Spontaneous Abortion Overview
- Bleeding < 20 weeks Gestation
- Identify Type
- Bed Rest
- Monitor for Hemorrhage
- Save Pads and Linens
- RhoGAM
- Dilation and Curettage (DandC)
- Cerclage
- Emotional Support
Spontaneous Abortion Types
- Missed Abortion
- No Fetal Heartbeat, No Cervical Dilation, No Bleeding
- Threatened Abortion
- No Cervical Dilation and Minimal Bleeding
- Inevitable Abortion
- Bleeding and Cervical Dilation with No Loss of Products of Conception
- Incomplete Abortion
- Bleeding and Cervical Dilation with Loss of Some Products of Conception
- Complete Abortion
- Bleeding with No Cervical Dilation, with Loss of All Products of Conception
Abruptio Placentae
- Premature Separation of Placenta
- Tearing Pain
- Bleeding (Often Concealed)
- Rigid Uterus
- Contractions
- Corticosteroids as Needed
- Emergent Delivery
- Increased Risks for Neonate
- Rh (Rhesus) Incompatibilities
- Increased Risk for Shock
- Monitor Fetal Heart Rate
Cesarean Section - Indications
- Active Genital Herpes Infection
- Cervical Cancer
- Eclampsia (Preeclampsia)
- History of Uterine Surgery
- History of C-section (Vertical)
- Malpresentation
- Fetal Distress
- Cord Compression/Prolapse
- Failed Vaginal Delivery
- Cephalopelvic Disproportion
- Abruptio Placentae or Placenta Previa
Prolapsed Umbilical Cord
- Cord Prolapses
- Visualization of Cord
- Prolonged or Variable Decelerations
- Hips Elevated
- Insert 2 fingers in Vagina
- Saline Towel on Cord
- Oxygen
Ectopic Pregnancy
- Lower Abdominal Pain
- Delayed Menses
- Abnormal Vaginal Bleeding
- Shock
- Referred Shoulder Pain
- Cullen Sign
- Methotrexate
- Surgery
- RhoGAM
Gestational Diabetes
- Usually Asymptomatic
- Fetal Macrosomia
- Polyhydramnios
- Glucose Intolerance After 24 Weeks Gestation
- 3-hr 100g Glucose Tolerance Test
- Diet and Exercise
- Close Glucose Monitoring
- Insulin
- Ultrasound (or Nonstress Test (NST))
- Delivery
Gestational Hypertension
- New-Onset Hypertension
- > 20 Weeks Gestation
- Nulliparity
- Obesity
- African American Females
- > 35 years Old
- Multiple Gestations
- Family History of Gestational HTN (or Preeclampsia)
- IUGR
- Prematurity
- Abruptio Placentae
- Fetal Monitoring
- Alpha-Methyldopa
- Beta-Blockers (Labetalol)
- Calcium Channel Blockers
- Hydralazine
Preeclampsia Assessment
- After 20 Weeks of Pregnancy
- Hypertension > 140/90
- Proteinuria or End-Organ Dysfunction
- Hypertension > 160/110
- Progressive Renal Insufficiency
- Vision Changes
- HELLP Syndrome
- Pulmonary Edema
Preeclampsia Interventions
- Side Lying Position and Bedrest
- Antihypertensives
- Magnesium Sulfate
- Labor Induction
Severe Preeclampsia
- Vasospasm and Decreased Organ Perfusion
- Intravascular Coagulation
- Increased Permeability and Capillary Leakage
- Hypertension
- Proteinuria or End-Organ Dysfunction
- Hepatic Dysfunction and Hemolysis
- Elevated Liver Enzymes
- Low Platelet Counts
Eclampsia
- Increased Central Nervous System Irritability
- Hyperreflexia
- Positive Ankle Clonus
- Headaches
- Visual Disturbances
- Epigastric or RUQ Pain
- Seizures
- Coma
- Don't Leave Bedside
- Magnesium Sulfate
Incompetent Cervix
- Premature Cervical Dilation
- Recurring Miscarriage
- Short Cervix
- Cervical Cerclage
- Rest
- Labor
Placenta Previa
- Placenta Covers Cervical Os
- Painless
- Bright Red Vaginal Bleeding
- Stable Fetus
- Bed Rest
- Observation
- Unstable Fetus
- C-section Delivery
- Risk for Shock
- Magnesium Sulfate
- Tocolysis
Postpartum Hemorrhage
- Uterine Atony
- Lacerations
- Retained Placenta
- Bleeding
- Hypotension
- Boggy Uterus
- Oxytocin
- Bimanual Compression of Uterus
- Surgery
- Blood Transfusion
Premature Rupture of Membranes (PROM)
- Rupture > 1 Hour Before Labor
- Infection
- PROM History
- Incompetent Cervix
- Fern Test
- Nitrazine Paper Test
- Ultrasound
- Consider Tocolytics
- Consider Antibiotics
- < 34 Weeks Gestation
- Corticosteroids
- > 34 Weeks Gestation
- Induction of Labor
RhoGam [Rho(D) Immune Globulin]
- Antepartum Prevention at 28 weeks
- Suppress Antibody Production
- Lysis of Fetal RBC in Maternal Bloodstream
- Myalgia and Lethargy
- Negative Coombs Test
- Standard Dose 300 mcg
- Microdose 50 mcg
- Blood Product
Fetal Macrosomia
- Increased Birth Weight
- > 4500 g
- Maternal Obesity
- Gestational Diabetes
- Weigh Newborn at Birth
- Ultrasound
- Hadlock's Formula
- Birth Canal Trauma
- Neonatal Hypoglycemia
- Shoulder Dystocia
- Planned Cesarean Section