Complications in Midwifery

1. S/S: spotting and cramping (the combination)2.Tx: measure hCG levels (worry when they drop), bedrest and pelvic rest (no sex), if miscarriage imminent --> IV, Blood, Dialation and curettage (removal of remaining products of pregnancy)

1. patho: benign neoplasm, can turn malignant --> grape-like cluster vesicles --> may/may not have a fetus involves (NCLEX = no fetus!)2. Cause- uterus enlarges too fast?3. S/S - absence of FHT, bleeding, sometimes will have vesicles.4. Dx - confirmed with ultrasound5. Tx: Small mole- D&C, Don't get pregnant if follow- up period because they will not be able to tell if rise in hCG levels are from pregnancy or malignancy > if malignant it is called choriocarcinoma, and will need chest x ray to determine metastsis > will measure hCG levels until normal; rechecked q 2-4 weeks then Q 1-2 months for 6 moths to a year

Gestation outside uterus, usually in fallopian tube, confirmed with ultrasoundS/S Pain, usual s/s of pregnancy followed by pain, spotting or bleeding into peritoneum (if fallopian tube ruptures vaginal bleeding may be present). If you've had one you are more likely to have a secondTx; Methotrexate (Rheumatrex/ Trexall) is given to Mom to stop growth of embryo to save the tube, if this doesn't work laparoscopic incision will be made into the tube and the embryo will be removed (entire tube may have to be removed). Laparotomy is done if the tube has ruptured or pregnancy advances.

Patho Most common cause of bleeding in the later months (usually 7), d/t wrong implantation of placenta. Ultrasound will be done to confirm placental location.Causes Placenta begins to prematurely separate when the cervix begins to dilate and efface --> baby doesn't get oxygen. NOrmally placenta should attach high in fundus. The placenta may be low on the side of the uterus (low lying placenta), halfway covering the cervix (partial previa), or completely covering cervix (complete previa)S/S painless bleeding in 2nd half of pregnancy (spotting of profuse). For mom this can result in hemorrhage and potential DIC risk (Disseminated intravascular coagulation). For baby it can result in preterm delivery, intrauterine growth retardation, fetal distress, anemia.Tx: Complete previa > usually requires hospitalization from as early as 32 weeks until birth, to prevent blood loss and fetal hypoxia if client goes into labor > if there is not much bleeding put patient on bed rest and monitor baby closely > monitor for contractions > usually have to do c section > do not perform vaginal examNote: Rule out other sources of bleeding like abruption and always to pad counts

Patho: Placenta normally implanted, abruptio may be partial or complete (tear/separation of placenta from uterus) > usually happens in last half of pregnancy > ultrasound confirms diagnosis > severity of separation based on scale from 1-3(worst) separation causes bleeding external or concealed > concealed means bleeding into uterus Cause: MVA, domestic violence, previous cesarean section, rapid decompression of uterus (rupture membranes), associated with cocaine, PIH (pregnancy induced hypertension) and smoking s/s rigid board like abdomen, with or without vaginal bleeding (think bleeding into body), abdominal pain and increased uterine tone, difficult to palpate fetus.Tx deliver C-section. manage fetal status and maternal shockRULE: do not do vaginal exams in the presence of unexplained vaginal bleeding

Patho: cervix dialates prematurely, 4th moth of pregnancy. This client will have a history of repeated, painless, second trimester miscarriages usually in the first trimester.Causes: the weight of the baby causes pressure on the cervix causing it to prematurely dilate.Tx: Purse-string suture (cerclage) at 14-18 weeks- reinforces the cervix --> may do c-section to preserve the suture or may clip suture for vaginal delivery. 80-90% chance of carrying to term after cerclage.

patho: starts like regular morning sickness, shows excessive vomiting --> dehydration --> starvation -->deathCauses: r/t high levels of estrogen and hCGs/s: BP decrease, H/H increase, UO decrease, K+ decrease (vomiting), weight decrease, Ketones in urine (from wasting fat for energy)Tx: NPO for 48 hours, IVG's 3000 ml for 1st 24 hrs, give antiemetic, vitamin replacement, quiet non-stimulating environment, oral hygiene, 6-8 small dry feedings followed by clear liquids, food/liquids shold be ice cold or piping hot, well ventilated room

Definition: increased bp, proteinuria, edema after 20th week. If mom's pre-pregnancy baseline BP is not known then 130/90 is considered to be mild preeclampsia. When client gains 2 or more lbs/week think PIH (same thing)S/S: sudden weight gain. Faces and hands are swollen d/t protein and albumin leaking into tissues., headache, blurred vision, seeing spots, hyper-reflexia (increased DTRs). Clonus-->seizure and vasospasmTx: Mild - BP 30/15 of there baseline documented 6 hours apart > bed rest as much as possible > increase protein in diet > have glomerular damage with proteinuria Severe- BP elevated 160/110 documetned 6 hours apart > give sedation (like magnesium sulfate) to delay seizures. If Diastolic BP > 100 use apresoline (Hydralazine) in addition to magnesium sulfate. Hydralazine is a peripheral vasodilator and also dilates smooth muscle, side effect is Tachy.Only cure is delivery

It acts as an anticonvulsant, sedative, and vasodialator. Its a simple salt solution (hypertonic) that will attract fluid back into vascular space and out of the tissues --> kidneys will diuresis. If shift occurs too fast or if kidneys are impared it could cause pulmonary edema. This helps save the kidneys.
When you are giving magnesium you have to check for magnesium toxicity Q 1-2 hours (BP, respirations, DTRs and LOC, look for SEDATION). Also monitor urinary output hourly and serum mag periodically,
If in labor, mag will slow or stop it so you must augment with oxytocin (Pitocin)

Bethamethoason stimulates surfactant production into the aveolar spaces and this caues less tension when infant breathes. given between 24-34 weeks to reduce infant mortaillty = "expectant management (balancing risk to mom vs baby)

The seizure itself!

If seizure happens in preeclamptic women. Treatment: watch labor, watch for heart failure, stroke, HA, reanal failure, DIC, HELLP syndrome, neurological damage, multisystem organ failure

HELLP syndrome is a group of symptoms that occur in pregnant women who have:

• H -- hemolysis (the breakdown of red blood cells)
• EL -- elevated liver enzymes
• LP -- low platelet count
  

definition: occurs between 20-37 weeks Treatment: Tocolytic therapy: Terbutaline (Brethine) and Magnesium sulfate, side affects are increased pulse and hyperactivity> Betamethasone (Celestone) also given via IV to mom to stimulate maturation of baby's lungs in case of preterm birth> hydrating mom and treating vaginal infections can also stop preterm labor

Definition: when umbilicus falls down though cervix.this most likely happens when presenting part not engaged and membranes rupture
Nursing Action: check FHT, if cord compression occuring you will see variable decelerations so immediate c-section is indicated. If cord not puslating -->fetal death has occurs (extreme emergency)
Treatment: Lift head off cord until physician arrives to relieve pressure. Put mom in trendelenberg or knee chest position, give oxygen, monitor FHT and NEVER NEVER NEVER push cord back in!!!