitous labor - PPD hemorrhage from uterine atony - lacerations - cord prolapse - subdural hemorrhage (risk to fetus) risk factors for precipitous labor - stimulant (cocaine) use - younger mothers - having babies close together -Hypertonic uterine dysfunction -Oxytocin stimulation -Multiparous client uterine rupture a tear in the wall of the uterus; MEDICAL EMERGENCY; straight to c-section or fetal death will occur due to lack of oxygen and nutrients nursing interventions for uterine rupture - MEDICAL EMERGENCY - admin IV fluids - anticipate giving IV oxytocin to contract the uterus and minimize bleeding - possible laparotomy - c-section to get baby out - stay with mom - psychosocial support Symptoms of uterine rupture - sudden severe pain then no pain following - increased bleeding - FHR decelerates, bradycardia - mom's contractions are absent - 2 bulges in the abdomen - rigid abdomen - BP, HR drops - eventually FHR undetectable - cool/clammy skin risk factors for uterine rupture previous c-section, abnormal presentation (breech, longitudinal), obstructed labor, high parity, prolonged labor, multiple gestation, unwise use of oxytocin, traumatic maneuvers of forceps or traction incomplete uterine rupture part of the uterus ruptures; still have blood, but have localized pain in abdomen not rigid uterine inversion the uterus turns inside out with either birth of the fetus or delivery of the placenta can occur if traction is applied to the umbilical cord to remove the placenta or if excessive traction is applied to the uterine fundus when the uterus is not contracted signs of uterine inversion - large amount of blood suddenly gushes from the vagina - the fundus is no longer palpable in the abdomen - the patient shows signs of hemorrhage (hypotension, dizziness, paleness, diaphoresis) - utertus is showing outside the vagina nursing interventions for uterine inversion - call for provider to bedside! - discontinue oxytocin - IV fluids - Oxygen via mask - Assess vitals - be prepared for CPR - provider fists the uterus back into place, then hardcore fundal massage to get the uterus to contract amniotic fluid embolism An extremely rare, life-threatening condition that occurs typically immediately post-birth, when amniotic fluid is forced into an open uterine blood sinus after a membrane rupture or partial premature separation of the placenta