- infection (endometriosis), bleeding at site of placenta (previa), did she receive prophylactic (r/t infertility) progesterone supplements-could cause preterm labor to start
- Cramping (like period), Backache (dull, low, with pressure and is continuous), Spontaneous contractions (more than 5/hr), increase or change in vaginal discharge
- Cervical cultures for G/C and GBS - done in first trimester, Bedrest, Trendelenberg position to keep pressure off bottom, progesterone (inhibit contractions), antibiotics/anti-inflammatory, Shirodkar suture / Cervical cerclage, also give tocolytics (if less than 6 cm dilation)
- Check fetal movement every hourBed rest (on left side mostly)Check BP, UA dailyBi - wkly NST's24 hr urine collection
- Bedrest (keep the fetus off the cervix), Hydration (2-3 L/day), Tocolysis - Terbutaline and Magnesium Sulfate (FDA approved anticonvulsant), also give progesterone to prevent
- U/SLab work - H/H,CBC,T/X (type and cross), Beta hCG, progesterone (to prevent contractions)Bed rest (especially with threatened abortion)Abstinence from sexIV/TransfusionD&CIf beyond 12 weeks induction of labor by oxytocin and prostaglandins may be used (if earlier, they will wait it out)Emotional support and bereavement care
- Pelvic ExamU/S (as early as 5 weeks)Salpingostomy - Before rupture, less than 2 cm in length and located in the ampulla.Laparoscopy and Laparotomy to remove the products of conception Methotrexate (with no folic acid intake) is sometimes used for less than 3.5 cm and requires beta hCG weekly for 12 weeks to make sure the contents are removed (less than 5,000)
- Quiet onset (no pain) of bright red vaginal bleedingAbdomen soft, palpableV/S stable
- Severe pain in the abdomenDark venous bloodAbdomen rigid and hardSudden onset
- -Unexplained bleeding (with or without the passage of tissue)-Cramping in the lower abdomen-Backache -S/S of infection-N/V-Feeling thirsty
- Prepare for emergency C/S (needs to be done STAT) and starting 16-18 gauge IV! Fetal monitoring, change to side position, put 8-10 L O2 on, D/C Pitocin
- Hypovolemia, Rigid, tender abdomen (peritonitis), Palpable mass on vaginal exam - extreme pain on one side, Vaginal bleeding, Lower abdominal pain (on one side), Fainting or dizziness
- -Threatened Abortion: slight spotting with no cervical dilation-Imminent (inevitable or not preventable) Abortion: cervix dilates and releases contents - Complete Abortion: heavy bleeding with fetus and tissue being completely expelled - Incomplete Abortion: some contents remain in the uterus-Missed Abortion: no cervical dilation with some to no spotting and products of conception remain in utero-Habitual Abortion: 3 or more losses for no known cause (possibly from hypertension leading to abruption placenta)
- Prior hx. of placenta previaMultiple pregnanciesHx. Of close pregnancies (1-1.5 years)Prior uterine scars
- Marginal: touching the cervis, but still to the sideComplete: completely covering the cervix with extreme risk of hemorrhage (pt will remain in hospital on bed rest)Low-lying: close to the cervix
- Bedrest (to prevent abd muscles from contracting) Stand for 45 min, sit for 15 min)Check fetal heart tonesMonitor blood loss (pad count every hour)Perineal careEducation re: S/S of labor, conditionHave current lab data- H/H, coag, electrolytes, Start 16-18 g IV to replace blood lossEmotional support!! NO vaginal exams or internal fetal monitoring!
- Spontaneous Abortions: Occurring naturallyInduced (therapeutic) Abortion: As a result of artificial or mechanical intervention
- -Evacuation of the mole - D&C-Biopsy the tissue for possible malignancy-Type & Cross for possible transfusion-Emotional support and bereavement care (possibility that the pt could be developing cancer)-Follow up for at least one year following (do not get pregnant until after 1 year)
- Beta HCG weekly for 3 weeks, then once a month for 6 months, then 3 more times with the remainder of the 6 months
- -Vaginal bleeding - brownish looking prune juice color-Spontaneous abortion 12-16 weeks because placenta does not stay together and sloughs off-Passage of hydropic vesicles (passing little grape looking things) -Uterine enlargement greater than expected gestational age (may only be 10 weeks but will be the size of 17 weeks) and fundus usually feels "doughy"-Absence of fetal heart tones with no activity noted-Hyperemesis gravidarum (due to high levels of HCG)-PIH (pregnancy induced hypertension) in second trimester