9: High Risk Pregnancy Flashcards
What age is considered high risk pregnancy?
> 35
What preexisting medical conditions indicate a high risk pregnancy?
RA, MS, SCI
What is an incompetent cervix?
Condition in which a weak cervix opens prematurely
When is an incompetent cervix typically diagnosed?
After one miscarriage or premature labor
What are interventions for incompetent cervix?
Cerclage, pessary, bedrest
What is cerclage?
Suturing of the incompetent cervix
What are general risk factors for preterm labor?
Multiple gestations, alcohol consumption, drugs, inadequate weight gain, standing, heavy physical labor, intercourse, hormones, infections, mental illness, stress
What is PROM?
Premature rupture of membranes - amniotic sac
When is labor likely to begin after PROM, and what happens if it does not?
Within 12 hours - if not within 24 will induce due to infection risk
Describe bleeding that indicates an early miscarriage
Pain in center of lower abdomen, severe pain for one day and then staining for three days
Describe bleeding with an ectopic pregnancy
Brown spotting associated with colicky/cramping pain with tenderness in the lower abdomen
Describe bleeding with a late miscarriage
Pick discharge for a couple of days followed by scanty brown discharge for one week. Then will bleed heavily
Describe bleeding in the 9th month
Pink or streaked mucous after intercourse or vaginal exam is normal
What is placenta previa?
The placenta has implanted in the lower end of the uterus and may be covering the cervical opening
With placenta previa, what will happen as the cervix dilates?
Placental separation from the uterine wall
How is placenta previa diagnosed?
Ultrasound
What is shown in the image?
Low-lying placenta previa
What is shown in the image?
Total placenta previa
What is shown in the image?
Partial placenta previa
What is abruptio placentae?
The placenta detaches from the uterine wall prematurely
Why is abruptio placentae a medical emergency?
Baby: no oxygen source
Mother: bleeding from separation
What is shown in the image?
Marginal separation of the abruptio placentae
What is shown in the image?
Partial separation of the abruptio placentae
What is shown in the image?
Complete separate and concealed hemorrhage of the abruptio placentae
What is PIH?
Pregnancy induced hypertension
What is gestational hypertension?
HTN develops > 20 weeks, will return to normal within 12 weeks post-partum
What BP indicated pre-eclampsia?
> 140/90 mmHg
What are the four key symptoms of pre-eclampisa?
- Increase in BP over 140/90
- Weight gain and edema
- Protein in urine
- Hyperreflexia
What is the leading cause of preterm birth?
Pre-eclampsia
What are symptoms of progressed pre-eclampsia?
Blurred vision, H/A, irritability, severe gastric pain
What are you more at risk for if you have a history of pre-eclampsia?
2x as likely to develop early onset CV disease
What is eclampsia?
Development of seizures or coma in women with pre-eclampsia
What is the mortality rate of eclampsia?
2%
What is HELLP Syndrome?
H: hemolysis
EL: elevated liver enzymes
LP: low platelets
Can HELLP syndrome occur without HTN?
Yes
What population is HELLP syndrome common in?
Pre-eclampsia or eclampsia
How do you manage HELLP syndrome?
Correction of coagulation abnormalities and delivery
What are four physical effects of bedrest?
- Glucose intolerance
- Sensory disturbances
- Fatigue
- Psychological effects
What are five antepartum training objectives for high risk pregnancy?
- Muscle conditioning
- Promote optimal circulation
- Bed mobility and energy conservation
- Comfort
- Education
What is the importance of muscle conditioning with high risk pregnancy pt’s?
Prevent decreased muscle tone and deconditioning
What is the safest position to exercise in for high risk pregnancy pt’s?
Sidelying
Why should you work to promote optimal circulation in high risk antepartum patients?
DVT prevention, maintain uterine blood flow to avoid mechanical obstruction, avoid valsalva
Why should you train modified bed mobility and energy conservation?
Avoid increased in abdominal pressure
What education should you provide in relation to childbirth?
Safe positions to assume during labor and delivery to optimize comfort, prepare for rehab following delivery