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Mother/Infant > ANTEPARTUM COMPLICATIONS > Flashcards

ANTEPARTUM COMPLICATIONS Flashcards

1
Q

ANTENATAL COMPLICATIONS

A 
STD?TORCH/BV in pregnancy 
ectopic pregnancy
-hyperemesis gravidarum 
cervical insufficiency 
spontaneous abortion 
diabetes in preganacy 
hypertension in pregnancy pre elampsia and eclampsia
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2
Q

INFECTIONS OF PREGNANCY

A 
T-toxoplasmosis
O- other like hepatitis
R- rubella
C- CMV
H- herpes simplex
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3
Q

HERPES SIMPLEX VIRUS

A
  • 1 in 6 americans infected
  • HSV-1 or HSV2 with type 2 causing more outbreaks
  • following primary infection clearing, viral shedding continues for up to 3 months ,subsequent outbreaks vary thereafter
  • 50% risk of fetal transmission with presence of lesion and primary infection
  • 60-90% of infections are truly asymptomatic or unrecognized
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4
Q

DIAGNOSIS

A
  • viral culture is primary test in most clinics
  • confirmed diagnosis by PCR
  • lesions begin as small macules that progress to vesicles on an erythematous base that eventually ulcerate, very painful
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5
Q

TREATMENT OF NEW ONSET HSV

A
  • acyclovir or a similar antiviral agent
  • hygiene measures to avoid secondary infection
  • pain management with lidocaine based topical if needed
  • diet rich in B vitamins, vitamin C, zinc, and calcium (boosts immunity)

-education and emotional support -greatest risk for transmitting to newborn occurs when mother gets infected in third trimester

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6
Q

TREATMENT OF HSV

A
  • acyclovir reduces length of time of outbreak and severity and asymptomatic viral shedding . use as suppressive to reduce transmission and @ 36wks gestation to protect fetus
  • if no lesion visible and on suppressive can safely deliver vaginally
  • teach clients about AVS
  • condoms reduce spread, but are not full proof
  • HSV most important STD in enhancing HIV transmission
  • psychological support need to empower client
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7
Q

EFFECTS ON NEONATE (HSV)

A
  • infant may be asymptomatic at birth but 2-12 days later may develop fever or hypothermia ,jaundice, seizures and poor feeding and half develop vesicular lesions
  • herpes encephalitis untreated is fatal
  • anti viral medications tremendously helpful
  • best treatment is primary prevention. treat mom when symptoms present and consider C/S . acyclovir does not appear to harm fetus but best avoided in 1st trimester
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8
Q

HERPES NURSING DIAGNOSIS

A
  • pain r/t lesions secondary to HSV
  • sexual dysfunction

prenatal visits include assessing for history of HSV in woman and partner

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9
Q

THE FOLLWING CAN LEAD TO PRETERM BIRTH

A
  • syphilis
  • HIV
  • chlamydia: fastest spreading std in US women 1in 20 girls between 14-19 has had it
  • bacteria vaginosis: BV techinically isn’t an STD ,irritates the uterus
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10
Q

EFFECTS OF SYPHILIS ON PREGNANT WOMEN

A
  • 25% will have stillbirth or neonatal death
  • 40-70% will have syphilis infected babies if untreated
  • can transplacentally be transmitted
  • if they survive, many of these babies have long term health problems even with aggressive therapy
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11
Q

NURSING CARE OF THE PREGNANT PATIENT WITH SYPHILIS

A
  • screen all patients at first visit and later -VDLR, or RPR
  • treat pregnant women with parental penicillin G and if allergic to penicillin try to desensitize if this isn’t possible can give erythromycin or azithromycin
  • assess newborns for symptoms
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12
Q

BABIES WITH CONGENOTAL SYPHILIS

A
  • can have symptoms at birth or symptoms may take weeks to develop
  • anemia,fever, rashes and skin sores, mist sores or congenital syphilis are infectious, liver and spleen and various deformities
  • the rise in infant syphilis morbidity is a public health concern
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13
Q

HIV AND AIDS IN CHILDBEARING POPULATION

A
  • at the end of 2012 an estimated 1.2 million persons aged 13 and older were living with HIV infection in the US .including 156,300 persons who had not been diagnosed
  • incidence of HIV in US obstetric population 1/1000
  • 90% of pediatric cases r/t perinatal transmission
  • sero-conversion to HIV is 6-12 weeks after exposure
  • use antiretrovirals before ,during and after labor
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14
Q

FACTORS THAT INCREASE VIRAL TRANSMISSION

A
  • previous child with HIV
  • preterm birth
  • decreased maternal CD4 counts
  • first born twin
  • SVD (vaginal delivery)
  • chorioamionitis
  • intrapartum blood exp.
  • failure to treat mom and fetus/newborn during perinatal period with zidovudine (AZT) aka (ADV)
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15
Q

CASE MANAGEMENT hiv

A
  • screen all women , if a woman is treated for HIV early in preganacy the risk of transmitting HIV to her baby can be 1% or less
  • test HIV positive women for other STDs , CMV and toxoplasmosis and offer PPD
  • check varicells and rubella titers
  • PAP
  • all positive patients receive AZT throughout preganacy regardless of CD4 counts , watch for BM depression
  • CD4 counts <200 get PCP prophylaxis
  • immunize against Hep B, HIB, PCV , Flu
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16
Q

CASE MANAGEMENT HIV

A

-consider social ,cultural and spiritual needs of the mother and confidentiality

  • a disproportionate number of women are minoritiea
  • identify family strengths and capiltalize on them
  • teaching includes safe sex throughout pregnancy
  • while preganacy is discouraged in HIV positive women, provide a hopeful milieu if the patient is pregnant
17
Q

CASE MANAGEMENT HIV

A
  • support for immune system by discussing importance of rest, diet ,activity and stress reduction
  • treatment and teaching for substance abuse
  • deliver within 4hrs of ruotures mambranes
  • a c section if viral load high
  • avoid vacuum and forceps
  • watch for postpartum bleeding and infection
  • avoid breast feeding
  • avoid internal fetal monitoring
18
Q

BACTERIAL VAGINOSIS

A
  • THE WHIFF TEST
  • FISHY SMELL
  • VERY COMMON IN PREGNANCY
  • INTERRUPTION OF NORMAL VAGINAL BACTERIAL FLORA
  • TREAT AS IT CAN LEAD TO PRETERM LABOR ,PROM OR CHORIOAMNIONITIS
  • TREATED WITH FLAGYL
19
Q

SYMPTOMS OF BV AND TREATMENT

A
  • although more than 50% of women with BV have no symptoms, when they do occur they include :
  • excessive ,thin gray or white vaginal discharge that sticks to the vaginal walls
  • fishy or musty smell most noticeable after sexual intercourse
  • vaginal itching and irritation
  • flagyl used to treat, no breast feeding allowed , or metronidazole or clindamycin
20
Q

ETOPIC PREGNANCY

A

-fertilized ovum implants outside uterine cavity

21
Q

RISK FACTORS

A
  • pid
  • prior ep
  • tubal surgery
  • IUD
  • endometreiosis
  • assisted reproduction
22
Q

SYMPTOMS

A 
missed period 
adenexal tenderness
variable abdominal pain 
vaginal bleeding and or shock 
Cullen's sign 
shoulder pain in some

Lab tests
low progesterone and HCG levels transvaginal ultrasound

23
Q

etopic pregnancy management

A

-MANAGE SYMPTOMS
pain,bleeding and emotional support

MEDICAL TREATMENT
-requires pt to be healthy with an unruptured <4cm pregnancy and absence of FHR. Methotrexate drug of choice

SURGICAL
-to spare tube salpingotomy or removal of tube

check RH status of patient

24
Q

HYPEREMESIS GRAVIDARUM = HG

A
  • uncontrolled vomiting
  • cause unknonwn
  • start management through medical ,social and OB/GYN history and PE
25
Q

MANAGEMENT OF HG

A
  • for sig dehydration ,hospitalize with IV fluids
  • pyridoxine (B6) and doxylamine first line agents
  • metoclopramide and odansetron if above ineffective Phenergan
  • diet: low fat,high protein , bland 5-6 small meals
  • chamomile tea,ginger ale,crackers and peanut butter
  • try to avoid corticosteroids
  • parenteral nutrition
  • conseling and support
26
Q

CERVICAL INSUFFIECENCY

A
  • painless dilation of the cervix without contractions that can lead to pregnancy loss in 2nd trimester
  • can be related to congenital factorsor acquired factors like cervical trauma ,inflammation or surgical damage
  • assessing cervical length using ultrasound helpful for women with shorter cervises , cerclage has not been effective in preventing preterm birth
27
Q

TREATMENT FOR CERVICAL INSUFFEINCEY

A
  • CERCLAGE PLACED AT 11-15WKS
  • CONTINUE BEDREST
  • ORAL TOCOLYTICS IF NEEDED
  • MONITORING
  • HYDRATION
  • REPORT TO HOSPITAL IS CONTRACTIONS <5 MIN APART ,sroM,OR URGE TO PUSH
28
Q

SPONTANEOUS ABORTION

A

miscarriage= spontaneous abortion <20wks
-90% occur before 8wks and may be r/t fetal anonmalies, endocrine disturbances,infections including chlamydia and systemic disorders

29
Q

CAUSES OF VAGINAL BLEEDING

A

1st trimester =miscarriage

2nd and 3rd trimester= placental issue, placenta location

30
Q

PATIENT CARE FOLLOWING SPONTANEOUS ABORTION

A

threatended=bed rest
inevitable/incomplete=D&C with pre-post op care late miscarriages may require prostaglnadins and oxytocin to prevent hemorrhage

  • shower for 2 weeks
  • introduce nothing into vagina until bleeding stops
  • diet high in protein and FE and plenty of rest
  • notify MD if foul smelling discharge ,fever or fatigue persists
  • avoid becoming pregnant for at least 2months
  • provide emotional support and spiritual care
31
Q

EXPECTED OUTCOMES FOLLOWING A SPONTANEOUS ABORTION

A
  • pt does not develop excessive bleeding or infection
  • verbalizes relief from pain
  • identify and utilize support systems
  • mother and family can discuss impact of loss o their lives
32
Q

PRECONCEPTION COUNSELING

A
  • for women with pregestational diabetes there is an increased risk of spontaneous abortion and birth defects directly related to glucose control at conception and during fetal development
  • preconceptual counseling and diabetes control and management improve pregnancy outcomes
  • increased thrombolytic events with metformin
33
Q

MATERNAL COMPLICATIONS OF GDM

A

macrosomia- >4,000gm birth weight , 4500= c-section

HTN and preeclampsia- rates increased

HYdramnios= up to 2L extra fluid,

Infection=rates higher UTI and yeast and result in higher insulin resistance and ketoacidosis

ketoacidosis=r/t diabetogenic effects of pregnancy less than 200 pregnancy

retinopathy- women with type 1

34
Q

FETAL AND NEONATAL COMPLICATIONS GDM

A

stillbirth- after 36wks r/t poor maternal glucose control

congenital anomaly rates of 5-10% per pregnancy with cardiac ,CNS and skeletal most common for pregestational diabetes

macrosomia leads to delivery complications

increased risk for respiratory distress

neonatal hypoglycemia ,electrolyte imbalances hyperbulirubinemia and polycythemia

35
Q

DIABETES IN PREGNANCY

A

1ST TRIMESTER- insulin needs may drop due to decreased maternal food intake

2ND TRIMESTER - insulin needs begin to rise as human placental lactogen rises and causes maternal insulin resistance

3RD TRIMESTER- insulin needs may double or more due to increasing insulin resistance

AFTER DELIVERY- insulin needs drop abruptly and initially may be less than pregregnancy needs

insulin during labor

36
Q

SCREENING FOR GDM

A
  • screen for low risk patients at 24-28 weeks with 1hr 50gram glucose test
  • is value >130-140mg/dl ,proceed to diagnostic 3hr 100gram glucose tolerance test
  • if two or more values on GTT are elevated, GDM is diagnosed
37
Q

TREATMENT FOR DIABETES

A

maintain FBS <95

maintain 2hr post prandial value <120mg/dl

self blood glucose monitoring FBS and 2hrs post-prandial

dietary:
- American diabetic association mealplan appropriate for pregnancy and diabetes ,with avoidance of concentrated CHO

-CHO counting id pt on intensive insulin regimen

38
Q

MEDS DURING PREGNANCY

A

GDM AND TYPE 2: glyburide may be used to control maternal blood glucose

GDM,TYPE 2: insulin may be needed to control blood glucose

TYPE 1: insulin required

39
Q

HYPERTENSION MEDICATIONS

A

LABETALOL: avoid if patient has hx of asthma

NIFEDIPINE: useful in treating preterm labor also

METHYLDOPA: “aldomet” and old standard

used when systolic >150-160 and diastolic BP>100

Mother/Infant (8 decks)

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