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■ Anticoagulation therapy is required for women experiencinga DVT during pregnancy with heparin.■ Treatment of PE is to stabilize a woman with a lifethreatening PE and transfer to ICU. Thromboembolitictherapy and catheter or surgical embolectomy may be done.Nursing Actions■ Manage pain, administering pain medication as needed.■ Teach woman how to administer heparin SQ to her abdomen.■ Instruct woman to report side effects such as bleeding gums, nosebleeds, easybruising, or excessive trauma atinjection sites.Hypertonic Uterine DysfunctionDefined as uncoordinated uterine activityoSigns/symptoms/findings on fetal heart rate tracingDecreased placental perfusionFrequent, painful contractions with inadequate uterine relaxation between contractions with little cervical changePossible Category 2 FHR tracingPainful, frequent UCs with inadequate uterine relaxation between UCs with little cervical changes (Fig. 10-1B).May be Category II (indeterminate) or Category III (abnormal) fetal heart rate (FHR) related to prolonged labor and inadequate uterine relaxationoProblems/complications with deliveryoNursing interventions:Promoting rest to break patternLetting the woman sleep for several hours, may wake up to normal labor patternAdministration of pain medicationWarm shower or bathtubQuiet environmentPO or IV hydrationContinuous fetal monitoringHypotonic Uterine DysfunctionThe strength of contractions is inefficient (<25 mm Hg) in promoting cervical dilation & effacementoSigns/symptoms/findings on fetal heart rate tracingDecreased frequency, strength, and duration of UCsLittle or no cervical changeLess than 0.5 cm/hr progress in cervical dilation for a primiparous woman in active laborLess than 1.0 cm/hr progress in cervical dilation for a multiparous woman in active laborIncreased fear and anxiety levelsoProblems/complications with deliveryRisk for maternal exhaustion and infectionRisk for fetal intolerance to labor and distressoInterventionsAmbulate or change position for comfort and to help labor progressIV hydration (D5LR)Augment labor with oxytocin (Pitocin)Prepare for provider to perform amniotomy
Prepare for c-section for fetal distress or when interventions are ineffectiveMaternal ObesityoBMI 30 or greateroRisks for pregnancyPre-eclampsiaGestational diabetesThrombosisMiscarriagePost-partum infectionUTIC-section deliveryPregnancy complicationsoInduction of LaboroIndicationsoContraindicationsPlacentia previa or Vasa previaCord compressionAbnormal fetal lie / presentationChephalopelvic disproportion b/c of malpresentation or abnormal pelvic bone structureActive genital herpes infectionInvasive cervical carcinomaHypersesitivity to cvervical ripening agentsPrevious uterine ruptureoBishop’s score>8 = good chances for vaginal delivery.