antepartum complications

Question 1

gestational diabetes

Answer 1

insufficient insulin production d/t preg
1t: decreased need for insulin (hormones enhance production and insulin response)
after = increased need (hormones act as insulin antagonists)
glucose crosses fetal membrane (produces own insulin

Question 2

DM - maternal risk

Answer 2

polyhydraminos (more fetal urine), preeclampsia-ecl (htn), ketoacidosis (stillbirth), dystocia (difficult labor - bigger bay), increased infection susceptibility
yeast infection, retinopathy

Question 3

DM - fetal risk

Answer 3

perinatal mortality (stillbirth), congenital anomalies (hypergly early), macrosomia (hypergly late), IUGR (decreased placental perfussion), RDS (surfactant production impaired), polycythemia (hgb cant released as much hO2), hypoglycemia after delivery, hyperbilly (immature liver enzymes)

Question 4

dm - screen

Answer 4

increase risk = early; assess risk at first visit
1hr gtt: >140 = further testing
3hr, diagnose if 2 levels exceed (fasting)

Question 5

dm - tm

Answer 5

diet and exercise, monitor, insulin
goals: fasting <95, 1hr <140, 2hr <120

Question 6

dm - nc

Answer 6

antepartum: assess (glucose levels and fetus - movement, vs, stress test), educate - disease, treat, monitor, insulin; support
intrapartal: assess timing of delivery and glucose
postpartal: assess glucose -> insulin req decrease, encourage breast feed

Question 7

anemia

Answer 7

Fe: take supplement
sickle cell: prevent crisis, treat with IV fluid, O2, abx, folic acid, analgesics
folic acid: supplement
Fe admin and SE

Question 8

substance abuse

Answer 8

prevent
s/s: vague/unusual complaints, hx, depression, STI, decreased nutrition, track marks, mood swings, hallucinations, freq accidents or falls, cirrhosis, hep
educate!, trusting and non judgeM

Question 9

HIV/AIDS

Answer 9

test and retest
nc: educate, prevent, precautions, ZDV, C/S, bottle feed, counsel and support

Question 10

cardiac disorder

Answer 10

congential heart, peripartum cardiomyopathy, eisenmenger syndrome, mitral valve prolapse

Question 11

cardiac disorder tm - antepartum

Answer 11

monitor S, vs, functional capacity, cough, dyspnea, edema, murmur, palpitation, rales, weight gain
assess anemia, infection, low support, life demands
restrict activity, 8-10 hr of sleep, avoid infection
visit q2 week, then q1
increase Fe, protein; decrease Na, adequate cal

Question 12

cardiac disorder tm - intrapartum

Answer 12

Vs and lungs q2hr , side lying/semifowlers, continuous EFM
prn: O2, diuretics, sedatives, analgesics, prophyl abx, digitalis
pushing = short, mod with relax btw
epi recommended (decrease CO and O2 demands)

Question 13

cardiac disorder tm - postpartum

Answer 13

Vs q4 hr and S of cardiac decomp; side lying or semiF, gradually increase activity, diet and stool soften, S of cardiac problems with d/c edu

Question 14

spontaneous abortion nc

Answer 14

assess amount and appearance of blood, monitor VS and comfort, RH?, coping
usually 1T

Question 15

spontaneous abortion - imminent

Answer 15

cervix open, placenta dettatch

Question 16

spontaneous abortion - threatened

Answer 16

closed cervix, preg may continue, bleeding

Question 17

spontaneous abortion - incomplete

Answer 17

remnants of preg (placenta)

Question 18

spontaneous abortion - complete

Answer 18

everything out

Question 19

recurrent miscarriage

Answer 19

3+ consecutive or 2 if old mom
care depends on hx and situation
genetic testing, thyroid disease, antiphospholipid antibody S

Question 20

ectopic pregnancy

Answer 20

sharp one sided!!!!! pain
IM methotrexate -> avoid sun, report pain and heavy bleeding
if sx = IV, preop and post op care, assess shock, analgesics

Question 21

gestational trophoblastic disease (molar preg)

Answer 21

proliferation of trophoblastic cells
s/s: dark brown bleed, anemia, grapelike vesicles, uterine enlarge, x FHT, high hcg, low MSAFP, hyperemesis gravidarum , preE

Question 22

gestational trophoblastic disease (molar preg) - complete

Answer 22

ovum without genetic, normal sperm

Question 23

gestational trophoblastic disease (molar preg) tm

Answer 23

D+C, hysterectomy (carcinoma), follow up (serial hcg)

Question 24

gestational trophoblastic disease (molar preg) - partial

Answer 24

ovum norm, 2 sperm, not divided

Question 25

hyperemesis gravidarum

Answer 25

lots of vom (hydrate and nutrition)
ketonuria, weight loss 5%

Question 26

hyperemesis gravidarum nc

Answer 26

assess and identify, adequate fluids, TPN, balanced diet, relaxed and quiet env, antiemetics, counsel and support, refer prn

Question 27

Rho alloimmunization

Answer 27

— mom and + fetus
mom makes antibodies -> hemolysis of rbc - > rapid production of erythroblasts, hyperbilly
fetal risk: anemia, CHF, jaundice, neuro damage, severe hemolytic S

Question 28

Rho alloimmunization tm - antepartum

Answer 28

indirect coombs test, Rh immunoglobulin IM
prophylactic 28 wk if - and spontaneous/induced abortion/ectopic, invasive, trauma
sensitized woman and
fetus: monitor fetus: non stress test, serial US, amniotic fluid analysis, doppler; if severe anemia or fetalhydrops: fetus given intrauterine blood transfusion, preterm

Question 29

Rho alloimmunization tm - postpartum

Answer 29

cord blood: - = rhogam w/n 72 hr, + = nothing, monitor fetus
kleihauer-betke: hom much + blood present and how much rhogam needed

Question 30

ABO incompatibility

Answer 30

mom = O, fetus = A, B, or AB
less serious
hemolysis -> hyperbilly, can do coombs, severe anemia not common

Question 31

s/s hypogly

Answer 31

palor, shaky, sweat, HA, hunger or n, irregular/fast HR, fatigue, irritable, anx, difficulty [], dizzy, lightheaded, tingling or numbness of tongue/lip/cheek, confusion, loss of coordination, slurred speech, blurry or tunnel vision

Question 32

coombs testing

Answer 32

indirect: mom, detect maternal antibodies
direct: cord, detect if antibodies adhered to infant RBC