Ante-Partum Complcations

Question 1

Why is GERD worse when a woman is pregnant? What are some management options?

Answer 1

Uterus is pushes the stomach up against the esophageal valve and causes reflux. OTC antacid or PPI (omeprazole).

Question 2

What effect will Hep B have on a growing fetus? What does a mom need to be concerned about with Hep B? What special nursing care will mom & babe receive? Can mom breastfeed?

Answer 2

Can cause preterm labour or spontaneous miscarriage. The later during pregnancy mom gets Hep = greater risk for fetus contracting/being affected by it. Baby will be washed well of maternal blood and immune globulin can be administered. Virus is not transmitted via breastmilk.

Question 3

Why does a pregnant woman develop cholecystitis? What kind of nursing/medical care is to be expected?

Answer 3

Hypercholesterolemia naturally occurs during pregnancy. Can expect: NPO to rest gut, decreased fat intake, IVF, analgesics. Might need to remove gall bladder via LAP surgery.

Question 4

Why might a woman’s mental illness get worse with pregnancy? Are psychotropic medications safe during pregnancy?

Answer 4

Stress from pregnancy can exacerbate mental illness. Many psychotropic meds are teratogenic to fetus. Need to consult with doctor/pharmacist.

Question 5

Why does antiphospholipid Ab syndrome cause mom to miscarry repeatedly? What treatment plan would a mom with this be on? Post-partally what risks are there for the mom?

Answer 5

Antiphospholipid Ab initiate coagulation which results in clots forming in arteries/veins supplying placenta. PO low dose aspirin & subcut heparin. DVT/PE are a risk.

Question 6

Why does a woman develop an ectopic pregnancy? Where are most pregnancies implanted? What are the S/S? Why is hemorrhage a risk? What medication is used to treat ectopic pregnancy?

Answer 6

Obstruction/ahesion of fallopian tube (from PID, CA etc) causing implantation in the tube instead of uterus (because zygote cannot pass). Most implanted in ampullar region. Sharp, stabbing pain in lower abdominal quadrants with scant vaginal spotting. Hemorrhage because of rupture of Fallopian tube. Treated with methotrexate PO.

Question 7

Why are some women confused with hydatiform mole? What happens here?

Answer 7

There is an abnormal proliferation and degeneration of trophoblastic villi (fluid filled vesicles) that secrete hCG (that is why woman thinks she is pregnant) as embryo does not make it past primitive stage. These types of cells are associated with choriocarcinoma.

Question 8

What is a cervical cerclage? Why does it need to be done?

Answer 8

Purse-string sutures placed in cervix to strengthen integrity to avoid premature cervical dilation so that fetus can be retained. Treat cervical insufficiency.

Question 9

What complications is a multiple gestation woman more susceptible to? Why?

Answer 9

Gestational HTN, hydraminos, placenta previa, preterm labour, anemia, PPH because of excess uterine stretching.

Question 10

What is the normal amount of amniotic fluid? Amount in hydraminos? What are some causes? What nursing care?

Answer 10

500-1000ml. >2000ml. Difficulty with fetuses ability to swallow/absorb, excessive urine production, gestational diabetes. Bed rest (increased placental perfusion & decrease pressure on cervix), increase fibre diet (no straining), amniocentesis to decrease fluid volume.

Question 11

What are potential causes of ogliohydraminos? What should a nurse assess for in a neonate who had ogliohydraminos?

Answer 11

Bladder/renal disorder in fetus, severe IUGR. Assess closely for kidney disease & compromised lung development (fetus cramped for space).

Question 12

Why is it important to get an accurate menstrual hx? What are dangers to the fetus of a post-term pregnancy?

Answer 12

Accurate due date. Meconium aspiration, macrosomia. After 42 wk the placenta calcifies & can no longer bring O2 rich blood to fetus.

Question 13

What is a “high risk pregnancy”?

Answer 13

Concurrent disorder, pregnancy-related complication or external factor jeopardizes the health of mom, fetus or both.

Question 14

What assessments should be done for a mom with CV disease? (9)

Answer 14

Edema (is it just pregnant edema around ankles/feet or systemic?), fatigue, cough, IUGR, increased RR, increased HR, decreased amniotic fluid, poor fetal heart tone & variability.

Question 15

What are some interventions for a mom with CV disease?

Answer 15

At least 2 rest periods per day & full night rest. Rest in LL position to increase placental perf. Digoxin & heparin (safe for fetus), stool softeners, epidural & no pushing (decrease strain on heart), prophylactic abx to avoid sub acute endocarditis.

Question 16

What week gestation is the blood volume at a maximum?

Answer 16

28-32 weeks

Question 17

What occurs to the blood during pregnancy? What might occur because of this?

Answer 17

Hemodilution because of extra blood volume. Anemia is exacerbated.

Question 18

What are some assessments of a mom with anemia?

Answer 18

Pallor, SOBOE, fatigue, IUGR/EFM, obstetrical history, menstrual history, HGB <110?, HCT <33%?

Question 19

What are some interventions for anemia?

Answer 19

27 mg of iron to PREVENT anemia, if already anemic =120-400 mg of iron. Folic acid = 400mcg. Rest periods. Nutrition (iron rich foods).

Question 20

What are nice teaching points for a mom taking iron supplements?

Answer 20

May cause constipation/GI irritation. Take with food & it is best absorbed in acid medium = OJ/vit C supplement. Ferrous sulfate (most common) will turn stool black = normal. Use a stool softener if constipated. Increase fluid intake to avoid constipation.

Question 21

When is an early spontaneous abortion? Late? Around what week gestation can bleeding be profuse & life threatening. What is an important emotional/relational thing to remember for a mom experiencing SA? What is something we should anticipate in a mom experiencing SA?

Answer 21

<16 wk. 16-20 wk. Bleeding >12 weeks. Never minimize moms loss! Infection because of retained POC.

Question 22

What is a major risk for a mom with placenta previa? What is something as HCP we should never do? Often what method of delivery is necessary for a woman with placenta previa? What type of bleeding will we notice? Why is the fetus O2 supply at risk? What will we want to monitor? What is the management? What is a medication we will give to the mom if the baby will be born preterm?

Answer 22

Hemorrhage. No PV exams EVER. C-section. Bright red, painless bleeding. Detachment of the placenta. Fetal HR monitor and uterine contractions. Bed rest, side lying (increase placental perfusion). Betamethasone (mature fetus’s lungs).

Question 23

What is abruptio placentae? What causes this? What is a risk with this? When do manifestations usually appear? What are S/S? What needs to be done? What do we check for when fetus is delivered?

Answer 23

Premature separation of the placenta from the uterus. Increased parity, HTN, cocaine/smoking during pregnancy, sudden decrease in uterine volume (ROM, delivery of one twin). DIC. Appear later in pregnancy or during labor. S/S: dark painful vaginal bleeding, sharp stabbing pain @ fundus, couvelaire uterus. Bleeding can be concealed. Need to deliver fetus. Check for fetal hypoxia at birth.

Question 24

At what time is classified preterm labor? What are two major risk factors for it? What are some things we are looking for to indicate preterm labor? What are some interventions? What medication are we going to administer if the fetus is preterm? What medications can we administer to stop contractions?

Answer 24

<37 wk. Dehydration and UTI. Look for: contractions 4 in 20 min or more, cervical changes, lower back pain, vaginal spotting, abdominal tightening, cramping. Bed rest, hydration, treat UTI. Betamethasone. Turbutalane & magnesium sulfate (smooth muscle relaxant).

Question 25

What can cause PROM? What are two risks associated with PROM? Why is labor not usually stopped if it starts? What are three interventions we will do? How can we confirm the presence of amniotic fluid after ROM?

Answer 25

Infection, multiple gestation. Cord prolapse & infection. Risk for infection is high. IV abx, bed rest and betamethasone. Nitrazine paper (ferning) and US.

Question 26

What are the cardinal signs of gestational HTN? What is eclampsia? What are risks associated with gestational HTN? What are things a nurse needs to assess for? Management?

Answer 26

Inc BP (>30 mmHg above pt baseline), edema (systemic), proteinuria. Seizure due to increased BP. Seizure, coma & death because of cerebral edema. Hyperreflexia (2+ is normal, anything higher is abnormal), urine dip for protein, 24 h creatnine clearance, clonus (determine impending seizure), weight. Bed rest, low stim, labetolol, magnesium sulfate (anti-convulsant).

Question 27

What is HELLP? What is a pre-cursor? Do we know exactly what causes it? What occurs with HELLP which makes birth risky? What is the cure?

Answer 27

Hemolysis, increased liver Es, decreased platelets. Pre-eclampsia is a pre-cursor. Abnormal bleeding & clotting make birth a risk. Delivery is the cure.

Question 28

What medications learned in this course are teratogenic?

Answer 28

Warfarin, lithium and SSRI.

Question 29

Why is folic acid important in pregnancy?

Answer 29

Form new RBC, prevent neural tube and abdominal wall defects.