OBSTETRICS AND GYNECOLOGY
OBSTETRICS AND GYNECOLOGY
NURSING
Exercise 1.0
a. What is hydatidiform mole
b. Outline the signs and symptoms of hydatidiform mole
c. State the management of molar pregnancy or hydatidiform mole
d. Outline things involves in follow up management of patient with molar pregnancy
e. State some complications of hydatidiform mole
Answer:
a. Definition of hydatidiform mole
• This is the abnormal development of primitive chorion which begins around the sixth week of pregnancy.
• The chorion grows profusely and becomes a cystic so that the uterus is filled with a mass of cystic vesicle which looks like a bunch of grapes.
• The embryo is absorbed , so no fetus is present(except in those rare cases when the hydatidiform mole develops from a fertilized ovum and normal fetus from the other fertilized ovum in a twin pregnancy)
b. Signs and symptoms of hydatidiform mole
• The usual signs and symptoms which suggest pregnancy are present but often more marked than normal.
• There may be history of intermittent bleeding during the pregnancy
• The uterus feels very soft and it is bigger than expected for the period of amenorrhea
• The patient often suffer from hyperemesis gravidarum
• Signs of pre-eclampsia are often preset. Hence pre-eclampsia early in pregnancy should be suspected of hydatidiform mole
• When hydatidiform is present, fetal movement and heart sounds are not felt.
• Pregnancy tests are strongly positive because of abnormally high level of human chorionic gonadotropin hormone.
c. Management of hydatidiform mole
• Patient must be admitted to the hospital for medical aid immediately
• The uterus must be empty without delay because of the high risk of severe haemorrhage
• Attempt full medical induction for younger women with molar pregnancy
• Carry out curettage after expulsion of mole and run oxytocin drip to ensure full, complete removal of uterine content.
• In order women, hysterectomy is preferred because of issues of malignancy
• Ensure that blood is available for transfusion to manage haemorrhage and shock.
d. Follow up management on hydatidiform mole
• Advice patient not to have another pregnancy for at least two years
• Provide family planning assistance
• Carry out estimation of urinary human chorionic gonatropin test after one month, then monthly for six month, then three monthly for eighteen months.
• If test conducted becomes positive again after it has been negative, it suggests either pregnancy or chorio- carcinoma
e. Complication of hydatidiform mole
• Haemorrhage
• Shock
• Perforation of the uterus
• Sepsis
• Chorion cancer.
Exercise 1.1
a. What is pregnancy induced hypertension also known as pre-eclampsia
b. Briefly describe the following types of pre-eclampsia
• Mild pre-eclampsia
• Moderate pre-eclampsia
• Severe or fulminating pre-eclampsia
c. Write four (4) causes of pre-eclampsia
d. Write four (4) possible diagnostic test which the obstetrician may request in eclampsia patient.
e. Outline clinical signs and symptoms that a woman with pre-eclampsia will demonstrate
f. Describe a detail management provided for a client with pre-eclampsia
g. Outline four (4) outcomes of pregnancy complicated by pre-eclampsia
Answer:
a. Definition of pregnancy induced hypertension
• This is a condition peculiar to pregnancy occurring after 24th week of pregnancy and more commonly around 30-32 weeks on wards.
• It is characterized by three (3) cardinal signs:
o Hypertension (rising blood pressure)
A rising blood pressure of 15-20mmhg above the mother’s normal diastolic pressure, or an increase of 90mmhg on two occasions.
A rise in the systolic blood pressure of 30mmhg or more during pregnancy
o Oedema (excessive weight gain)
This occurs as a result of reduced osmotic pressure leading to fluid retention in the tissues
o Proteinuria
Protein in urine in the absence of urinary tract infection is a positive indication of pregnancy induced hypertension.
The amount of protein detected in urine varies from one plus to four pluses.
b. Types of pre-eclampsia
Mild Moderate Severe
Symptoms None Mild headache Frontal headache
Oedema Oedema ++
Visual disturbance
Signs
BP <140/100 <160/110 >160/110
Proteinuria None None ++ or +++
Reflexes Normal Normal Hyper-reflexia/clonus
Fundi Normal Normal Occasional papilloedema
Renal Normal Normal Decreasing urinary output
Bloods
FBC Normal Normal Rising or falling Hb
Decreasing platelets
Urate Normal Slightly raised Increasing
LFTs Normal Normal Increasing
Clotting Normal Normal Prolonged
Fetus Normal Normal/SGA Asymmetric SGA
Treatment None Anti-hypertensives Anti-hypertensive
Anti-epileptics/MgSO4
? Delivery Delivery
Where: FBC, full blood count; LFTs, liver function tests; SGA, small for gestational age.
c. Causes of pre-eclampsia
• The actual cause of pregnancy induced hypertension is unknown, however, there are certain conditions that may predispose the pregnant woman to pre-eclampsia.
• These conditions are:
o Client with diabetes
o Chronic nephritis
o Hydatidiform mole
o Client with essential hypertension
o Obesity
o Older primigravida (older pregnant women)
o Previous history of pre-eclampsia
o Women over 35 year of age
o Polyhydramnios
o Over distension of the uterus in multiple pregnancy
d. Diagnostic tests
• Blood pressure test
• Urinalysis for protein, acetone and sugar (daily)
• Weighing
• Examination for oedema
• Plasma urea and electrolyte estimation (weekly).
• Plasma urate levels (weekly).
• Total urinary protein excretion (once).
• Liver function tests (twice weekly).
• Full blood count and clotting screen.
e. Clinical signs and symptoms
• Hyper-reflexia and clonus.
o This is due to the cerebral oedema and gives the clinical picture of an upper motor neurone lesion.
• Dizziness
• Severe frontal headache
o Due to cerebral oedema. The headache is dragging or throbbing in nature and is worse when the woman is supine. It occurs classically first thing in the morning and resolves to some extent during the day if the patient is mobile.
• Vomiting
• A rapid rise in blood pressure.
• Rapid increase in proteinuria.
• Decreasing urine output
• Epigastria pain
o This is due to stretching of the liver capsule.
• Flashes of light before the eyes
• Visual disturbance
o Due to oedema of the optic nerve or the retina consisting of black holes in the visual field or double vision.
f. Detail management of pregnancy induced hypertension.
• The management of pre-eclampsia encompasses: preventive management, active management and drug therapy.
o Preventive management
This involves:
Perform screening during antenatal to detect client with rising blood pressure
Conduct urine test for protein, acetone and sugar to rule out any abnormality
Client should be weighed and examined for oedema during each antenatal visit
Client should be educated on the cardinal signs and symptoms of pre-eclampsia
During ante-natal education, emphasize on the importance and the need for adequate rest and sleep
Advice client on the intake of high protein diets and fruits rich in vitamin
o Active management
Admit client to the hospital and ensure complete bed rest as rest helps in the reduction of blood pressure and oedema, and improves placenta circulation which promotes fetal growth
Nurse client in a sitting up position or left lateral position to promote fetal circulation
Normal well nutritious diet should be served: high in protein, fibres and vitamins
Liberal fluids must be given orally and maintain intake and output chart.
Monitor vital signs four (4) hourly in mild case and two (2) hourly in severe cases.
Check mothers weight daily in mild cases and alternate days in severe cases
Contact urine test for protein and acetone daily, and record urine output per day to check renal function
Conduct abdominal examination twice daily, morning and evening and report and discomfort or tenderness immediately to the doctor
Check fetal heart rate twice daily for viability
Check and monitor fetal kick chart to monitor the degree of fetal movement and discomfort.
Conduct ultra sound once a week to assess fetal growth.
o Drug therapy
Antihypertensive drugs such as methyldopa, Nifidipine and Hydralazine are used to manage the blood pressure.
g. Complication of pre-eclampsia
The complication of pre-eclampsia are classified into:
• Maternal complications
o Eclampsia
o Abruptio placenta
o Permanent hypertension
o Kidney, brain and liver damage
o Cerebrovascular accident
o Maternal death
• Fetal complications
o Low birth weight
o Placental insufficiency
o Prematurity
o Intra uterine hypoxia
o Intra uterine death
NURSING
Exercise 1.0
a. What is hydatidiform mole
b. Outline the signs and symptoms of hydatidiform mole
c. State the management of molar pregnancy or hydatidiform mole
d. Outline things involves in follow up management of patient with molar pregnancy
e. State some complications of hydatidiform mole
Answer:
a. Definition of hydatidiform mole
• This is the abnormal development of primitive chorion which begins around the sixth week of pregnancy.
• The chorion grows profusely and becomes a cystic so that the uterus is filled with a mass of cystic vesicle which looks like a bunch of grapes.
• The embryo is absorbed , so no fetus is present(except in those rare cases when the hydatidiform mole develops from a fertilized ovum and normal fetus from the other fertilized ovum in a twin pregnancy)
b. Signs and symptoms of hydatidiform mole
• The usual signs and symptoms which suggest pregnancy are present but often more marked than normal.
• There may be history of intermittent bleeding during the pregnancy
• The uterus feels very soft and it is bigger than expected for the period of amenorrhea
• The patient often suffer from hyperemesis gravidarum
• Signs of pre-eclampsia are often preset. Hence pre-eclampsia early in pregnancy should be suspected of hydatidiform mole
• When hydatidiform is present, fetal movement and heart sounds are not felt.
• Pregnancy tests are strongly positive because of abnormally high level of human chorionic gonadotropin hormone.
c. Management of hydatidiform mole
• Patient must be admitted to the hospital for medical aid immediately
• The uterus must be empty without delay because of the high risk of severe haemorrhage
• Attempt full medical induction for younger women with molar pregnancy
• Carry out curettage after expulsion of mole and run oxytocin drip to ensure full, complete removal of uterine content.
• In order women, hysterectomy is preferred because of issues of malignancy
• Ensure that blood is available for transfusion to manage haemorrhage and shock.
d. Follow up management on hydatidiform mole
• Advice patient not to have another pregnancy for at least two years
• Provide family planning assistance
• Carry out estimation of urinary human chorionic gonatropin test after one month, then monthly for six month, then three monthly for eighteen months.
• If test conducted becomes positive again after it has been negative, it suggests either pregnancy or chorio- carcinoma
e. Complication of hydatidiform mole
• Haemorrhage
• Shock
• Perforation of the uterus
• Sepsis
• Chorion cancer.
Exercise 1.1
a. What is pregnancy induced hypertension also known as pre-eclampsia
b. Briefly describe the following types of pre-eclampsia
• Mild pre-eclampsia
• Moderate pre-eclampsia
• Severe or fulminating pre-eclampsia
c. Write four (4) causes of pre-eclampsia
d. Write four (4) possible diagnostic test which the obstetrician may request in eclampsia patient.
e. Outline clinical signs and symptoms that a woman with pre-eclampsia will demonstrate
f. Describe a detail management provided for a client with pre-eclampsia
g. Outline four (4) outcomes of pregnancy complicated by pre-eclampsia
Answer:
a. Definition of pregnancy induced hypertension
• This is a condition peculiar to pregnancy occurring after 24th week of pregnancy and more commonly around 30-32 weeks on wards.
• It is characterized by three (3) cardinal signs:
o Hypertension (rising blood pressure)
A rising blood pressure of 15-20mmhg above the mother’s normal diastolic pressure, or an increase of 90mmhg on two occasions.
A rise in the systolic blood pressure of 30mmhg or more during pregnancy
o Oedema (excessive weight gain)
This occurs as a result of reduced osmotic pressure leading to fluid retention in the tissues
o Proteinuria
Protein in urine in the absence of urinary tract infection is a positive indication of pregnancy induced hypertension.
The amount of protein detected in urine varies from one plus to four pluses.
b. Types of pre-eclampsia
Mild Moderate Severe
Symptoms None Mild headache Frontal headache
Oedema Oedema ++
Visual disturbance
Signs
BP <140/100 <160/110 >160/110
Proteinuria None None ++ or +++
Reflexes Normal Normal Hyper-reflexia/clonus
Fundi Normal Normal Occasional papilloedema
Renal Normal Normal Decreasing urinary output
Bloods
FBC Normal Normal Rising or falling Hb
Decreasing platelets
Urate Normal Slightly raised Increasing
LFTs Normal Normal Increasing
Clotting Normal Normal Prolonged
Fetus Normal Normal/SGA Asymmetric SGA
Treatment None Anti-hypertensives Anti-hypertensive
Anti-epileptics/MgSO4
? Delivery Delivery
Where: FBC, full blood count; LFTs, liver function tests; SGA, small for gestational age.
c. Causes of pre-eclampsia
• The actual cause of pregnancy induced hypertension is unknown, however, there are certain conditions that may predispose the pregnant woman to pre-eclampsia.
• These conditions are:
o Client with diabetes
o Chronic nephritis
o Hydatidiform mole
o Client with essential hypertension
o Obesity
o Older primigravida (older pregnant women)
o Previous history of pre-eclampsia
o Women over 35 year of age
o Polyhydramnios
o Over distension of the uterus in multiple pregnancy
d. Diagnostic tests
• Blood pressure test
• Urinalysis for protein, acetone and sugar (daily)
• Weighing
• Examination for oedema
• Plasma urea and electrolyte estimation (weekly).
• Plasma urate levels (weekly).
• Total urinary protein excretion (once).
• Liver function tests (twice weekly).
• Full blood count and clotting screen.
e. Clinical signs and symptoms
• Hyper-reflexia and clonus.
o This is due to the cerebral oedema and gives the clinical picture of an upper motor neurone lesion.
• Dizziness
• Severe frontal headache
o Due to cerebral oedema. The headache is dragging or throbbing in nature and is worse when the woman is supine. It occurs classically first thing in the morning and resolves to some extent during the day if the patient is mobile.
• Vomiting
• A rapid rise in blood pressure.
• Rapid increase in proteinuria.
• Decreasing urine output
• Epigastria pain
o This is due to stretching of the liver capsule.
• Flashes of light before the eyes
• Visual disturbance
o Due to oedema of the optic nerve or the retina consisting of black holes in the visual field or double vision.
f. Detail management of pregnancy induced hypertension.
• The management of pre-eclampsia encompasses: preventive management, active management and drug therapy.
o Preventive management
This involves:
Perform screening during antenatal to detect client with rising blood pressure
Conduct urine test for protein, acetone and sugar to rule out any abnormality
Client should be weighed and examined for oedema during each antenatal visit
Client should be educated on the cardinal signs and symptoms of pre-eclampsia
During ante-natal education, emphasize on the importance and the need for adequate rest and sleep
Advice client on the intake of high protein diets and fruits rich in vitamin
o Active management
Admit client to the hospital and ensure complete bed rest as rest helps in the reduction of blood pressure and oedema, and improves placenta circulation which promotes fetal growth
Nurse client in a sitting up position or left lateral position to promote fetal circulation
Normal well nutritious diet should be served: high in protein, fibres and vitamins
Liberal fluids must be given orally and maintain intake and output chart.
Monitor vital signs four (4) hourly in mild case and two (2) hourly in severe cases.
Check mothers weight daily in mild cases and alternate days in severe cases
Contact urine test for protein and acetone daily, and record urine output per day to check renal function
Conduct abdominal examination twice daily, morning and evening and report and discomfort or tenderness immediately to the doctor
Check fetal heart rate twice daily for viability
Check and monitor fetal kick chart to monitor the degree of fetal movement and discomfort.
Conduct ultra sound once a week to assess fetal growth.
o Drug therapy
Antihypertensive drugs such as methyldopa, Nifidipine and Hydralazine are used to manage the blood pressure.
g. Complication of pre-eclampsia
The complication of pre-eclampsia are classified into:
• Maternal complications
o Eclampsia
o Abruptio placenta
o Permanent hypertension
o Kidney, brain and liver damage
o Cerebrovascular accident
o Maternal death
• Fetal complications
o Low birth weight
o Placental insufficiency
o Prematurity
o Intra uterine hypoxia
o Intra uterine death
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