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Activate L&D code teamRapid sequence intubationStabilize with O2, IV fluids, and blood productsContinuous FHR monitoringPrep emergency deliveryMultiple GestationoRisks during pregnancy and delivery processComplications of Multiple Gestation
QUIZ 6 STUDY GUIDEMaternal:oAnemiaoHydramniosoPreeclampsiaoPreterm laboroPostpartum hemorrhageoCesarean deliveryFetaloMalpresentationoPlacenta previaoAbruptio placentaeoPremature rupture of the membranesoPrematurity umbilical cord prolapseoIntrauterine growth restrictionoCongenital anomalies oIncreased risks for shared placentas and/or chorionic sacsPlacental Abruption (Abruptio Placentae)oTry a concept map!!! (Risk factors, findings/assessments/monitoring and nursing care/management & interventions/ medications (hehe, just kidding, there are none ). oPremature separation of normal placenta from uterine walloPlacental abruption is initiated by hemorrhage into the decidual basalis—bleeding into here results in hemorrhage and placental separationoA hematoma forms that leads to destruction of the placenta adjacent to it. oThe separation may be partial or total and can be classified as:Grade 1: mildGrade 2: moderateGrade 3: severeoBleeding with placental abruption is almost always maternaloRisk factorsHistory of previous abruptionHTN, preeclampsia EclampsiaAbdominal traumaDrug use, cigarette smokingPPROMThrombophiliaUterine anomalies, fibroidsShort umbilical cordIncreased parity, AMAoSigns and SymptomsSevere abdominal pain (sharp, stabbing, high in fundus)Uterine contractions Uterine tendernessHypertonus (hard, board-like uterus) Tense, PainfulVaginal bleeding (unless concealed)
QUIZ 6 STUDY GUIDEDark vaginal non-clotting bleeding may or may not be presentIf separation is in the center of the placenta, then blood may be trapped between the placenta and decidua, concealing the hemorrhage. A concealed hemorrhage occurs in about 10% abruptions. This results in uterine tenderness and abdominal pain.If separation occurs at the edge of the placenta, then the blood usually escapes externallyPort-wine colored amniotic fluidNausea and vomitingSigns of hypovolemic shock when 25-30% of maternal blood loss has occurredFetal distress on the monitor oManagementEmergency. Immediate c-section if birth not imminent18 gauge IV accessO2 via mask, fetal monitoring, maternal VS, lateral positioning, labs, blood transfusion (have 2 Packed RBCs available)Labs: CBCFibrinogen levelsPlatelet countPT/PTTFibrin degradation products (sx of DIC)oDifference between concealed and visible bleedingPlacenta PreviaooDefinition- Occurs when the placenta attaches to the lower uterine segment near or over the internal cervical os instead of the body/fundus of the uterusoRisk factorsEndometrial scarringPrevious placenta previaPrior c-sectionAbortion involving suction curettageMultiparity or short pregnancy interval