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8. High Risk Pregnancy Flashcards

1
Q

Three biggest risk factors for maternal mortality

A

PIH
PPH
PE

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2
Q

Hypertensive disorders of pregnancy (3)

A

o Pregnancy-Induced HTN (PIH)
o Pre-Eclampsia
o Eclampsia

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3
Q

PHI: Def

A

HTN in pregnancy with onset after 20 weeks gestation

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4
Q

Chronic HTN in pregnancy

A
  • Onset before 20 weeks

* Continuing past PP period (42 days)

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5
Q

HTN: Def (#s)

A

+ 140/90

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6
Q

Pre-eclampsia: Def

A

PIH with proteinuria

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7
Q

DIagnosis of PIH

A

Proteinuria on two separate tests at least 6 hours parat

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8
Q

Can pre-eclampsia occur postpartum?

A

Yes, up to 48 hours

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9
Q

Pre-eclampsia “triad” of symptoms symptoms (3)

A
  • HTN
  • Proteinuria
  • Edema
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10
Q

Pre-eclampsia 2ndary symptoms (4)

A
  • Headaches
  • Visual changes
  • Epigastric pain
  • Sudden excessive weight gain
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11
Q

Why would a pre-eclampsia patient experience headache and visual changes?

A

Vasoconstriction → Increased pressure

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12
Q

Why would a pre-eclampsia patient experience epigastric pain?

A

Decreased perfusion to the liver → Elevated liver enzymes

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13
Q

Diagnosis of mild preeclampsia
• 2 Diagnostic criteria
• 2 characteristics patient would have

A

o BP 140/90
o 2+ to 3+ protein

o Moderate puffiness
o Deep tendon relfexes are WNL

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14
Q

Diagnosis of severe preeclampsia
• 2 diagnostic criteria
• 4 other characteristics patient would have

A

o BP 160/110
o 3+ to 4+ protein

o Generalized edema and noticeable puffiness
o Hyperreflexive
o Symptomatic
o Oliguria

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15
Q

Management of mild preeclampsia

A

o Rest in LLP Periodically
o High protein and high calorie diet
o Fetal movement counting

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16
Q

Management of severe preeclampsia

A 
o	Hospital and bed rest
o	Decreased environmental stimulation
o	Is and Os
o	Fetal assessment (NST/BPP)
o	Magnesium sulfate
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17
Q

Eclampsia (def)

A

Pre-eclampsia with convulsions

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18
Q

Treatment of eclampsia

A

Magnesium sulfate therapy

BIRTH IS THE ONLY CURE

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19
Q

Mechanism of Magnesium sulfate in eclampsia

A

Blocks neuromuscular transmission, causes vasodilation

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20
Q

Loading dose of magnesium sulfate for eclampsia

A

IV piggyback 4-6 grams over 15-30 minutes

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21
Q

MAintenance dose of magnesium sulfate for eclampsia

A

2g/h

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22
Q

Safe magnesium serum levels

A

4-7 or 8

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23
Q

Signs and symptoms of magnseium toxicity (5)

A
  • Decreased respiratory rate
  • Decreased urine output (oliguria)
  • Feeling of warmth, nausea
  • Muscle weakness, decreased reflexes
  • Slurred speech
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24
Q

Risk factors for eclampsia (10)

A
  • Chronic renal disease
  • Chronic HTN
  • Diabetes
  • Obesity
  • Primigravity
  • Twin gestation
  • Family hx of PIH
  • History of Preeclampsia in past pregnancies
  • Maternal age < 19 or > 40 years old
  • Rh Incompatibility
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25
HELLP Syndrome (def)
Life threatening occurrence that compromises 10% of people with PIH. Acronym for lab results.
26
What does HELLP stand for
* H - Hemolysis * E - Elevated * L – Liver Enzymes * L - Low * P – Platelets
27
Platelet levels with HELLP
Typically below 100,000 (normal ~ 150,000 – 400,000); coagulants are all normal. Abnormal Clotting factor.
28
Causes of early pregnancy bleeding: (5)
``` o Spontaneous abortion o Molar pregnancy o Incompetent cervix o Ectopic Pregnancy o Implantation spotting ```
29
Spontaneous abortion - Definition - Criteria for "early" - Criteria for "late"
* Def: Pregnancy that ends before 20 weeks * Early: Prior to 12 weeks * Late: 12-20 weeks
30
• _____% of clinically recognized pregnancies end in abortion • ___% of this is related to ____________
* 10-20% | * 50% related to chromosomal abnormalities
31
Complete abortion: def
Fetus and all of the products of conception have been expelled from the uterus
32
Incomplete abortion (def)
Loss of pregnancy; some but not all of the products of conception have been expelled from the uterus
33
Threatened abortion: Def
Possible loss of pregnancy with early signs and symptoms.
34
Four characteristics of a threatened abortion
* Cervix beginning to dilate * Cramping * Bleeding * No POC has passed
35
Inevitable abortion: Def
Threatened loss of pregnancy that cannot be prevented or stopped.
36
Four characteristics of an inevitable abortion
* Cramping * Bleeding * Os is opened * Usually ROM
37
Missed abortion: Def
Loss of pregnancy where the POC remain in the uterus. | • Your body missed the cue to get rid of it.
38
Risk factors for spontaneous abortion: 7
* Endocrine Imbalance * Infection * Maternal structural problems * Immunological factors * Systemic disorders * Drug use * Inadequate nutrition
39
What is a molar pregnancy?
When a hydatidiform mole forms instead of a fetus.
40
Choriocarcinoma (def)
When a molar pregnancy becomes cancerous
41
Gestational Trophoblastic Disease (def)
Problem with trophoblast cells early on. Instead of helping embryo attach, trophoblastic cells give rise to a tumor.
42
Molar pregnancy: Complete v. Parital
* Complete: Contains no genetic material | * Partial: Nonviable fetus
43
Signs and Symptoms of a molar pregnancy (5)
* Vaginal bleeding * Severe nausea and vomiting * Uterus is large for dates * No fetal heart tones or activity * hCG levels high and rising rapidly
44
Treatment for molar pregnancy (4)
* Bereavement counseling * Remove the fetus * hCG monitoring * Continued monitoring, no pregnancy for 1 year
45
What should happen to hCG levels after molar pregnancy is removed?
* Declines | * Should be undetectable by 3 weeks
46
Incompetent Cervix (def)
Passive and painless dilation of the cervix in the 2nd trimester
47
Risk factors for incompetent cervix (4)
* Hx of previous cervical lacerations during childbirth * Excessive cervical dilation * Congenitally short cervix * Cervical uterine abnormalities
48
Ectopic pregnancy: Def
Fertilized ovum is implanted outside of the cervix
49
Where do most ectopic pregnancies occur?
95% are implanted in the AMPULE (the outer 3rd)
50
Causes of late pregnancy bleeding (3)
o Placenta previa o Placenta abruption o Gestational Diabetes
51
Placenta previa (def)
Placenta partially or completely covers the internal cervical os
52
What is the difference in what the woman feels with a placenta previa versus a placenta abruption
Placenta previa is painless, | Placenta abrupta is painful
53
Management of placenta previa (5)
* Bed rest * NPV * Evaluate fetal well-being * NEVER do a vaginal exam * C-Section
54
Risk factors for placenta previa: History (4)
* Previous previa * Previous C-Section * Hx of Elective TOP (Termination of Pregnancy) * Closely spaced pregnancies
55
Risk factors for placenta previa: Current Pregnancy (5)
* Multiple gestation * Closely spaced pregnancies * Advanced medical age * Smoking -- Vasoconstrictor * Cocaine use -- Vasoconstrictor
56
Placenta abruption (def)
Premature separation of the placenta from the uterine wall
57
SxS of placental abruption - 2 Classic symptoms - 2 other symptoms
“Classic” S&S: o Uterine-tenderness o Board-like abdomen * Vaginal bleeding may be concealed * Abdominal pain w/ctx greater than expected; may be localized
58
What does a "board-like abdomen" indicate?
Indicates internal hemorrhage
59
Risk factors for placental abruption (5)
* PIH * Cocaine use * Trauma (Blunt force) * Smoking * Poor nutrition
60
Gestational diabetes: Def
Physiologic glucose intolerance in pregnancy
61
Gestational diabetes: Epidemiology
Occurs in 4% of all pregnancies
62
Gestational diabetes: Prognosis
50% will develop glucose intolerance later in life
63
Glucose testing in pregnant women: Screening
Glucose Challenge Test (GCT) | o 24-28 weeks
64
Glucose testing in pregnant women: Diagnostic
Glucose Tolerence Test (GTT) | o Follow-up to evaluated GCT
65
Gestational Diabetes Risk Factors: History (4)
* Family history of IDDM: Maternal (esp insulin dependent) * Previous baby weighing >4000g * Previous unexplained stillbirth * Spontaneous abortion
66
Gestational Diabetes Risk Factors: Current (5)
* Maternal age >30 * Obesity * Congenital anomalies * Sxs of diabetes * Recurrent glucosuria noted on dipstick
67
Diagnosing Gestational Diabetes (2)
• GCT value of >200 OR • 2 abnormal values on GTT
68
``` Abnormal values on GTT (4) • Fasting • 1 hr • 2 hr • 3 hr ```
FASTING >/= 105 mg/dL 1 hour >/= 190mg/dL 2 hour >/= 165mg/dL 3 hour >/= 145mg/dL
69
Big picture: What should you worry about with maternal glucose?
Stable vs Volitle
70
Dietary treatment for gestational diabetes (6)
* Standard diabetic diet * Small, frequent meals * High fiber meals * High fiber foods * Lower fat intake * Avoid sugar, concentrated sweets
71
Lab goals for glucose control (3)
* Fasting levels <120mg/dL | * Goal: 60mg/dL and 100 mg/dL
72
"Size less than dates": Causes (3)
* Intrauterine Growth Restriction (IUGR) * Small for gestational age * Oligohydraminos
73
What causes IUGR? (2)
* Pathological process | * Decreased oxygen and nutritional availability to fetus
74
IUGR: Symmetrical (2 char)
* Represents chronic / long-term insult | * Small in all parameters including head development
75
IUGR: Assymetrical (3 char)
* Late occurring / short-term deprivation * “Head-sparing” * Typical small body, large head
76
What is the difference between an "IUGR" diagnosis and a "Small for gestational age" diagnosis?
* UGR is pathological | * SGA is non-pathological
77
Oligohydraminos: Def
Abnormally small amount of amniotic fluid Amniotic fluid index <5
78
Normal amniotic fluid index
5-20cc
79
Oligohydraminos is associated with _____
Marked perinatal mortality
80
Factors that coincide with oligohydraminos (4)
o Congenital anomilies o IUGR o Early rupture of membranes o Post-maturity
81
Management of oligohydraminos (5)
``` o Bedrest o Hydration o Encourage good nutrition o Assess fetal well-being: FMC, AFV, BPP o Induction and delivery if severe and fetus is mature ```
82
"Size Greater than Dates" Causes (6)
* Macrosomia * Large for gestational age (LGA) * Multifetal preganancy * Fibroid uterus * Polyhydraminos * Post-term pregnancy
83
Polyhydraminos: Def
Excessive amount of amniotic fluid | Amniotic fluid index >20cc
84
Polyhydraminos: Characteristics (2)
* Difficulty auscultating fetal heart tones and palpating fetus * Unstable fetal lie
85
What do you have to rule out with polyhydraminos?
GDM and ABO/Rh Disease
86
Risk factors for polyhydraminos (4)
o Multiples o Uncontrolled GDM o Fetal Malformations o Chromosomal Abnormalities
87
Complications of polyhydraminos (6)
``` o Fetal malpresentation o Placental abruption o Uterine dysfunction during labor o PP Hemorrhage o Cord prolapse o Preterm labor ```
88
Post-term pregnancy: Def
Pregnancy that extends beyond the 42nd week gestation
89
Clinical manifestations of post-term pregnancy (4)
o Maternal weight loss o Decreased uterine size o Meconium in the fluid o Advanced bone maturation of the fetal skeleton with a hard skull
90
Maternal risks involved with post-term pregnancy (5)
``` o Dysfunctional labor o Perineal trauma o PPH o Infection o Interventions (forceps, vacuum, c-section) are more likely to be necessary ```
91
Fetal risks involved with post-term pregnancy (4)
o Macrosoma o Birth trauma o Distress o Hypoxia / asphyxia
92
Management of post-term pregnancy (3)
o Testing: BPP, NST, FMC o Cervical assessment for ripeness o Induction
93
Normal platelet levels
normal ~ 150,000 – 400,000

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