早产、胎膜破裂、胎儿窘迫与女性护理母婴护理课件

NursingCareforWomenwithPretermLabor,PrematureRuptureofMembranes,andFetalDistress徐丽华上海交通大学护理学院早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理LearningObjectivesDefinethekeyterms:pretermlabor,prematureruptureofmembranes,fetaldistressUnderstandthedifferenceinpertermbirthandlowbirthweightIdentifyrisksfactorsofpertermlaborUnderstandthecurrentinterventiontotreatpretermlaborDiscussthenursingcareforwomenexperiencedpertermlabor,pertermruptureofmembranes,andfetaldistress早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理PertemLaborDefination:Cervicalchangeanduterinecontractionsoccurringbetween20weeksan37weeksofpregnancyPertermbirthlead75%oftheperinatalmortalityPertermbirthalsoisthesecondleadingdeathofinfantsintheUSA,nexttoCHD.(ComerfordFreda,2000)早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理PertermLaborand

LowBirthWeightPertermLabor:<37weeksofgestationalageLowbirthweight:weightattimeofbirthislessthanorequalto2500grams.Intrauterinegrowthretadation:IUGR早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理RiskFactorsofPretermLaborDemographicRisks:youngmother,lowsocioeconomicstatus,unmarried,lowlevelofeducationMedicalrisk:historyofpretermbirth,multipleabortions,uterineanomalies,lowpregnancyweight,DM,Hypertention，multiplegestation,infection,incompetentcervix,UTI,bleeding,placentapreviaorabruptioplancenta,anemia,fetalanomalies早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理BehavioralandEnvironmentalRiskforPretermLaborDiethylstilbestrol(DES)ExposureSmokingPoorNutritionAlcoholorothersubstanceuse,expeciallycocaineLateornoprenatalcareStress,uterineirritability,longworkinghours,inabillitytorest早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理RiskFactorsforPertermLaborBacterialVaginosis40%increasedriskSyphilisandgonorrhea50%increasedriskAsymptomaticbacteriuria50%increasedrisk早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理SymptomsofPretermLabor

20-37weeksofgestationalagePelvicpressurefeelslikethebabyispushingdownLow,dullbackacheMenstrual-likecrampsChangeorincreaseinvaginaldischargeUterinecontractions(hardness),every10minutesormoreoftenwithorwithoutpainIntestinalcrampingwithorwithoutdiarrhea早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理SupressionofUterineActivityTocolyticsTherapy：Ritodrine（Yutopar）TerbutalineMagnesiumSulfateIndomethacin早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理ContraindicationstoTocolysisMaternalfactor：SeverePIHoreclampsiaActivevaginalbleedingsIntrauterineinfectionCardiacdistressMedicalorobstericconditionthatcontraindicatescontinuationofpregnancy早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理ContraindicationstoTocolysisFetalFactors:Estimatedgestationalage>37weeksDilationof>4cmEstimatedweightofbirth>2500gramsFetalDemiseLethalfetalanomalyChorioamnionitisAcuteFetalDistressChronicIUGR早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理NursingDiagnossifor

PertermLaborKnowledgedeficitrelatedto-recognitionofpretermsymptomsRiskformaternalorfetalinjuryrelatedto–pretermlaborandbirthAnxietyrelatedto–pertermbirthandfamilyconsequencesImpairedmobilityrelatedtoprescribedbedrestAnitipatorygrievingrelatedto–pretermlaborandbirth早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理NursingcareforwomenwithtocolytictherapyPositiononLfsideforbetterplacentaperfusionAssessbloodpressure,pulse(not>120/min),andrespiratoryrateAssesssignsofpulmonaryedema(chestpain,shortnessofbreath,crackles,rhonchi)Assessurinaryoutputq1h,monitorforketonuriaLimitfluidintaketo2500-3000ml/dayProvidepsychosocialsupportandreleaseanxietyMonitorelectrolyte,bloodglucoselevel早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理PromotingFetalLungMaturityAntenatalglucocorticoidtherapy:betamethasone,dexamethasoneAction:stimulatesfetallungmaturationbypromotingreleaseofenzymesthatinduceproductionandorreleaseoflungsurfactantNursingconsideration:Assesssignsofinfection,pulmonaryedema,bloodglucselevel,lungsound,takes24hoursfordrugtoeffective,nottogivewomen>35weeksofpregnancy.早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理HealthTeachingfor

pertemlaborpreventionWhenpertermlaboroccur:Liedownonyourleftsidefor1hourDrink2-3glassessofwaterorjuicePalaateforcontractionsIfnocontraction,assumelightactivity,ifsysmpotmcomeback,needtonotifyhealthcareprofessionals.Lifestylemodification早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理SigsnofPertermLoborUterinecontractionsevery5minutesorlessVaginalbleedingOdorousvaginaldischargeFluidleakingfromthevagina早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理PrematureRuptureofMembrance(PROM)

胎膜早破Definition:Ruptureoftheamnioticsacandleakageofamnioticfluidbeginningatleast1hoursbeforetheonsetoflaboratanygestationalage.早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理PROM-IncidencePretermprematureruptureofthemembranes(PPROM):itismembranesrupturebefore37weeksofgestation25%ofallcasesofpretermlaborInfectionprecedesPPROMComplainsofsuddengushoffluidfromthevaginaorslowleakoffluidfromthevagina.早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理PPROM-InfectionInfectionistheserioussideeffectofPPROMChorioamnionitis:intraamnioticinfectionofthechorionandamnionthatcanharmthefetusandnewborn早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理IncidenceofPPROMandPretermBirth3-30%ofwomenwithPPROMwillhavepoistiveamnioticfluidcultureMayleadtosepesis,congenitalpneumonia,meningitisofthenewbornduetointrauterineinfectioncasuedbyRPROM

早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理FetalSurviallance-

countingfetalmovementTeachingforfetalmovementskickcount:ChooseatimeofdayforquietmomentStartingatcertaintimeandcountthebaby’smovementuntilreach10.Ifnotcount10in12hours,needtoseephysician.Orcount4movementsaftereachmeals,shouldhave4movementin1hour,ifbyendof2hours,stilllessthan4movement,needtoseephysician.早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理BiophysicalProfilesforFetusFetalbreathingmovementsGrossbodymovementFetaltoneReactivefetalheartrateQualitativeamnioicfluidvolumeScore:normal8-10;equivocal6;abnormal<4Manning,1995早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理AmnioticFluidIndexMeasurementTodetermine:Normalvalue5-19cm.Oligohydramnios-amnioticfluidpacketoffluidintwoperpendicularplanesis<5cmPolyhyramnios-amnitoicfluidpacketfluidintwoperpendicularplanesis>20cm,withfetalfloating,freemovmentoflimbs早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理NursingcareforwomenwithPPROMFetussurvillance:countfetalmovementatleastBID,10fetalmovementsina12-hoursperiod.UnderstandthevolumeofamnioticfluidremainedintheamnioticsackSignsofstressonFetalmonitorStrickpreventionofinfectionduetoamnioticsacisrupturedandbacterialmayentertheuterustoinfectfetus.Relievepsychologicalstressduetoprolongedbedrestandpossibilityofprematurebirth早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理DischargeCriteriaforWomenwithPPROMDocumentedPPROM>72hrCervicaldilaiton3cmNosignofchorioamnionitis/pyelonephritisNosignorsymptomsofpretermlaborClinetwillingnesstocomplywithstrictpelvicrestNobreechortransversepresentation(chancesofproplapsecord)早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理HealthTeachingforwomenwithPPROMTaketemperatureQ4hwhenawake,Reportifmorethan380CRemainonmodifiedbedrestInsertnothinginthevaginaNosexualactivity,NotubbathsAssessforuterinecontraction&fetalmovementWatchforfoul-smellingvaginaldischargeWipefronttobackafterurinatingorhavingabowelmovementTakeantibioticsifperscribed早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理FetalDistressMaternal

RiskFactorsPregnancyInducedHypertensionCaridacDiseasesHyperemesisgravidarumSTI,vagnialinfectionPertermlaborDM,Anemia,SubstanceabusePlacentaprevia,abruptioProlongedlaborordifficultybirthAbnormalfetalpresentationTraumaticlabororbirth早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理Complicationduringlabor-

fetaldistressIntrauterinepressure>75mmHgContraction>90secondsContractionoccurring2minorlessapartFetalbradycardia,tachycardia,ordecreasedvariablityIrregularFHRMeconium-stainedamnioticfluidArrestinprogressofthelaborMaternalfevelFoul-smellingvaginaldischargeVaginalBleeding早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理ProlapseofcordduringlaborFetalbradycardiaMembranesrupturedCordliesbelowthepresentationpartofthefetusNeedtodoemergencydelivery早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理NursingInterventionforProlapsedCordPositionchange,trendelenburgormodifiedsimspositionSteriletowelwrapthecordOxygen8-10L/minIVfluidMonitoringFHRDonotplacecordbackintocervixPrepareemergencybirth(vagniaalorcesarean)早产、胎膜破裂、胎儿窘迫与女性护理-母婴护理UltrasonographyinThirdTrimesterforAssessingFetusGestationalageViabilityDetect