Abnormal OB

Normal OB

OZEF (Fetal Development)

  • Ovum

  • Zygote

  • Embryo

  • Fetus

  1. Ovum

    • within 24 hours

  2. Zygote

    • cell division

    • will turn into morula

    • endometrium - implantation happens (progesterone maintains thickness of endometrial lining)

    • HCG can be detected in the urine as early as 10 days after coitus

  3. Embryonic stage happens 5-8 weeks only (organogenesis happens)

    • Heath education about nutrition - green leafy vegetables increases folic acid (RDA: 400-600 mcg/day)

  4. Fetus - TERM pregnancy is between 37-40 weeks

    • There is enough fetal lung surfactant to prevent atelectasis

    • Lecithin Sphyngomyelin (lung surfactant) ratio 2:1

Abnormal OB Notes

Types of abortion

A. Induced - artificially done (Legal in USA if only done before 12 weeks)

  • Elective

  • Medical - recommended ng doctor

  • Abortifacients: Mifepristone and misoprostol

  • Prostaglandin soften and dilate cervix, key word is “prost” in medications

  • Mifepristone (Antiprogesterone) first, then after 3 days, misoprostol

  • Side effects: Uterine cramping and Fever

  • NURSING MANAGEMENT: MONITOR FOR BLEEDING

B. Spontaneous (miscarriage) - naturally occurring

  • 50-60% chromosomal abnormalities

  • Urinary tract infection complications can cause miscarriage

  • UTI complications: Sepsis and pyelonephritis

  • Dehydration: hypothalamus > posterior pituitary gland > ADH and Oxytocin > fluid retention and uterine contraction

  • Therefore, a pregnant woman must always be hydrated

Subtypes:

Possibly alive fetus

  1. Threatened - cervix is closed

  2. Inevitable - cervix is open

Expired fetus

  1. Incomplete - some are retained

  2. Missed - all are retained

  • Management: Raspa

    • Scant bleeding or spotting is normal

    • Profuse or heavy bleeding is abnormal (1 pad/hour)

  • EVA or MVA for nontraumatic

  1. Complete - all are expelled

  2. Recurrent pregnancy loss “habitual abortion” - 3 miscarriages

  • Common cause: Aneuploidy

Example: Alex Gonzaga Pregnancies

  • Blighted ovum - fertilized but expired

  • Chemical pregnancy - increased HCG

  • Fetal heart tone is present but also led to death

  • Fourth is successful

  1. Septic

  • Common cause: E. Coli

Management

No strict bedrest

NPO status

Proper hydration with IV fluids

FHT (120-160) if lower, notify MD

No vaginal exam.. ONLY SPECULUM


1-3 months

Abortion

  • Bleeding and dilation

Ectopic

  • Multiple partners

4-6 months

H. Mole

  • matanda

  • still have hyperemesis gravidarum

  • overdistention early age

PCD

  • Pink Bleeding

7-9 weeks

Placenta previa

  • Old with multiparity

Abruptio

  • Addict