A.DESCRIPTION. Vasa previa is a rare development disorder made up of two separate disorders.
1. Velamentous insertion of the umbilical cord, in which the umbilical blood vessels course through amnion and chorion and meet to form the umbilical cord a distance from the placental surface. This places the fragile umbilical vessels at risk for tearing and hemorrhage.
2. The fragile unprotected umbilical vessels cross the internal os and are in front of the presenting fetal head, thus creating a vasa previa.
B.ETIOLOGY. Uncertain. However, it may be due to uneven growth of the placenta or abnormal implantation of the blastocyte.
C. PATHOPHYSIOLOGY. The fetal vessels rupture or are compressed, leading to fetal hypoxia.
D.ASSESSMENT FINDINGS
1.Associated findings
a. Vasa previa is of no danger to the mother.
b. Once the umbilical vessel rupture, fetal demise is virtually certain.
2. Clinical manifestations
a. Vessels are occasionally palpated during a vaginal examination.
b. Minimal bright red vaginal bleeding is evident.
c. Fetal bradycardia occurs.
3. Laboratory and diagnostic findings
a. Ultrasound may reveal vasa previa
b. Kleihauer-Betke or fetal cell blood test will confirm the presence of fetal blood cells.
MEDICATION USED FOR INTRAPARTUM COMPLICATIONS
|
CLASSIFICATIONS |
USED FOR |
SELECTED INTERVENTIONS |
|
Tocolytics Ritodrine HCl (Yutopar) Terbutaline sulfate (Brethine) |
* Terminates preterm labor * Acts on beta-2 receptor sites |
*Assess maternal and fetal heart rates continuously during infusion *Always use an infusion control mechanism to maintain a specified flow rate. *Always administer as a “piggy back” IV *Measure I&O every hour. Output should be 30 ml/hr or more. *Assess maternal BP continuously during infusion of this drugs. *Monitor for the following side effect hypotension, increased heart rate, hypokalemia, pulmonary edema, nausea vomiting, headache, and increase serum glucose |
|
Calcium channel blocker Nifedioine (Procardia) |
*Inhibits contraction of smooth muscle |
*Assess maternal and fetal heart rate continuously during administration. *Measure I&O every hour. Output should be 30ml/hr or more. *Assess maternal BP continuously during administration of these drugs. *Monitor for the following side effects: headache,jitteriness, shakiness, palpitations, chest pain, and tachycardia. |
|
Non-steroidal anti-inflammatory drugs (NSAID) Indomethacin (Indocin) |
*Prostaglandin antagonist that can be used to inhibit uterine contractions. |
*Assess and maternal and fetal heart rates continuously during administration. *Measure I&O every hour. Output should be 30 ml/hr or more. *Assess maternal BP continuously during administration of these drugs. *Monitor for the following side effects: headache, nausea, vomiting, prolonged bleeding time, blurred vision, and syncope. |
|
Anticonvulsant Magnesium Sulfate (MgSO4) |
* A CNS depressant that halts uterine contractions * Muscle relaxant; prevent seizures |
*Assess maternal and fetal heart rates continuously during infusion. *Always use an infusion control mechanism to maintain a specified flow rate. *Always administer as a “piggy back” IV *Measure I&O every hour. Output should be 30ml/hr or more. *Assess maternal BP continuously during infusion of this drugs. *Assess deep-tendon reflexes every 2 to 4 hours during continuous infusion of MgSO4. *Discontinue MgSO4 if tendon reflexes are absent or if respirations fall below 14/minute. *Monitor the following side effects, including flushing thirst, respiratory depression, decreased urinary output, respiratory arrest, and cardiac arrest. |
|
Electrolyte Calcium gluconate (10% solution) |
*Used as an antidote for effects of magnesium sulfate electrolyte. *Maintains nervous and muscle cell permeability. *Acts as an activator in the transmission of nerve impulses and contraction of cardiac, skeletal, and smooth muscle. |
*Assess maternal and fetal heart rates continuously infusion. *Always use an infusion control mechanism to maintain a specified flow rate. *Always administer as a “piggy back” IV * Measure I&O every hours. Output should be 30ml/hr or more. *Assess maternal BP continuously during infusion of these drugs. *Monitor for the following side effects: Bradycardia, syncope, nausea, vomiting, phlebitis at IV site, and cardiac arrest. |
|
Prostaglandin Dinoprostone (Prepidil, Prostin E2 [suppository or gel]) |
* Stimulates uterine smooth muscle to contract *Initiates softening, effacement, and dilation of the cervix |
*Suppository (prostaglandin) is inserted ever 2 hrs times 3. *Keep the suppository cold and bring it to room temperature before insertion. After insertion, have the client remain dorsal recumbent for 15-30 minutes. *The gel inserted into the cervical os by catheter two times; 6 hours apart. * Monitor for the following side effects: headache, nausea, vomiting, hypotension, dyspnea, and uterine hyperstimulation. |
|
Oxytoncic Oxytocin (Pitocin, Syntocinon [IV drip]) |
*Used for induction of labor. |
*Oxytocin is infused at a rate of 1-2 mU/minute and increased by 1-2 mU/minutes every 15-30 minutes until a contraction pattern is established. *Monitor vital signs and fetal heart rate closely. *Assess the contractile pattern. *Limit IV fluids to 150 ml/hours * Mix 10 IU oxytocin in 1000 ml Ringer’s lactate and hang as a “piggy back” solution. * Always use the infusion port closest to the client. * Monitor for water intoxication |
|
Corticosteroid-inflammatory immunosuppressant (Betamethasone, Celestone) |
*Hastening fetal lung maturity * Preventing respiratory distress syndrome in the newborn |
*Give to mother 12-24 hours before deliver *Administer initial dose IM *May repeat in 24 hours and again in 2 weeks *Assist with measures to halt preterm labor *Observe for burning, itching, and irritation at the injection site *Adverse effects include swelling, tachycardia, sodium and fluid retention, increased risk of infection with long term use. *Initial dose is 12.5mg IM |
E.NURSING MANAGEMENT
1. Identify and assist with treatment of the disorder
a. Monitor FHR and status during labor
b. Assist with diagnosis of the condition
c. Anticipate and assist with emergency cesarean birth
2.Provide physical and emotional support
3. Provide client and family education. Explain emergency procedures to the client and family.
