● RISK FACTORS
○ Maternal hypertension, cocaine, abdominal trauma, polyhydramnios, multiple gestation, previous placental abruption
● SIGNS AND SYMPTOMS:
○ May have sudden onset of intense usually localized abdominal (uterine) pain with or without vaginal bleeding
○ Vary with degree of separation
○ Abdominal pain, rigid abdomen
○ Vaginal bleeding
○ Bloody stained amniotic fluid
○ Uterine contractions or hypertonus
○ Abnormal FHR patterns
● NURSING INTERVENTIONS
○ Watch for s/s of DIC
○ Assess bleeding/vital signs including fundal height and abdominal girth
○ No abdominal manipulation or vaginal exams until placenta previa ruled out
○ NO SUPINE ← left side lying position
○ Monitor FHR continuously with external monitors
○ Type and cross, CBC, clotting factors, Rh factor
○ IV start & fluids
○ Prep for delivery → possibly cesarean
○ REPORT: tachysystole, FHR changes
○ Observe for signs of shock
● RISK FACTORS
○ Previous placenta previa, previous C section, smoking, maternal age over 35, multiple gestations, etc.
● SIGNS AND SYMPTOMS
○ Usually painless uterine bleeding 2nd or 3rd trimester
○ Uterine tone soft upon palpation
● NURSING INTERVENTIONS depends on...
○ Amount of bleeding
○ Labor status
○ Gestational age
○ Fetal response
○ If labor active and os is completely covered, C/S indicated
○ If bleeding controlled and labor absent, conservative management:
■ Activity limitation
■ No tampon use
■ No sexual intercoarse
■ Monitor and report bleeding
■ Patient instructed to report diagnosis when admitted to hospital
■ Cesarean preparation class
○ Count fetal movements
First Stage - onset regular contractions until full dilation of cervix, longest stage.
Latent phase: progress in effacement; little increase in decent. Begins with true regular contractions, duration 6-8 hours, behavior (excited, talkative), contractions (mild to moderate, irregular, every 5-30 mins, lasting approx. 30-45 seconds)
Active Phase: more rapid dilation of cervix and increased rate of descents of presenting. Duration about 3-6 hours, behavior (more serious, apprehensive, needs encouragement, fatigue, some difficulty following directions, doubtful of pain control), contractions (moderate to strong, more regular, every 3-5 mins, lasting approx. 40-70 seconds, may have epidural if so desire)
Transition Phase - more rapid dilation of cervix and increased rate of descent of presenting part. Duration about 20-40 mins, behavior (severe pain, may lose control, irritable, frustrated, N/V, STRONG URGE TO PUSH) contractions (very strong, very intense phase, regular every 2-3 mins, lasting 45-90 seconds)
Time cervix is fully dilated to birth of fetus.
-Contractions may be weak at beginning of this stage, may not yet feel urge to push, allow women to "labor down", contractions resume, strong urge to push, encourage open glottis pushing, fetal station advances, crowning then birth.
-Perineal trauma related to childbirth.
-perineal lacerations (first degree, second degree, third degree, fourth degree = vag rectal muscle.
-vaginal and urethral lacerations
-Episiotomy if necessary.
Full dilation (10cm) and cervical effacement (100%) to birth of the baby.
Uncontrollable urge to push.
Crowning of head.
Variable - Cord Compression
Causes- #1 maternal position (cord between fetus and pelvis), cord around neck, body etc., knot in cord, short cord, prolapsed cord (EMERGENCY --> push back in and hold = c section) usually occurs during transition and second stage labor
Interventions - Change maternal position (side), discontinue pitocin, 8-10L O2 facemask, asses cord for prolapse, assist with amnioinfusion (NS,LR)(with oligoamnio)
Early - Head Compression
Cause - head in birth canal
Interventions - none
-temporary increase in FHR, normal, abrupt increase in FHR above baseline, increase 15 beats and return to baseline in less than 2 mins, usually reassuring sign -> indicated fetal well being, often occur with fetal movements
Late - Placenta
Causes - maternal hypotension, uterine tachsystole, anesthesia, placenta previa, abruption, HTN, Postmaturity, IUGR, DM, intraamniotic infections
Interventions: Change maternal positions, increase IV fluids (hypotension), dc pitocin, oxygen, elevate legs (hypotension), palpate uterus for tachysystole