4Spontaneous AbortionIn a complete abortion, all of the products of conception are expelled.In an incomplete abortion, some, but not all, of the products of conception are expelled. (For example, the placenta may remain in the uterus.)In a missed abortion, the fetus dies and the products of conception remain in the uterus.
5Pregnancy Complications Incompetent cervixUnable to remain closed for the duration of the pregnancyNo known causeEarly delivery resultsCervical cerclage procedureSuture tied around the cervixComplete bedrest
6Care of the patient with incompetent cervix Emotional supportFear of losing the baby causes anxiety and worryReportAbdominal painUterine contractionsFluid leaking from the vagina
7Pregnancy complications Hyperemesis gravidarumSevere nausea and vomitingCause dehydration and weight lossNormal “morning sickness stops by the 12th weekContinues into the second trimesterOften requires hospitalization for enteral nutrition
8Pregnancy complications Gestational diabetesPregnancy inducedUsually develops during the second trimesterNo history of diabetesIncreases risk of development of type II laterRisksLarge babies cause difficult delivery
9Preeclampsia/Eclampsia PREGNANCY COMPLICATIONSPreeclampsia/EclampsiaGestational Hypertensionbp greater than 140/90Develops after 20th week of gestationCan lead to death of mother and babyMd ordersBed restantihypertensive medshospitalization
10Gestational hypertension Report to the nurse right away if a preeclampsia/eclampsia patient:Complains of blurred visionIs irritable or seems especially tenseComplains of severe heartburnHas decreased urinary outputHas puffy or swollen face and hands
14Pregnancy Complications Pre-term laborOccurs between 20th and 37th weekDanger due to baby’s lungs are not full developedReason if often not knownRisksPrevious preterm laborMultiple pregnancyUterine or cervical problemsAge of mother (less than 16 or older than 40)
15Tell the nursec/o low back pain or abdominal painUrinary urgencyFluid leaking from the vaginaMay signify labor is starting
16Premature rupture of membranes (PROM) Occurs prior to due dateBefore labor beginsMd may make labor begin if the mother does not go into labor within 24 hoursMother and baby become at risk for infection
17Pre-term premature rupture of membranes (pre-term PROM) Prior to 37th week of pregnancyBaby’s lungs are not fully developedMDmedication to maintain pregnancy to get past 37th week.BedrestHelp with ADL’s
18Multiple Gestation Twins (the most common) Triplets Quadruplets QuintupletsMultiple gestation can sometimes cause a pregnancy to be “high-risk”
19MonozygoticOne egg is fertilizedShare a placentaAlways same genderDizygoticTwo eggs are fertilizedEach baby has own placentaMay be the same gender or different
20Divided into 4 categories INFERTILITYDivided into 4 categoriesProblems with the man's reproductive system.Problems with the woman's fallopian tubes.Problems with the woman's uterus and/or cervix.Problems with ovulation.
21LABOR AND DELIVERY Vaginal birth Mother is not high risk or there are no problems with the pregnancyCesarean section birthComplications that cause stress on mother or baby
22Responsibilities of the PCT Vary from facility to facilityMay include Basic care and advanced care skillsroutine vital signsassisting with ambulationToilteingpreparation of sterile suppliescollection of blood samples from umbilical cordclean the patient after delivery
23Labor and Delivery- process Oxytocin is released by the pituitary gland causing the uterus to contract in the upper muscular portionContractions push the baby downward against the cervixPressure of the baby on the cervix causes it to dilate (the opening becomes larger)When the cervix is fully dilated the baby passes into the birth canal (vagina)The placenta is delivered
24Delivery is done by the primary health care provider ObstetricianMD who specializes in obstetrics and gynecology in addition to medical schoolCertified nurse midwifeRN who completes 1-2 years of additional graduate trainingCannot perform c-sections
25Signs of Labor Lightening Baby begins to move down into the pelvis Abdomen changes appearance “dropped”Usually indicates labor in 2 weeks
26Signs of Labor Bloody show Blood tinged vaginal discharge that is mixed with mucousMucous plug blocks opening to cervix during pregnancyCervix softens and begins to efface (become thinner
27Signs of Labor Braxton-Hicks contractions Irregular contractions that occur with more freauency as labor approachesIrregular frequency and intensity
28primipara-=a women delivering her first baby Multipara= a women who has delivered a babyFirst stage of labor differs for each
29First Stage of Labor Divided into three stages: Early latent phase Mild discomfort, backache5-8 minutes apart for seconds
30First stage of Labor Mid/active phase Contractions become more frequentDiscomfort increasesMonitoring of contractions and FHRTransitional phaseMost intense contractions every 2-3 minutes for as long as 80 secondsCervix dilates from 7-10 cmCrowning
31Second Stage of Labor Cervix is completely dilated Pushing stage Baby is delivered
32Third Stage of Labor The placenta is delivered On average, delivery of the placenta takes between 5 and 20 minutesNursing assistant’s responsibilities:Cleaning the perineal areaApplying an ice pack and a perineal padChanging soiled linensMonitoring vital signs every 15 minutes
33Fourth Stage of LaborBegins with the delivery of the placenta and ends when the woman’s condition has been stabilizedVital signs continue to be monitoredNursing assistant will assist the patient with urination
34Cesarean DeliveryDelivery of the baby through a surgical incision made in the mother’s abdomenNecessary when a vaginal delivery is not possible or safe for the mother or babyRecovery time following a cesarean delivery is generally longer than the recovery time following a vaginal delivery
35Possible Reasons for a Cesarean Delivery Anatomical difficultiesCephalopelvic disproportion (CPD)Baby’s head is too large to pass through the pelvisAbnormal fetal presentationBreech=legs or buttocks firstShoulder=may be repositioned by the MDPrevious cesarean deliveryEmergency procedure (if complication develops during pregnancy, labor, or delivery)
37Nursing Assistant’s Role During Cesarean Delivery Serve as a scrub personPerform a surgical scrub, put on a sterile gown and gloves, and work within a sterile fieldLearn the steps of the cesarean section procedure, the names of the instruments used, and how to properly pass the instruments and other supplies to the doctorSee Box 12-1
38VBAC Vaginal birth after cesarean Possible if no complications during the pregnancyUterine scar is located in lower portion of the uterusPrevious pregnancy did not have a life threatening problem
39Postpartum Complications HemorrhageGreatest first hour after deliveryCan occur 24 hours and up to 6 weeks after delivery
40Postpartum Complications Puerperal infectionAn infection that develops after childbirthAffects structrues of the reproductive tractOther structures could be affectedUrinary tractWoundbreast
41Postpartum Complications ThrombophlebitisMost common cardiovascular problemClots form in deep veins of the legs or pelvisIf break loose cause pulmonary embolism and respiratory/cardiac arrest.
42QuestionWhen caring for a patient with incompetent cervix, you should report to the nurse right away which of the following observations?The patient has abdominal painThe patient has uterine contractionsThere is fluid leaking from the vaginaAll of the above
43Answer D. All of the above All may be signs of an impending spontaneous abortion.
44Question Tell whether the following statement is true or false. Usually, a woman with PROM will go into labor within 24 hours, but the doctor may choose to administer medications that make labor begin sooner to lower the risk for infection.TrueFalse
45AnswerA. TruePROM puts the mother and the fetus at risk for infection.
46QuestionHow many phases are in the first stage of labor?4362
47AnswerB. 3The three phases of the first stage of labor are: early latent, mid/active, and transitional.
48Question What are some postpartum complications? Hemorrhage Puerperal infectionThrombophlebitisAll of the above
49Answer D. All of the above The postpartum period is the 6-week period of time following the birth. The most common postpartum complications include hemorrhage, infection, and thrombophlebitis.