Page 691 - Saunders Comprehensive Review For NCLEX-RN

1. Multiple gestation results from fertilization of 2 ova
(fraternal or dizygotic) or a splitting of 1 fertilized
ovum (identical or monozygotic).
2. Complications include miscarriage, anemia, congenital
anomalies, hyperemesis gravidarum, intrauterine
growth restriction, gestational hypertension,
polyhydramnios, postpartum hemorrhage, premature
rupture of membranes, and preterm labor and
delivery.

B. Assessment

1. Excessive fetal activity
2. Uterus large for gestational age
3. Palpation of 3 or 4 large parts in the uterus
4. Auscultation of more than 1 fetal heart rate
5. Excessive weight gain
C. Interventions
1. Monitor vital signs.
2. Monitor fetal heart rates, activity, and growth.
3. Monitor for cervical changes.
4. Prepare the client for ultrasound as prescribed.
5. Monitor for anemia; administer supplemental
vitamins as prescribed.
6. Monitor for preterm labor, and treat preterm labor
promptly.
7. Prepare for cesarean delivery for abnormal
presentations.
8. Prepare to administer oxytocic medications as
prescribed after delivery to prevent postpartum
hemorrhage from uterine overdistention.
XVIII. Placental Abnormalities
A. Description: Placenta accreta is an abnormally adherent placenta;
placenta increta occurs when the placenta penetrates the uterine
muscle itself; placenta percreta occurs when the placenta goes all
the way through the uterus.
B. Assessment: May cause hemorrhage immediately after birth
because the placenta does not separate easily
C. Intervention

1. Monitor for hemorrhage and shock.

2. Prepare the client for a hysterectomy if a large portion
of the placenta is abnormally adherent.
XIX. Placenta Previa
A. Description
1. Placenta previa is an improperly implanted placenta in
the lower uterine segment near or over the internal
cervical os (Fig. 22-3).

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