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Pregnancies can still occur when only one tube is

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pregnancies can still occur when only one tube is present, although fertility decrease. Also, the samecondition that cause ectopic pregnancy in the tube that was removed may exist in the other tube.If tube is ruptured;Combat shock/stabilize cardiovascularoIV’s- fluid resuscitationoDraw blood for type and cross matchoGive blood replacementLaparotomy/SalpingectomyPsychological SupportGestational Trophoblastic DiseaseHydatiform Molar PregnancyEtiology:A developmental anomaly of the placenta with proliferation and edema of the chorionic villiThe villi appear as fluid filled grape-size vesicles, can grow enough o filled uterus to the size of anadvanced pregnancy if not diagnosis and treatedAs a result of the abnormal growth, the placenta, but not the fetus, develops.AssessmentVaginal Bleeding -- scant to profuse, brownish in color(prune juice)Enlargement of the uterus out of proportion to the duration of the pregnancyVaginal discharge of grape-like vesiclesMay display signs of preeclampsia early (before 24 wks)Excessive N/V possibly related to high beta-hCG levelsNo Fetal heart tone or QuickeningInterventions and Follow-UpEmpty the Uterus by suction D&C or Hysterotomy= Risk for choriocarcinomaPrior to evacuation the following diagnostic tests are done to develop a baseline:Chest x-raysBlood chemistry tests – H&H levelsSerumβ-hCG – pregnancy test –hCG levels will be very highType and cross match, clotting factorsHydratiform Molar Pregnancy-Extensive Follow-Up for one yearAssess for the development of choriocarcinoma
Chest X-rayPlaced on oral contraceptivesTrend Blood test for levels of B-hCG frequently;normal HCG 64,600-116,310 MLU/mlevery 1 to 2 weeks until three normal prepreganancy levels are attainedTest is repeated 1-2 months for up to a year and following any subsequent pregnanciesPregnancy should be avoided, normally pregnancy raises B-hCG levels which could obscure evidence ofchoriocarcimaHEMORRHAGIC CONDITIONS OF LATE PREGNANCYAfter 20 weeks of pregnancy, the two major causes of hemorrhage are disorders of theplacenta; Placenta previa and abruption placentae.Placenta Previa-Low implantation of the placenta in the uterus near the fetal presenting part.-Usually die to reduced vascularity in the upper uterine segment from an old cesarean scaror fibroid tumor.3 cathegories;Low or Marginal; placenta is implanted in the lower uterus, but its lower border is more than 3 cm fromthe cervical osPartial; lower border of the placenta is more than 3 cm of the internal cervical os but doesnotcompletely cover the osTotal; Placenta completely covers internal cervical osManifestations;Painless uterine bleedingBright red bleedingFist episode of bleeding is slight then becomes profuseSign of blood loss comparable to extent of bleedingUterus soft, non-tenderFetal parts palpable; FHT’s countableBlood clotting defect absentInterventions and Nursing CareCare is based on condition of mother and fetus.

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Term
Spring
Professor
N/A
Tags
Obstetrics, Ectopic pregnancy, vaginal bleeding, Nursing Care

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