Incompetent Cervix

A cervix is termed "incompetent" when it cannot take the weight

pressing against it as the fetus grows. This weakening may cause the
cervix to open long before the baby is ready to be born.
A cervix that is too weak to stay closed during a pregnancy.
Factors:
DES exposure
Cervical Trauma
Hormonal influences
Congenitally short cervix
Forced D & C
Uterine anomalies
Signs and Symptoms
A mucousy or watery vaginal discharge
Vaginal spotting or bleeding
Menstrual-like cramping
Pelvic pressure or "heaviness"
Treatment
Cerclage - a suturing of the cervix to keep it from continuing to
dilate prematurely.
Pessary - a plastic or rubber device that may be placed in your
vagina to elevate and support the cervix
TREATMENT
*Tocolytics - Stop or prevent labor contractions

Nursing Considerations
Advise to refrain from any sexual activity.
Bedrest
Position client to minimize pressure on the cervix
Observations for contraction, rupture membranes
Monitor fetal heart tones
Placenta Previa
Is the development of the placenta in the lower uterine segment, partially or completely
covering the internal cervical os.

Types of Placenta Previa

Total placenta previa -occurs when the internal cervical os is completely covered
by the placenta.
Partial placenta previa - occurs when the internal os is partially covered by the
placenta.
Marginal placenta previa- occurs when the placenta is at the margin of the
internal os.
Low-lying placenta previa -occurs when the placenta is implanted in the lower
uterine segment. In this variation, the edge of the placenta is near the internal
os but does not reach
Etiology
Multiparity
Advanced maternal age
Multiple gestation
Previous Cesarian birth
Uterine incision
Prior placenta previa
Clinical Manifestations
Vaginal bleeding is apt to occur suddenly during the third trimester.
Bleeding is usually bright red and painless.
Initial bleeding is not usually profuse enough to cause death; it spontaneously ceases, only to
recur later.
The first bleed occurs (on average) at 27-32 weeks' gestation.
Contractions may or may not occur simultaneously with the bleeding
Assessment
Determine the type and amount of bleeding
Record maternal and fetal vital signs
Inquire as to the presence or absence of pain associated with bleeding
Palpate the presence of uterine contractions
Evaluate hemoglobin and hematocrit status
Nursing Interventions
Improving tissue perfusion
Ensuring fluid volume
Reducing fear and anxiety
Preventing infection
Abruptio Placenta-
Premature separation of the normally implanted placenta of unknown cause.
Types of Abruptio Placenta
* Concealed Hemorrhage
- Placenta separates centrally, and large amount of blood accumulates
under the placenta
*External Hemorrhage
Separation is along the placental margin, blood flows under the
membranes through the cervix
Etiology : Unknown
Risk factors:
- uterine anomalies
- multiparity
- pre-eclampsia
- renal or vascular disease
- trauma to the abdomen
◦ - previous 3rd trimester bleeding
- abnormally large placenta
- short umbilical cord
Contributing Factors: Pregnancies complicated by hypertension, trauma, previous history of
abruptio placenta, alcohol and drug use.
Clinical Manifestations
1. intense, localized uterine pain with or without vaginal bleeding
2. concealed or external dark red bleeding
3. uterus firm to board like, with severe continuous pain
4. uterine contractions
5. uterine outline probably enlarged or changing shape
6. FHR present or absent
7. fetal presenting part may be engaged
Management
- Fluid replacement
- Oxygen by mask
- Monitor FHB
- Monitor maternal vital signs every 5 -15 mins
- Keep on lateral position
- Do not perform any vaginal or pelvic exam
Disseminated Intravascular Coagulation (DIC)
- is an acquired disorder of blood clotting
Symptoms include:
- easy bruising and bleeding on the IV site
Conditions Associated with DIC
- Abruptio placenta
- PIH
- Amniotic fluid embolism
- Placental retention
- Septic abortion
- Retention of dead fetus
- Saline abortion
Therapeutic Management
- Halt the underlying insult
- Marked coagulation must be stopped
- Iv administration of heparin
Preterm Labor
- Labor occurs after 20 weeks and before 37 weeks
gestation.
Etiology
- PROM
- Pre-eclampsia
- Hydramios
- Abruptio placenta
- Incompetent cervix
- Trauma
- Uterine structural anomalies
- Multiple gestation
- Chorioamnionitis
- Fetal death
Clinical Manifestations
- persistent, dull, low back pain
- Vaginal spotting
- feeling of pelvic pressure
- abdominal tightening
- menstrual like cramping
- increased vaginal discharge
- uterine contractions
- intestinal cramping
Nursing Management
1. Assess the mother’s condition and evaluate signs of labor
- obtain a thorough OB history
- determine frequency, duration, intensity of UC
- obtain specimen for CBC, urinalysis
- determine cervical dilation and effacement
- assess status of membrane and bloody show
2. Evaluate the fetus for distress, size and maturity
- sonography and lecithin-sphingomyelin ratio
3. Perform measures to manage or stop preterm labor
- bed rest on side lying position
- prepare for possible UTZ, amniocentesis
4. Provide for physical and emotional support
5. Provide client and family education
Drug Administration
Betamethasone – a steroid, is given to hasten lung maturity
- takes effect in 24 hrs and last for 7 days
Tocolytic agents – halts labor
Ex. Nifedipine (Procardia), Indocin, Magnesium sulfate
Premature Rupture of Membranes
- is the rupture of the chorion and amnion 1 hour or more before the onset of
labor
Cause : unknown
Leading cause of death associated with PROM is infection
Assessment findings
1. Clinical Manifestations
- AF gushing from the vagina
- maternal fever, fetal tachycardia, malodorous discharge may indicate infection
2. Laboratory and diagnostic study findings
- Ferning is evident
- Nitrazine test
Nursing Management
1. Prevent infection and other possible complications
- Make an accurate evaluation of the membrane status
- Keep vaginal exam to a minimum
2. Determine maternal and fetal status
- continually assess for signs of infection
- maintain bed rest
3. Provide client and family education
Pregnancy Induced Hypertension
(PIH: Preeclampsia & Eclampsia

Preeclampsia
- is a hypertension disorder of pregnancy developing after 20 week
gestation and characterized by edema, hypertension and proteinuria.

Eclampsia
- is an extension of preeclampsia and is characterized by the client
experiencing seizures
Etiology
Cause : Unknown

Possible contributing factors:

- genetic or immunologic
- Primigravid status
- conditions that create excess trophoblast tissues – multiple gestation, diabetes
or H-mole
- younger than 18 or older than 35 years
Assessment findings
1. Clinical manifestations of Mild preeclampsia:
- BP exceeding 140/90 mmHg
- excess above baseline of 30mmHg in systolic pressure or 15 mmHg in diastolic
pressure on 2 readings taken 6 hours apart
- Generalized edema of the face, hands and ankles
- Wt. gain of about 1.5kg (3.3 lbs) per month in the 2nd trimester or more than
1.3 to 2.3 kg (3-5lbs) in the 3rd trimester
- Proteinuria 1+ to 2+ or 300 mg/dl in a 24 hour sample
Assessment findings
2. Warning Signs of worsening Preeclampsia
- rapid rise in BP
- rapid weight gain
- generalized edema
- Increased proteinuria
◦ - epigastric pain
- severe headache
- visual disturbances
- oliguria (<120 ml in 4 hrs)
- severe nausea and vomiting
3. Clinical manifestations of severe Preeclampsia
- BP exceeding 160/110 mmHg on two readings taken 6 hours apart with the client on bed
- Proteinuria exceeding 5g/24 hrs
- Oliguria <than 400ml in 24 hours
- headache
- blurred vision, spots before the eyes
- pitting edema of the sacrum, face, upper extremities
- dyspnea, nausea and vomiting
- epigastric pain

4. Eclampsia
- exist once the patient has experienced a grand mal seizure
Nursing Management
1. Monitor for, and promote the resolution of, complications
- Monitor vital signs and FHR
- Minimize external stimuli, promote rest and relaxation
- Measure and record I&O, protein level and spec gravity
- Assess for edema of the face, lower and upper extremities
- weigh the client daily
- assess deep tendon reflexes every 4 hrs.
- assess for separation of placenta, headache and visual disturbance and altered level of
consciousness
2. Provide treatment as prescribed
- Mild preeclampsia – bed rest, balanced diet, Mg S04
- Severe preeclampsia – CBR, balanced diet, Mg S04, fluid and electrolyte
replacement, sedative antihypertensive drug, anticonvulsive drug
- Eclampsia – Mg S04 IV
3. Institute seizure precautions
4. Address emotional and psychosocial needs
Medication Side Effects
1. Magnesium Sulfate
-Used to prevent and treat convulsions;
-its primary action is to lower the blood pressure
-decreases neuromuscular irritability and depress the nervous system
-is irritating to veins, so the infusion site must be monitored
- is excreted through the kidneys, urine output should be monitored to prevent toxicity
- is a central nervous depressant, respiratory status must be monitored
- Depresses deep tendon reflexes