antepartum complications Flashcards
gestational diabetes
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
DM - maternal risk
polyhydraminos (more fetal urine), preeclampsia-ecl (htn), ketoacidosis (stillbirth), dystocia (difficult labor - bigger bay), increased infection susceptibility
yeast infection, retinopathy
DM - fetal risk
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)
dm - screen
increase risk = early; assess risk at first visit
1hr gtt: >140 = further testing
3hr, diagnose if 2 levels exceed (fasting)
dm - tm
diet and exercise, monitor, insulin
goals: fasting <95, 1hr <140, 2hr <120
dm - nc
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
anemia
Fe: take supplement
sickle cell: prevent crisis, treat with IV fluid, O2, abx, folic acid, analgesics
folic acid: supplement
Fe admin and SE
substance abuse
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
HIV/AIDS
test and retest
nc: educate, prevent, precautions, ZDV, C/S, bottle feed, counsel and support
cardiac disorder
congential heart, peripartum cardiomyopathy, eisenmenger syndrome, mitral valve prolapse
cardiac disorder tm - antepartum
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
cardiac disorder tm - intrapartum
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)
cardiac disorder tm - postpartum
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
spontaneous abortion nc
assess amount and appearance of blood, monitor VS and comfort, RH?, coping
usually 1T
spontaneous abortion - imminent
cervix open, placenta dettatch
spontaneous abortion - threatened
closed cervix, preg may continue, bleeding
spontaneous abortion - incomplete
remnants of preg (placenta)
spontaneous abortion - complete
everything out
recurrent miscarriage
3+ consecutive or 2 if old mom
care depends on hx and situation
genetic testing, thyroid disease, antiphospholipid antibody S
ectopic pregnancy
sharp one sided!!!!! pain
IM methotrexate -> avoid sun, report pain and heavy bleeding
if sx = IV, preop and post op care, assess shock, analgesics
gestational trophoblastic disease (molar preg)
proliferation of trophoblastic cells
s/s: dark brown bleed, anemia, grapelike vesicles, uterine enlarge, x FHT, high hcg, low MSAFP, hyperemesis gravidarum , preE
gestational trophoblastic disease (molar preg) - complete
ovum without genetic, normal sperm
gestational trophoblastic disease (molar preg) tm
D+C, hysterectomy (carcinoma), follow up (serial hcg)
gestational trophoblastic disease (molar preg) - partial
ovum norm, 2 sperm, not divided
hyperemesis gravidarum
lots of vom (hydrate and nutrition)
ketonuria, weight loss 5%
hyperemesis gravidarum nc
assess and identify, adequate fluids, TPN, balanced diet, relaxed and quiet env, antiemetics, counsel and support, refer prn
Rho alloimmunization
— mom and + fetus
mom makes antibodies -> hemolysis of rbc - > rapid production of erythroblasts, hyperbilly
fetal risk: anemia, CHF, jaundice, neuro damage, severe hemolytic S
Rho alloimmunization tm - antepartum
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
Rho alloimmunization tm - postpartum
cord blood: - = rhogam w/n 72 hr, + = nothing, monitor fetus
kleihauer-betke: hom much + blood present and how much rhogam needed
ABO incompatibility
mom = O, fetus = A, B, or AB
less serious
hemolysis -> hyperbilly, can do coombs, severe anemia not common
s/s hypogly
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
coombs testing
indirect: mom, detect maternal antibodies
direct: cord, detect if antibodies adhered to infant RBC
