Antental complications Flashcards

1
Q

What are the common pregnancy complications ?

A
  • Bleeding during pregnancy
  • Gestational diabetes ( GDM )
  • Pregnancy-induced hypertension ( PIH )
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2
Q

What are the first trimester complications? ( common causes of bleeding )

A

Spontaneous abortion / miscarriage

  • Threatened
  • Inevitable
  • Complete
  • Missed
  • Incomplete

Ectopic pregnancy
Abdominal pregnancy

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3
Q

What are the second trimester complications? ( common causes of bleeding )

A

Gestational trophoblastic disease ( Hydatidiform mole )

When a normal sperm cell fertilizes one of these oocytes, the resulting embryo has only one set of chromosomes. Because the embryo has no genes from the mother, the pregnancy cannot develop normally, resulting in a hydatidiform mole.

Premature cervical dilatation

Disseminated intravascular coagulation ( DIC )

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4
Q

What are the third trimester complications ? ( common causes of bleeding )

A
  • Placenta previa
  • Abruptio placenta
  • Preterm labour
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5
Q

What to do if there is spontaneous abortion ( threatened ) ?

A
  • avoid strenous activity / bed rest, avoid coitus for 2 weeks
  • medication : progesterone if inadequate luteal function
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6
Q

What to do if there is spontaneous abortion ( Inevitable / incomplete ) ?

A
  • misoprostol orally to induce contractions

- suction curettage / dilation and curettage / dilation & evacuation

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7
Q

What to do if there is spontaneous abortion ( missed ) ?

A
  • < 14 weeks : dilation and curettage
  • . 14 weels : prostaglandin suppository or oral misoprostol to dialte the cervix, then oxytocin infusion or administration of mifepristone.
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8
Q

what is GDM?

A

gestational diabetes mellitus

- a chronic disease in which glucose metabolism is impaired by a lack of insulin or by ineffective insulin utilization

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9
Q

what are the types of pre-gestational diabetes?

A

Type 1 and Type 2 ( pre-gestational diabetes )

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10
Q

What are the effects of GDM on pregnant mother?

A
  • Increase spontaneous miscarriage : 15-30%
  • Pregnancy induced hypertension ( 3-5 times )
  • Increased rate of CS and postpartum hemorrhage : macrosomic baby
  • UTIs increase
  • Polyhydramnios ( > 2000ml )
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11
Q

What is the effect of GDM on fetus?

A
  • Fetal death
  • Congenital anomalies
  • Macrosomia ( > 4,500g )
  • Fetal growth restriction
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12
Q

Assessment of GDM

A
  1. Health history ; physical examination
  2. Risk factors.
  3. Maternal surveillance
  4. Fetal surveillance
  5. GDM screening test ; glucose challenge test
  6. GDM diagnostic test : 2-hour oral glucose tolerance test
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13
Q

What are the risk factors?

A

Personal/ family history of GDM, previous unexplained stillbirth, marked obesity and glycosuria

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14
Q

What is maternal surveillance ?

A

The screening at first prenatal visit ; additional screening at 24 to 28 weeks for women considered at risk
urine for protein, ketones, nitrates and leukocyte esterase ; evaluation function/ trimester ; eye exam in first trimester ; hbA1c

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15
Q

what is fetal surveillance?

A

ultrasound ; alpha-fetoprotein levels ; amniocentesis

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16
Q

What is glucose challenge test?

A

sample drawn 1 hour after a 50g glucose drink : 7.2 mmol/L and over : abnormal

17
Q

What is 2 hour oral glucose tolerance test?

A

samples drawn after 75g glucose drink

18
Q

Less than 140mg/dL ( 7.8 mmol / L )

A

Normal glucose tolerance

19
Q

From 140 to 199 mg/dL ( 7.8 to 11.1 mmol/L )

A

Prediabetes ( impaired glucose tolerance )

20
Q

= / > 200mg/dL ( 11.1 mmol/L ) on more than one testing occasion

A

Diabetes

21
Q

What is the medical management for GDM ?

A

It would maintain blood glucose level in the normal range and prevent ketoacidosis

22
Q

What is pre-pregnancy care?

A
  • Normal blood glucose level : several months before pregnancy
  • Daily multivitamin supplement e.g. folic acid
23
Q

Blood glucose monitoring

A

Blood glucose level during pregnant : 7 point blood sugar profile , 95 mg/dL ( fasting )

Blood glucose level control : HbA1c < 7%

24
Q

Close maternal and fetal surveillance

A
  • Nutritional management

- Hypoglycemic agents

25
Q

Optimal glucose control

A
  • Blood glucose levels ; medication therapy

- Nutritional therapy

26
Q

Patient education and counseling

A
  • Measures during labour and birth ; postpartum

- Prevention of complications

27
Q

What is Patient Induced Hypertension ( PIH )?

A

a condition in which vasospasm occurs during pregnancy in both small and large arteries

28
Q

What are the signs of PIH

A

Hypertension, Proteinuria and generalised edema

29
Q

What are the severe manifestations?

A

headache, blurred vision, nausea, vomitting, convulsion, coma

30
Q

What is gestational hypertension?

A

BP > 140/90 mmHg

31
Q

Mild pre eclampsia

A

BP > or equal 140 / 90mmHG
Systolic diastolic BP : 30 /15 mmHG more
May with mild proteinuria ( 1+ or 2+ ) or edema

32
Q

What are the types of PIH

A

Mild pre-eclampsia
Severe pre-eclampsia
Eclampsia

33
Q

Severe pre eclampsia

A
  • BP > or 160 / 110 mmHg / diastolic BP 30 mmHG more
  • Proteinuria ( 3+ or 4+ ). >5g/ 24 hours urine
  • Edema : different levels
  • Headache, blurred vision , nausea and vomiting
34
Q

Eclampsia

A
  • It is a seizure or coma occurs due to cerebral edema
  • Fetal hypoxia : Fetal mortality rate 25%
  • Antepartum / intrapartum / postpartum eclampsia
35
Q

PIH - Medical management

mild preeclampsia management

A
  • Bed rest, daily BP monitoring and fetal movement counts

- Hospitalisation - IV magnesium sulphate during labour

36
Q

Severe preeclampsia management

A

Hospitalization - oxytocin and IV magnesium sulphate ; preparation for birth

37
Q

Eclampsia management

A
  • seizure management
  • IV management sulphate and antihypertensive agents
  • Births once seizures controlled
38
Q

What is the nursing assessment?

A

Risk factors, BP, nutritional intake, weight, edema, urine for protein, other laboratory tests

39
Q

What is the nursing management for PIH?

A
  • Home management for mild preeclampsia
  • Hospitalization for severe preeclampsia ; quiet environment, sedatives, seizure precautions, antihypertensives, assessing for magnesium toxicity and labour
  • Seizure management for eclampsoa ; fetal monitoring ; uterine contraction monitoring, preparation for birth
  • Follow up postnatal care