question

Danger Signals of Pregnancy

answer

Any bleeding from the vagina Gush of fluid from vagina (clear, not urine) Regular contractions occurring before completion of 37 weeks Severe headache or changes in vision Epigastric pain Vomiting that persists & is severe Change in fetal activity patterns Temperature elevation, chills, or "sick" feeling indicative of infection Swelling in upper body, especially face & fingers

question

First Trimester Complications of Pregnancy

answer

Abortion (Miscarriage) Incompetent cervical OS Ectopic pregnancy Gestational trophoblastic disease (hydatidiform mole)

question

Abortion (Miscarriage)

answer

Loss of pregnancy before viability of fetus, may be spontaneous (miscarriage), therapeutic or elective

question

Abortion (Miscarriage) Assessment Findings

answer

Vaginal bleeding Contractions, pelvic cramping, backache Lowered hemoglobin if blood loss is significant Passage of fetus/tissue

question

Nursing Intervention for Abortion (Miscarriage)

answer

Save all tissue passed Keep patient at rest & teach reason for bed rest Increase fluids PO or IV Prepare patient of surgical intervention if needed Provide discharge teaching about limited activities & coitus after bleeding ceases Observe reaction of mother & others, providing emotional support & give opportunity to express feelings of grief & loss

question

Therapeutic Management of Abortion (Miscarriage)

answer

Depends on situation: Inevitable abortion Incomplete abortion

question

Inevitable Abortion (Miscarriage)

answer

Vacuum curettage or dilation & curettage (D&C)

question

Incomplete Abortion (Miscarriage)

answer

D&C with Pitocin or methergine

question

Incompetent Cervical OS

answer

*Painless* condition in which cervix dilates without uterine contractions & allows passage of fetus, usually the result of prior cervical trauma/biopsy

question

Medical Management of Incompetent Cervical OS

answer

May be treated with cerclage

question

Cerclage

answer

Suturing of the cervix closed until patient is ready to give birth to term baby When the patient goes into labor, the suture is removed for vaginal delivery

question

Incompetent Cervical OS Assessment Findings

answer

History or repeated, relatively *painless* abortions Early & progressive effacement & dilation of cervix Bulging of membranes through cervical OS

question

Nursing Interventions for Incompetent Cervical OS

answer

Continue observation for contractions, rupture of membranes & monitor fetal heart tones Position patient to minimize pressure on cervix

question

Ectopic Pregnancy

answer

Any gestation outside the uterine cavity Most frequently in the fallopian tubes, where the tissue is incapable of the growth needed to accommodate pregnancy, so rupture of the site usually occurs before 12 weeks Any condition that diminishes the tubal lumen may predispose a woman to ectopic pregnancy

question

Classic Signs of Ectopic Pregnancy

answer

Missed menstrual period Positive pregnancy test Abdominal *pain* Vaginal spotting

question

Other Assessment Findings of Ectopic Pregnancy

answer

History of missed periods & symptoms of early pregnancy Abdominal *pain*, may be localized to one side Rigid, tender abdomen, sometimes abnormal pelvic mass Bleeding, if severe may lead to shock Low hemoglobin & hematocrit, rising WBC HCG titers usually lower than in intrauterine pregnancy

question

Nursing Interventions & Medical Management of Ectopic Pregnancy

answer

Giving Methotrexate to dissolve the tubal pregnancy if possible, least invasive Surgical intervention may be required

question

Methotrexate

answer

Folic acid antagonist that interferes with the proliferation of trophoblastic cells

question

Nursing Interventions & Surgical Management of Ectopic Pregnancy

answer

Prepare patient for surgery Institute measures to control/treat shock if hemorrhage is severe, continue to monitor postoperatively Allow patient to express feelings about loss of pregnancy & concerns about future pregnancies

question

Gestational Trophoblastic Disease (Hydatidiform Mole or Molar Pregnancy)

answer

Proliferation of trophoblasts, embryo dies Unusual chromosomal patterns seen (either no genetic material in ovum or 69 chromosomes) The chronic villi change into a mass of clear, fluid-filled grapelike vessels Complete or partial Cause is essentially unknown Seems like a pregnancy but no fetus occurs Can set the patient up for cancer later in life

question

Gestational Trophoblastic Disease (Hydatidiform Mole or Molar Pregnancy) Assessment Findings

answer

Absence of fetal heart sounds in the presence of other signs of pregnancy is a classic sign A uterus that is larger than expected for gestational age High levels of HCG with excessive nausea & vomiting (also seen in twins) Dark red to brownish vaginal bleeding (common signs) after 12th weeks (resembles prune juice) Anemia often accompanies bleeding Symptoms of preeclampsia before usual time of onset No palpation of normal fetal parts Ultrasound shows no fetal skeleton

question

Gestational Trophoblastic Disease (Hydatidiform Mole or Molar Pregnancy) Nursing Interventions

answer

Provide pre-and postoperative care for evacuation of uterus *Teach contraceptive use so that pregnancy is delayed for at least one year due to increase risk of cancer* Teach patient need for follow up lab work to detect rising HCG levels indicative of choriocarcinoma Teach about risk of future pregnancies, if indicated

question

Second Trimester Pregnancy Complications

answer

There are few unique causes of bleeding in the second trimester

question

Third Trimester Pregnancy Complications

answer

Placenta previa Abruptio placenta Preterm labor Premature rupture of membranes Rupture of membranes Oligohydramnios Hydramnios (polyhydramnios)

question

Preterm Labor

answer

Labor that occurs before the end of the 37th week of pregnancy Cause is frequently unknown

question

Preterm Labor Prevention (Causes)

answer

Minimize or stop smoking (a major factor of preterm labor & birth) Minimize or stop substance abuse/chemical dependency Early & consistent prenatal care Appropriate weight gain Minimize psychological stressors Learn to recognize signs & symptoms of preterm labor

question

Medical Management of Preterm Labor

answer

Unless labor is irreversible, or a condition exists which the mother or fetus would be jeopardized by the continuing of the pregnancy, or the membranes have ruptured, the usual medical intervention is to attempt to arrest the premature labor

question

Tocolysis

answer

Use of medication in an attempt to stop labor May delay birth for 24-48 hours Important to administer betamethasone or transfer mother to a tertiary care facility

question

Medication Treatments for the Medical Management of Preterm Labor

answer

Magnesium sulfate Nifedipine Indomethacin Beta-Adrenergic Drugs Betamethasone

question

Magnesium Sulfate

answer

Stops uterine contractions with fewer side effects than beta-adrenergic drugs & interferes with muscle contractility Magnesium sulfate acts upon the myoneural junction, diminishing neuromuscular transmission It promotes maternal vasodilation, better tissue perfusion & have anticonvulsant effect

question

Magnesium Sulfate Risks

answer

Magnesium toxicity PPH

question

Magnesium Sulfate Administration

answer

Must be 1:1 with the nurse Give magnesium sulfate on an IV pump as secondary with fluids running as primary

question

Magnesium Sulfate Nursing Responsibilities

answer

Monitor patients respirations, blood pressure & reflexes as well as I&O, flushing & other signs and symptoms of magnesium sulfate toxicity

question

Magnesium Sulfate Side Effects

answer

Few serious side effects Initally patient feels hot, flushing, may cause headache, nausea, diarrhea, dizziness & lethargy *hypotonia & flushing* are the most common side effects

question

Magnesium Toxicity

answer

Monitor respiratory rate *(<12 breaths/minute)* & hourly urine output *(<30 mL/hr)*

question

Magnesium Sulfate Antidote

answer

Calcium gluconate

question

nifedipine

answer

(Adalat/Procardia)

question

nifedipine Drug Class

answer

Calcium Channel Blocker

question

nifedipine Action

answer

Relax smooth muscles including the uterus by blocking calcium entry

question

nifedipine Side Effects

answer

Hypotension Flushing

question

indomethacin

answer

(Indocin)

question

indomethacin Drug Class

answer

Prostaglandin synthetase inhibitor

question

indomethacin Action

answer

Relaxes smooth muscle by inhibiting prostaglandins

question

indomethacin Side Effects

answer

Nausea Vomiting Dyspepsia

question

Beta-Adrenergic Drugs

answer

ritodrine (Yutopar) terbutaline (Brethine)

question

ritodrine (Yutopar)

answer

Only beta-adrenergic approved by the FDA for tocolysis but it is infrequently used because of side effects & minimal increase in length of pregnancy

question

terbutaline (Brethine)

answer

Not approved by the FDA for tocolysis but is more widely used

question

Betamethasone

answer

Given when premature labor cannot or should not be arrested & fetal lung maturity needs to be improved Stimulates fetal lung maturation Used to cause fetal surfactant induction which helps to open the babies airways upon delivery

question

Betamethasone Administration

answer

IM to the mother usually every 12 hours times 2 then weekly until 34 weeks gestation

question

Nursing Interventions for Preterm Labor

answer

Keep patient at rest, side-lying position Hydrate the patient & maintain weight IV or PO fluids Maintain continuous maternal/fetal monitoring (maternal/fetal vital signs every 10 minutes) be alert for abrupt changes Monitor maternal I&O Monitor urine for glucose (diabetes) & ketones (dehydration) Watch cardiac & respiratory status carefully Evaluate lab test results carefully

question

Oligohydramnios

answer

Decrease amount of amniotic fluid between 32 to 36 weeks May be associated with placental insufficiency or fetal urinary tract abnormalities

question

Oligohydramnios Risks

answer

Perinatal morbidity & mortality

question

Oligohydramnios Interventions

answer

Amniofusion

question

Oligohydramnios Assessments

answer

Fetal well being

question

Potter's Syndrome

answer

Lack of urine into amniotic cavity Bilateral renal agenesis (BRA) or complete absence of the kidneys Fetus does not survive long after birth

question

Hydramnios (Polyhydramnios)

answer

Too much amniotic fluid between 32 to 36 weeks Associated with fetal anomalies Increased incidence of preterm births, fetal malpresentation & cord prolapse Could indicate large baby

question

Some Possibilities for Hydramnios

answer

Prenatal Bartter's Syndrome Poorly-controlled maternal diabetes Twin or multiple gestations Fetal abnormalities which make it difficult for the baby to swallow & process the fluid normally Rh blood incompatibility which can bring on fetal anemia & other factors

question

Neonatal Bartter Syndrome

answer

The condition is caused by a defect in the kidney's ability to reabsorb sodium In most cases, Neonatal Bartter syndrome is seen between 24 & 30 weeks of gestation with excess amniotic fluid

question

Characteristics of Neonatal Bartter Syndrome

answer

Hypokalemia Metabolic alkalosis Increased urinary excretion of sodium, potassium & chloride Normal blood pressure (?)

question

Rupture of Membranes

answer

Loss of amniotic fluid, prior to term, unconnected with labor

question

Dangers of Rupture of Membranes

answer

Prolapsed cord Infection Potential need for premature delivery

question

PPROM

answer

Premature prolonged rupture of membranes Less than 37 weeks, longer than 18 hours

question

Nursing Assessment for Rupture of Membranes

answer

Report from mother/family of discharge fluid Sterile speculum Nitrozene paper Ferning Pooling Monitor maternal/fetal vital signs on continuous basis, especially for maternal temperature (hourly) Calculate gestational age Observe for signs of infection & signs of onset of labor (may induce if there are signs of an infection) Observe & record color, odor, amount of fluid Delay vaginal exam unless fetal distress (prolapsed cord) Provide explanations of procedures & findings Support mother & family Prepare mother/family for early birth if indicated

question

Nitrozene Paper

answer

Change of color to dark blue if positive

question

Ferning

answer

Wiping fluid on slide to see if "ferns" appear when dried

question

Possible Cause/Result of Rupture of Membranes

answer

Chorioamnionitis

question

Placenta Previa

answer

Low implantation of the placenta so that it overlays some or all of the internal cervical OS Amount of cervical OS involved classifies placental previa as marginal, partial or complete

question

Placenta Previa Etiology

answer

Cause is uncertain but uterine factors may be involved (scaring)

question

Placenta Previa Assessment Findings

answer

*Bright red* vaginal bleeding after 7th month is cardinal indicator Bleeding may be intermitten, in gushes or continuous Uterus remains soft Fetal heart rate usually stable unless maternal shock present No vaginal exam by nurse Diagnosed by sonography

question

Placenta Previa Nursing Intervention

answer

Ensure complete bed rest Maintain sterile conditions for any invasive procedures Make provisions for emergency C-section Continue to monitor maternal/fetal vital signs Measure blood loss carefully Assess uterine tone regularly

question

Abruptio Placenta

answer

Separation of placenta from part or all of the normal implantation site, usually accompanied by *pain* Usually occurs after 20th week of pregnancy Seen frequently in women with hypertension, previous abruptio placentae, late pregnancies & multigravidas but cause essentially unknown

question

Abruptio Placenta Assessment Findings

answer

*Painful* vaginal bleeding *Tender board like uterus* Fetal bradycardia & late decelerations, absent fetal heart tones in complete abruption Additional signs of shock

question

Abruptio Placenta Nursing Interventions

answer

Ensure bed rest Check maternal/fetal vital signs frequently Prepare for IV infusions of fluids/blood as indicated Monitor urinary output Anticipate coagulation problems Provide support to parents as outlook for fetus can be poor Prepare for emergency surgery as indicated

question

Other Complications with Pregnancy

answer

Hyperemesis gravidarum Preeclampsia Diabetes Placental Abnormalities Rh sensitization

question

Hyperemesis Gravidarum

answer

Excess nausea & vomiting of early pregnancy leads to dehydration & electrolyte disturbances

question

Hyperemesis Gravidarum Causes

answer

Possible severe reaction to HCG Not psychological Greater risk in conditions where HCG levels are increased HCG levels peak around 6 weeks after conception, plateau then begin to decline after 12th week Symptoms often improve later in pregnancy but may last entire time

question

Hyperemesis Gravidarum Assessment Findings

answer

Nausea & vomiting, progressing to retching between meals Weight loss

question

Hyperemesis Gravidarum Nursing Interventions

answer

Begin NPO & IV fluid & electrolyte replacement IV anti-nausea medication Monitor I&O Gradually re-introduce PO intake, monitor amounts taken & retained Monitor TPN & central line placement if unable to eat Provide mouth care Offer emotional support Refer to home health as appropriate for continued IV or TPN therapy

question

Preeclampsia

answer

Refers to a condition unique to pregnancy where hypertension is accompanied by proteinuria & edema Maternal or fetal condition may be compromised

question

Preeclampsia Onset

answer

After 12th week of pregnancy, may appear in labor up to 48 hours post partum

question

Preeclampsia Characterization

answer

Wide spread vasospasm

question

Preeclampsia Probable Cause

answer

Essentially unknown High in primigravidas, multiple pregnancies, hydatidiform mole, poor nutrition, essential hypertension, familial tendency Gradual loss of normal pregnancy related resistance to angiotensin 2 May also be related to decrease production of some vasodilating prostaglandins

question

Usual Clinical Classification of Hypertensive Disorders in Pregnancy

answer

Preeclampsia Preeclampsia-Eclampsia Chronic hypertension Preeclampsia superimposed on chronic hypertension Gestational hypertension (does not become preeclampsia)

question

Mild Preeclampsia Assessments

answer

Appearance of symptoms after 20th week of pregnancy Blood pressure >140 but 90 but 0.3g but <2g in 24 hour specimen (1+ or higher on dipstick) (?) All other assessments normal

question

Nursing Interventions for Mild Preeclampsia

answer

Promote bed rest as long as signs of edema or proteinuria are minimal, preferably side-lying Provide well balanced diet with adequate protein & roughage, no sodium restrictions Explain need for close follow up weekly or twice weekly visits to physician

question

Severe Preeclampsia Assessments

answer

Blood pressure of >160/110 or higher on 2 occasions at least 6 hours apart while on bedrest Proteinuria >5g/24 hours (3+ on dipstick) Pulmonary edema/heart failure Cyanosis may be present Headaches, nausea & vomiting, visual disturbances & irritability Epigastric or right quadrant pain Growth restriction, reduced amniotic fluid & fluid volume

question

Severe Preeclampsia Nursing Interventions

answer

Minimize all stimuli/restrict visitors Check vital signs & lab values frequently Have airway, suction & oxygen equipment available Assess deep tendon reflexes & clonus Administer medication as ordered Continue observation for 24 to 48 hours postpartum Most likely start of magnesium sulfate up to 24 hours after delivery Promote best res, side-lying Carefully monitor fetal vital signs Monitor I&O Take daily weights Initiate seizure precautions Monitor for magnesium sulfate toxicity Administer sedatives as ordered

question

Deep Tendon Reflexes

answer

Grade reflexes 4+ 3+ 2+ 1+ 0

question

4+

answer

Hyperactivity, very brisk, jerky or clonic response, abnormal

question

3+

answer

Brisker than average, may not be abnormal

question

2+

answer

Average response, minimal

question

1+

answer

Diminished response; low normal

question

Clonus

answer

With a normal response, the foot returns to its normal position of plantar flexion Clonus is present if the foot "jerks" or "taps" against the examiner's hand Record the number of taps or beats of clonus, if none than indicate: no clonus

question

HELLP Syndrome

answer

Laboratory diagnosis for a variation of severe preeclampsia, not a separate illness Possible life threatening complication *H*emolysis *E*levated *l*iver *e*nzymes *L*owered *p*latelets

question

HELLP Syndrome Cure

answer

Delivery is the only known cure

question

HELLP Syndrome Presentation

answer

Non specific

question

Eclampsia Assessment Findings

answer

Increased hypertension precedes convulsion followed by hypotension & collapse Coma may ensue Labor may begin, putting fetus in great jeopardy Convulsions may recur

question

SEIZURE

answer

Safety (bed railing pads) Establish/maintain airway IV bolus Zealous observation Uterine activity Rapid resuscitation Evaluate fetus

question

Chronic Hypertension

answer

Associated with increased incidence of abruptio placenta & increased perinatal mortality Ideally management begins before pregnancy or when women is hypertensive before 20 weeks No signs preeclampsia (?)

question

Chronic Hypertension Treatment

answer

aldomet (Methyldopa)

question

aldomet (Methyldopa)

answer

Most often recommended for chronic hypertension after lifestyle changes

question

Chronic Hypertension Treatment Goal

answer

Maintain a diastolic below 90 mmHg

question

Chronic Hypertension with Superimposed Preeclampsia

answer

In women with hypertension before 20 weeks & new-onset proteinuria In women with both hypertension & proteinuria before 20 weeks & significant increase in hypertension plus one of the following: new onset of symptoms, thrombocytopenia, elevated liver enzymes Increased morbidity for both the mother & fetus

question

Gestational Hypertension

answer

Transient elevation of blood pressure occurs for the first time after mid pregnancy without proteinuria or other signs of preeclampsia If preeclampsia does not develop & blood pressure returns to normal by 12 weeks post partum If blood pressure elevation persists after 12 weeks post partum, the women is diagnosed with chronic hypertension

question

Diabetes Mellitus

answer

Gestational diabetes mellitus is any degree of glucose intolerance with its onset or first recognition during pregnancy

question

Gestational Diabetes Mellitus Onset & Reversal

answer

Onset during pregnancy & reversal after termination of pregnancy

question

Gestational Diabetes Mellitus Risks

answer

Increased risk of adult onset diabetes later in life

question

Significance of Diabetes in Pregnancy

answer

Interaction of estrogen, progesterone & cortisol raise maternal resistance to insulin If the pancreas cannot respond by producing additional insulin, excess glucose moves across the placenta to fetus where fetal insulin metabolizes it & acts as growth hormone, promoting macrosomia Maternal insulin needs to be carefully monitored during pregnancy to avoid widely fluctuating levels of blood glucose Dose may drop during first trimester then rise during second & third trimesters Higher incidence of fetal anomalies & maternal hypoglycemia

question

Assessment Findings for Gestational Diabetes Mellitus

answer

Polyuria Polydipsia Weight loss Polyphagia Elevated glucose levels in blood & urine 1 hour glucose tolerance test at 24 to 28 weeks 3 hours glucose tolerance test used if results from 1 hours GTT>180 mg/dl

question

Gestational Diabetes Mellitus Nursing Interventions

answer

Teach patient the effects & interactions of diabetes & pregnancy & signs of hyper & hypoglycemia Teach patient how to control diabetes in pregnancy Monitor fetal status throughout pregnancy & usually will be referred to endocrinologist Assess status of mother & baby frequently Monitor carefully fluids, calories, glucose & insulin during labor & delivery May start on insulin drip during labor & delivery Continue careful observation in post delivery period High risk for hypoglycemia for newborn

question

Infections (TORCH)

answer

Toxoplasmosis Other infections Rubella Cytomegalovirus Herpes Devastating to the fetus causing abortions, malformations & even fetal death

question

Infections Nursing Interventions

answer

Instruct the pregnant woman in signs & symptoms that indicate infections Caution women to avoid obviously infected persons & other sources of infections May affect delivery options

question

Placental Abnormalities

answer

*Developmental problems of the placenta:* Placental lesions Succenturiate placenta Circumvallate placenta Battledore placenta *Degenerative changes:* Infarcts Placental calcifications

question

Succenturiate Placenta

answer

One or more accessory lobes of fetal villi will develop on the placenta

question

Succenturiate Placenta Maternal Complications

answer

Post partum hemorrhage if placenta is retained

question

Succenturiate Placenta Fetal Complications

answer

No fetal-neonate complications as long as all parts of the placenta remain attached until after birth of the fetus

question

Circumvallate Placenta

answer

A double fold of chorion & amnion form a ring around the umbilical cord, on the fetal side of the placenta

question

Circumvallate Placenta Maternal Complications

answer

Increased incidence of late abortion, antepartum hemorrhage & preterm labor

question

Circumvallate Placenta Fetal Complications

answer

Intrauterine growth restriction Prematurity and/or fetal death

question

Battledore Placenta

answer

The umbilical cord is inserted at or near the placental margin

question

Battledore Placenta Maternal Complications

answer

Increased incidence of preterm labor & bleeding complications

question

Battledore Placenta Fetal Complication

answer

Prematurity & fetal stress

question

Velamentous Insertion of the Umbilical Cord

answer

The vessels of the umbilical cord divide some distance from the placenta in the placental membranes

question

Velamentous Insertion of the Umbilical Cord Maternal Complications

answer

Hemorrhage if one vessel is torn

question

Velamentous Insertion of the Umbilical Cord Fetal Complications

answer

Fetal stress Hemorrhage

question

Placental Accreta

answer

Abnormal adherence Placenta grows into the uterine wall The incidence of placenta accrete also significantly increases in women with previous C-section compared to those without prior surgical delivery

question

Rh Sensitization

answer

Rh-negative women who become pregnant with an Rh positive fetus may become sensitized to the Rh antigen if there is any accidental contact between maternal & fetal blood Can occur also during amniocentesis of other invasive procedure

question

Complications of Rh Sensitization

answer

Sensitized Rh negative women develop anti-Rh antibodies which may cross the placenta in subsequent Rh-positive pregnancies & attack & destroy the fetal RBC's

question

Newborn Effects of Rh Incompatibility & Sensitivity

answer

Progressively severe Erythroblastosis fetalis Hydrops fetalis

question

Erythroblastosisi Fetaslis

answer

The antibodies from the mom cross the placenta & attach to fetal red blood cells & destroy them

question

Hydrops Fetalis

answer

Severe anemia that results in heart failure

question

Rh Sensitization Assessment

answer

All pregnant women should be tested for blood group, Rh factor & antibody screening, a history of previous miscarriage, blood transfusions or infants experiencing jaundice should be noted

question

Rh Sensitization Intervention

answer

Unsensitized Rh-negative patients should be given 300mg of Rh immune globulin (RhoGAM) IM at *28 weeks & within 72 hours of delivery* RhoGAM is not given to mothers who are already sensitized & have antibodies Rh immune globulin is also given after abortion, ectopic pregnancy, amniocentesis & any other situation that might result in maternal exposure to the fetal Rh antigen Kleihauer-Betke test

question

Kleihauer-Betke Test

answer

Test to see if there has been any maternal & fetal blood mixing

question

Fetal Demise

answer

First trimester fetal loss Fetal anomaly Neonatal death Stillbirth or intrauterine fetal demise

question

First Trimester Fetal Loss

answer

Ectopic pregnancies Elective termination

question

Fetal Anomaly

answer

The loss of their "perfect child" Intensity of grief may be affected by the type & severity of the anomaly Anticipatory grieving

question

Neonatal Death

answer

Death within the first month of life Typically related to congenital defect, sepsis, prematurity or SIDS

question

Stillbirth/Intrauterine Fetal Demise

answer

Fetal demise in utero after 20 weeks gestation

question

Delivery of Stillbirth/Intrauterine Fetal Demise

answer

Most mothers spontaneously begin labor within 2 weeks after IUFD, if labor does not ensue, they need to go to the labor & delivery unit

question

First Symptom of Fetal Death

answer

Absent movement (?)

question

Nursing Care during Perinatal Loss

answer

Planning & implementation with grieving parents Follow up after discharge

question

Induction of Labor

answer

Prostaglandins

question

Prostaglandins

answer

Vaginal suppositories 12 to 24 weeks dinoprostone (Prostin E2/Cervidil) misoprostol (Cytotec)

question

dinoprostone (Prostin E2)

answer

Suppositories for 14 to 28 weeks

question

misoprostol (Cytotec)

answer

Intravaginal tablets for 2nd & 3rd trimester fetal demises & for termination of 2nd & 3rd trimester pregnancies

question

Nursing Care for Fetal Demises

answer

Communicating & caring techniques Options for parents

question

Communicating & Caring Techniques

answer

Actualize the loss Provide time to grieve Allow for individual differences, cultural, spiritual & physical needs of the parents

question

Options for Parents

answer

Seeing & holding Bathing & dressing Privacy Visitation with other family members Religious rituals/funeral arrangements Special memories Memory box & pictures

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