Retained Placenta-OB Shock-uterine Inversion

5/13/2018 Retained Placenta-OB Shock-uterine Inversion

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Reta ined P lacenta I nvers ion of the U terus Obstetric Shock

Course Title: NCMN - Care of Mother, Child and Family


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Object i \ / e sGiven the simulated conditions/situations, the students willbe able to: Describe the deviations from the normal in relation to

the complications and its etiology. Identify the causes, signs and symptoms, possiblecomplications, and medical and nursing management

of retained placenta, acute inversion of the uterus,Obstetric shock

Differentiate the causes of postpartum complications. Identify expected outcomes of a postpartal woman

experiencing any of the complications as discussed


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Object i \ / e sGiven the simulated conditions/situations, the students willbe able to: Assess a woman and her family for deviations from the

normal during the puerperium. Write the pathophysiology of the disease Plan interventions that meet the special needs of the

postpartum mother and her family with a postpartalcomplication, such as planning for an extendedhospitalization and home management.


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Object i \ / e sGiven the simulated conditions/situations, the students willbe able to: Express importance of knowing this disease Review understanding of the disease Relate the classroom discussion of disease to latest

journal regarding the disease for personal reactionstatement


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PlacentaTh ick , d isk-sh aped o rgan .

Two (2) components :1 . Materna l - a ttaches to the ute rus (Duncan)2 . Fe ta l - sm ooth, w ith b ranch ing vesse lscovering the m embrane-covered surface

(Sch u Itze 's )

Funct ions:1 . Metabol ic2 . T ransfe r3 . Endocrine


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Third Stage of Labor Begins with the birth of the baby and ends with the expulsion

of the placenta. The shortest stage (ave. of 5 to 30 minutes) No difference in duration between nulliparas and parous

women.

,.-",.",,,,,..,~.._--.--~r-_ .= .. - ~ .- "....... . !~ !'I ~ Ii II. .1 I III !! Ii I' .1II I ~! ~i~ iI II I! i ~ 'I " II!-., ..__,_"" r.....,.= = .. ,, - . .. .. .. " "" '' -- '- - . .. .. . _ " ,

Pilaoe;nta.


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De live ry o f the baby~

Ute rine cav ity becom es sm alle r & decrease placen ta l s ite~

Placen ta l sepa ra te from u te rine w all

S c hu ltz e me c ha nism D uncan m echan ism

Expu ls io n o f P lacen ta


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Reta ined P lacen taA. Nonadherent retained

PlacentaB. Adherent retained Placenta


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Nonadheren t R e ta ined P lacen taEtio logy: P a rtia l separa tion o f a no rma l p lacen ta En trapmen t o f the separa ted placen ta Mismanagement of the 3rd stage of labor Abno rma l adherence o f the p lacen ta Poo r separa tion (pre te rm b irths )


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Management Manual separation and removal Uterine exploration and placental removal(after administration of light anesthesia)


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Adherent Retained PlacentaEtiology: UnknownHypothesis: Zygotic implantation in area of defectiveendometrium


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Degrees of Attachment:Placenta Accreta - slight penetration ofmyometrium by placental trophoblast


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Degrees of Attachment:Placenta Increta deep penetration ofmyometrium by placenta

o


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Degrees of Attachment:Placenta Precreta perforation of uterus byplacenta

o


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Management M anua l rem ova l o f p la cen tao r p lacen ta l rem nan ts

Us ing a la rge cu re tte , theu te rus is sc raped


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U terine P ro lapseversus

U terine Invers ionAcu e Uterine Inversion

AINEI veASI


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Inversion of U terus

Definition: eELSEVIER. NC - EnE MAGES.COMThe uterus is partly or completely turned inside out.


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Two types of Inversion:

1. Partial inversion - inner surface of fundus isdrawn down into the uterine cavity.


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Two types of Inversion:

2. Complete/Severeinversion - theinside of the fundusprotrudes throughthe cervix into the.vagina.


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Causes: Mismanagement of 3rd stage of labor Short umbilical cord Manual removal of placenta Spontaneous inversion

~Uterus turns inside out and appear outside

the vulva (inversion)~

Traction on the uterine supportive ligaments

Severe painJ,

Lossof balance between sympathetic andparasympathetic stimulation of vascular smooth muscleIt J, t

Massive vasolidation Faint/ Co I I apse ~ HR/RR,Cold & sweating skin, dilated pupilsI I I

t


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I Massive vasolidation I I Faint/Col lapse I ~ HR/RR, C old & sw ea tin g skin , d ila ted pupilsI I ItIn cre as ed v as cu la r c omp artm e nt

tHypovo lemia & decrease in s ys tem ic v as cu la r re sis ta nc e

~N eurog en ic shock

I DEATH I


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Management: Immediate intravenouscrystalloids.

Removal and attempt toreplace the uterus.

IV nitroglycerin asordered to relax uterinemuscle.

Oxytocin to contractuterine. Suturing of cervical.mcisron


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Obstetric ShockHypo tens ion w ithou ts ig n ifica n t exte rna Ib eed ing m ayoccas iona y deve lop inan obs te tric pa tien t.


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Shock in Obstetrics Cardiogenic Hypovolemic Neurogenic Anaphylactic Septic


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Cause: Concealed hemorrhage Uterine Inversion Amniotic Fluid Embolism


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ShockA condition in which thecardiovascu ar systemfails to perfuse the tissuesadequate y, resu ting inwidespread impairmentof cellu ar metabo ism.

McCance & Huether (2001)


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C ard iovascu lar Function H eart Function : lossof the pump B lood Function : nothing to pump B lood P ressu re : no force in the pump


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Types of Shock and their immediatecauseTypeCardiogenicHypovolemicNeurogenicAnaphylactic

Septic

CauseHeart FailureReduced blood volumeNeural alterations of smooth muscletone resulting in vasodilationImmune system pathology resultingin vasodilationResulting in cardiac depression anddilatation with vasodilation


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Pathophys io log ica l causes o f shock in ch ildbearingCard iogen icPulmonaryembolism

Hypovo lemicHemorrahgeassociated withchildbearing

Severe anemia Ruptured ectopicpregnancy

Cardiac Ruptured uterusdisorders suchas valvular orcongenitalproblemsSeverehypertension

Coagulopathyhypertensionfollowing amnioticfluid embolismDiabetic crisis

Neurogen icAcute inversionof the uterus

Aspiration ofacid gastriccontentsIntrauterinemanipulationswithoutadequateanesthesia

Anaphylact icAdverse drugreactions

Sept icInfection inseptic abortionand puerperalinfection


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Compensa to ry Mechan l s rnDecrease cardiac output Enhance cardiac performance. . . . but increased demand for.

r oxygen and nutrientsRenin produced by kidneys rstimulates aldosterone releaser

Tissue perfusion begins to fallRetain of sodium and water ,~Decrease of nutrient and

,, oXigen deliveri to cellsHypothalamic responses rcause catecholamine releasefrom adrenal glands Impaired cellular metabolism

r rVasoconstriction occurs to Signs of shock will bemaintain blood pressure manifested


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How It appens

Cycle ofdecomp nsation

What to 100 for


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HYPOVOLEM IC SHOCKIn hypovolemic shock, reducedintravascular volume causes circulatorydysfunction and inadequate tissueperfusion.

It's commonly caused by acute b loodloss.


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HYPOVOLEM IC SHOCKo It P ns


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HYPOVOLEM IC SHOCK


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HYPOVOLEM IC SHOCK


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H Y f

What to look for

Seoc.crtJm

~~,Ir _f_~._~)f . l \~~1_.. . .


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S igns and Symptoms of ShockSigns: Nausea W eakness Fee ling of hot or co ld D izziness Confus ion Fear Anxie ty Thirs t Shortage of breath

w ith a ir hunger

Symptoms: Increased PR and RR Decreased BP and

card iac output Co ld, c lammy skin Pa llo r Reduced core

temperature


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Iden tifica tion o f pa tien t a t risk . E s tab lish prophylac tic m easu res du ring labo r Labo ra to ry sc reen ing fo r anem ia and a typica lant ibodies

IV in fus ion v ia la rge -bo re need le o r ca the te rprio r d e liv ery S tandby b lood fo r poss ib le b lood trans fus ion C lose m on ito ring o fVS IV c rys ta llo id s (No rm al sa line o r Lac ta tedR inge r's so l u tion ) in fused v ia IV .

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Retained Placenta-OB Shock-uterine Inversion