早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理母嬰護(hù)理課件

NursingCareforWomenwithPretermLabor,PrematureRuptureofMembranes,andFetalDistress徐麗華上海交通大學(xué)護(hù)理學(xué)院早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理LearningObjectivesDefinethekeyterms:pretermlabor,prematureruptureofmembranes,fetaldistressUnderstandthedifferenceinpertermbirthandlowbirthweightIdentifyrisksfactorsofpertermlaborUnderstandthecurrentinterventiontotreatpretermlaborDiscussthenursingcareforwomenexperiencedpertermlabor,pertermruptureofmembranes,andfetaldistress早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理PertemLaborDefination:Cervicalchangeanduterinecontractionsoccurringbetween20weeksan37weeksofpregnancyPertermbirthlead75%oftheperinatalmortalityPertermbirthalsoisthesecondleadingdeathofinfantsintheUSA,nexttoCHD.(ComerfordFreda,2000)早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理PertermLaborand

LowBirthWeightPertermLabor:<37weeksofgestationalageLowbirthweight:weightattimeofbirthislessthanorequalto2500grams.Intrauterinegrowthretadation:IUGR早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理RiskFactorsofPretermLaborDemographicRisks:youngmother,lowsocioeconomicstatus,unmarried,lowlevelofeducationMedicalrisk:historyofpretermbirth,multipleabortions,uterineanomalies,lowpregnancyweight,DM,Hypertention，multiplegestation,infection,incompetentcervix,UTI,bleeding,placentapreviaorabruptioplancenta,anemia,fetalanomalies早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理BehavioralandEnvironmentalRiskforPretermLaborDiethylstilbestrol(DES)ExposureSmokingPoorNutritionAlcoholorothersubstanceuse,expeciallycocaineLateornoprenatalcareStress,uterineirritability,longworkinghours,inabillitytorest早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理RiskFactorsforPertermLaborBacterialVaginosis40%increasedriskSyphilisandgonorrhea50%increasedriskAsymptomaticbacteriuria50%increasedrisk早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理SymptomsofPretermLabor

20-37weeksofgestationalagePelvicpressurefeelslikethebabyispushingdownLow,dullbackacheMenstrual-likecrampsChangeorincreaseinvaginaldischargeUterinecontractions(hardness),every10minutesormoreoftenwithorwithoutpainIntestinalcrampingwithorwithoutdiarrhea早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理SupressionofUterineActivityTocolyticsTherapy：Ritodrine（Yutopar）TerbutalineMagnesiumSulfateIndomethacin早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理ContraindicationstoTocolysisMaternalfactor：SeverePIHoreclampsiaActivevaginalbleedingsIntrauterineinfectionCardiacdistressMedicalorobstericconditionthatcontraindicatescontinuationofpregnancy早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理ContraindicationstoTocolysisFetalFactors:Estimatedgestationalage>37weeksDilationof>4cmEstimatedweightofbirth>2500gramsFetalDemiseLethalfetalanomalyChorioamnionitisAcuteFetalDistressChronicIUGR早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理NursingDiagnossifor

PertermLaborKnowledgedeficitrelatedto-recognitionofpretermsymptomsRiskformaternalorfetalinjuryrelatedto–pretermlaborandbirthAnxietyrelatedto–pertermbirthandfamilyconsequencesImpairedmobilityrelatedtoprescribedbedrestAnitipatorygrievingrelatedto–pretermlaborandbirth早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理NursingcareforwomenwithtocolytictherapyPositiononLfsideforbetterplacentaperfusionAssessbloodpressure,pulse(not>120/min),andrespiratoryrateAssesssignsofpulmonaryedema(chestpain,shortnessofbreath,crackles,rhonchi)Assessurinaryoutputq1h,monitorforketonuriaLimitfluidintaketo2500-3000ml/dayProvidepsychosocialsupportandreleaseanxietyMonitorelectrolyte,bloodglucoselevel早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理PromotingFetalLungMaturityAntenatalglucocorticoidtherapy:betamethasone,dexamethasoneAction:stimulatesfetallungmaturationbypromotingreleaseofenzymesthatinduceproductionandorreleaseoflungsurfactantNursingconsideration:Assesssignsofinfection,pulmonaryedema,bloodglucselevel,lungsound,takes24hoursfordrugtoeffective,nottogivewomen>35weeksofpregnancy.早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理HealthTeachingfor

pertemlaborpreventionWhenpertermlaboroccur:Liedownonyourleftsidefor1hourDrink2-3glassessofwaterorjuicePalaateforcontractionsIfnocontraction,assumelightactivity,ifsysmpotmcomeback,needtonotifyhealthcareprofessionals.Lifestylemodification早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理SigsnofPertermLoborUterinecontractionsevery5minutesorlessVaginalbleedingOdorousvaginaldischargeFluidleakingfromthevagina早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理PrematureRuptureofMembrance(PROM)

胎膜早破Definition:Ruptureoftheamnioticsacandleakageofamnioticfluidbeginningatleast1hoursbeforetheonsetoflaboratanygestationalage.早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理PROM-IncidencePretermprematureruptureofthemembranes(PPROM):itismembranesrupturebefore37weeksofgestation25%ofallcasesofpretermlaborInfectionprecedesPPROMComplainsofsuddengushoffluidfromthevaginaorslowleakoffluidfromthevagina.早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理PPROM-InfectionInfectionistheserioussideeffectofPPROMChorioamnionitis:intraamnioticinfectionofthechorionandamnionthatcanharmthefetusandnewborn早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理IncidenceofPPROMandPretermBirth3-30%ofwomenwithPPROMwillhavepoistiveamnioticfluidcultureMayleadtosepesis,congenitalpneumonia,meningitisofthenewbornduetointrauterineinfectioncasuedbyRPROM

早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理FetalSurviallance-

countingfetalmovementTeachingforfetalmovementskickcount:ChooseatimeofdayforquietmomentStartingatcertaintimeandcountthebaby’smovementuntilreach10.Ifnotcount10in12hours,needtoseephysician.Orcount4movementsaftereachmeals,shouldhave4movementin1hour,ifbyendof2hours,stilllessthan4movement,needtoseephysician.早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理BiophysicalProfilesforFetusFetalbreathingmovementsGrossbodymovementFetaltoneReactivefetalheartrateQualitativeamnioicfluidvolumeScore:normal8-10;equivocal6;abnormal<4Manning,1995早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理AmnioticFluidIndexMeasurementTodetermine:Normalvalue5-19cm.Oligohydramnios-amnioticfluidpacketoffluidintwoperpendicularplanesis<5cmPolyhyramnios-amnitoicfluidpacketfluidintwoperpendicularplanesis>20cm,withfetalfloating,freemovmentoflimbs早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理NursingcareforwomenwithPPROMFetussurvillance:countfetalmovementatleastBID,10fetalmovementsina12-hoursperiod.UnderstandthevolumeofamnioticfluidremainedintheamnioticsackSignsofstressonFetalmonitorStrickpreventionofinfectionduetoamnioticsacisrupturedandbacterialmayentertheuterustoinfectfetus.Relievepsychologicalstressduetoprolongedbedrestandpossibilityofprematurebirth早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理DischargeCriteriaforWomenwithPPROMDocumentedPPROM>72hrCervicaldilaiton3cmNosignofchorioamnionitis/pyelonephritisNosignorsymptomsofpretermlaborClinetwillingnesstocomplywithstrictpelvicrestNobreechortransversepresentation(chancesofproplapsecord)早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理HealthTeachingforwomenwithPPROMTaketemperatureQ4hwhenawake,Reportifmorethan380CRemainonmodifiedbedrestInsertnothinginthevaginaNosexualactivity,NotubbathsAssessforuterinecontraction&fetalmovementWatchforfoul-smellingvaginaldischargeWipefronttobackafterurinatingorhavingabowelmovementTakeantibioticsifperscribed早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理FetalDistressMaternal

RiskFactorsPregnancyInducedHypertensionCaridacDiseasesHyperemesisgravidarumSTI,vagnialinfectionPertermlaborDM,Anemia,SubstanceabusePlacentaprevia,abruptioProlongedlaborordifficultybirthAbnormalfetalpresentationTraumaticlabororbirth早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理Complicationduringlabor-

fetaldistressIntrauterinepressure>75mmHgContraction>90secondsContractionoccurring2minorlessapartFetalbradycardia,tachycardia,ordecreasedvariablityIrregularFHRMeconium-stainedamnioticfluidArrestinprogressofthelaborMaternalfevelFoul-smellingvaginaldischargeVaginalBleeding早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理ProlapseofcordduringlaborFetalbradycardiaMembranesrupturedCordliesbelowthepresentationpartofthefetusNeedtodoemergencydelivery早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理NursingInterventionforProlapsedCordPositionchange,trendelenburgormodifiedsimspositionSteriletowelwrapthecordOxygen8-10L/minIVfluidMonitoringFHRDonotplacecordbackintocervixPrepareemergencybirth(vagniaalorcesarean)早產(chǎn)、胎膜破裂、胎兒窘迫與女性護(hù)理-母嬰護(hù)理UltrasonographyinThirdTrimesterforAssessingFetusGestationalageViabilityDetect