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MIN Exam 2 > Antepartum Complications > Flashcards

Antepartum Complications Flashcards

1
Q

TORCH

A 
T: Toxoplasmosis
O: other like hepatitis
R: Rubella
C: CMV
H: Herpes Simplex
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2
Q

Symptoms of some infections may appear in mother as ____ and in baby as ____

A

flu-like, more serious

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3
Q

Herpes Simplex Virus

A

HSV

  • 1 in 6 americans
  • 1 and 2 with type 2 causing more outbreaks than 1
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4
Q

Following primary herpes infection clearing, ……

A

viral shedding continues for up to 3 months

subsequent outbreaks vary thereafter

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5
Q

_____ risk of fetal transmission with presence of lesion and primary infection of herpes

A

50%

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6
Q

__ to __ of herpes infections are truly asymptomatic or unrecognized

A

60 to 90%

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7
Q

Primary test for herpes

A
  • viral culture in most clinics

- confirm diagnosis by PCR

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8
Q

Clinical Manifestations of Herpes

A
  • lesions begin as small macules that progress to vesicles on an erythematous base that eventually ulcerate
  • very painful
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9
Q

Tx of New onset HSV

A
  • Acyclovir or a similar antiviral agent
  • hygiene measures to avoid secondary infection
  • pain management with an NSAIDs or a lidocaine based topical if needed
  • diet rich in B vitamins, vitamin C, zinc and calcium
  • education and emotional support
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10
Q

Greatest risk for transmitting to NB occurs…

A

when mother gets infected in the third trimester

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11
Q

Acyclovir

A

reduces length of time of outbreak and severity and asymptomatic viral shedding (ASV)

-use as suppressive Rx to reduce transmission and at 36 weeks gestation to protect fetus

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12
Q

When can herpes infected patient deliver vaginally?

A
  • if no lesions visible

- on suppressive rx

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13
Q

Condoms and Herpes

A

-reduce spread but no full proof

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14
Q

HSV most important STD in enhancing _____

A

HIV transmission

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15
Q

Herpes effects on neonate

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

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16
Q

herpes encephalitis

A

untreated is fatal

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17
Q

Tx for infants infected with herpes

A
  • anti-viral medications help tremendously
  • best tx is primary prevention (tx 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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18
Q

Can Lead to pre-term birth

A
  • syphilis
  • HIV
  • chlamydia
  • bacteria vaginosis
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19
Q

Fastest spreading STD in US women

A

Chlamydia

1 in 20 girls between 14-19 has had it

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20
Q

______ isn’t technically isn’t an STD

A

Bacteria Vaginosis (BV)

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21
Q

Effects of Syphilis on pregnant women

A
  • 25% will have stillbirth or neonatal death
  • 40-70% will have syphilis-infected baby if untreated
  • if they survive, many of these babies have long term health problems even with aggressive therapy
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22
Q

Nursing care of Pregnant patient with syphilis

A
  • screen all patients at first visit and later - VDRL and RPR
  • tx pregnant women with parental PCN-G and if allergic to PCN try to desensitize. If this isn’t possible, erythromycin and azithromycin
  • PCN-G can be given throughout pregnancy, but best results with the least negative fetal outcomes occur if tx by 18 weeks
  • assess NB for symptoms
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23
Q

When do babies have symptoms of congenital syphilis

A

-at birth or may take several weeks to develop

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24
Q

Symptoms of babies with congenital syphilis

A
  • anemia
  • fever
  • rashes and skin sores
  • moist sores of congenital syphilis are infectious
  • liver and spleen and various deformities
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25
Q

HIV and AIDS in childbearing population

A
  • end of 2012, an estimated 1.2 mil aged 13 and older living with HIV infection
  • incidence of HIV in obstetrics: 1/1000
  • 90% of pediatric cases r/t perinatal transmission
  • sero-conversion to HIV is 6-12 weeks after exposure
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26
Q

Factors that increase viral transmission

A
  • previous child with HIV
  • preterm birth
  • decreased maternal CD4 counts
  • firstborn twin
  • SVD
  • chorioamnioitis
  • intrapartum blood exposure
  • failure to tx mom and fetus/NB during perinatal period with zidovudine “AZT” aka “ZDV”
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27
Q

Bacterial Vaginosis

A
  • whiff test
  • very common in preg. pts
  • interruption of normal vaginal bacterial flora
  • tx as it can lead to preterm labor, PROM, or chorioamnionitis
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28
Q

chorioamnionitis

A

intra-amniotic infection (IAI) is an inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection. It typically results from bacteria ascending into the uterus from the vagina and is most often associated with prolonged labor.

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29
Q

Symptoms of BV

A
  • 50% of women with BV have no symptoms
  • excessive, thin gray or white vaginal discharge that sticks to the vaginal walls
  • fishy, musty, unpleasant vaginal odor, most noticeable after sexual intercourse
  • vaginal itching and irritation
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30
Q

Tx of BV

A

Rx with metronidazole or clindamycin

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31
Q

Ectopic Pregnancy

A

-fertilization implants outside uterine cavity

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32
Q

Symptoms of ectopic pregnancy

A
  • missed period
  • adenexal tenderness
  • variable abdominal pain
  • vaginal bleeding and or shock
  • Cullen’s sign (unbilical bruising)
  • shoulder pain in some
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33
Q

Risk Factors for Ectopic Pregnancy

A
  • PID
  • Prior EP
  • TUbal surgery
  • IUD
  • Endometriosis
  • Assisted Reproduction
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34
Q

Labs & Diagnostic Tests

A
  • low progesterone and hCG levels

- transvaginal ultrasound

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35
Q

Managing Symptoms of Ectopic Pregnancy

A
  • pain
  • bleeding
  • emotional support
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36
Q

Tx for Ectopic Pregnancy

A
  • requires pt to be healthy with an unruptured less than 4cm pregnancy and absence of FHR
  • Drug of choice: Methotrexate (MTX)
  • Surgery to spare the tube (Salpingostomy) or removal of tube (Salpingectomy)
  • check Rh status of patient
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37
Q

Hyperemesis Gravidarum

A

HG

  • 70% in first trimester some N/V
  • uncontrolled vomitting
  • less than 1% develop HG
  • exact cause unknown
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38
Q

Risk factors for HG

A
  • less than 20 years
  • obese
  • multi-fetal
  • GTD
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39
Q

Clinical Manifestations of HG

A
  • greater than 5% pre-pregnancy weight loss
  • dehydration
  • F&E imbalance
  • ketosis
  • ketonuria
  • BP may be low and HR rapid
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40
Q

Med Management of HG

A
  • IVF for sig. dehydration
  • Pyridoxine (B6) and Doxylamine first line agents
  • Metoclopramide and ondansteron if first line ineffective
  • avoid corticosteroids - risky
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41
Q

Diet Management for HG

A 
low fat
mod-high protein
bland 
5-6 smaller meals
chamomile tea
ginger ale
PB on toast/crackers

Worst case scenario would be parenteral nutrition

42
Q

Cervical insufficiency

A

(incompetent Cervix)

  • painless dilatation of the cervix without CTX that can lead to pregnancy loss in 2nd trimester
  • can be related to congenital factors or acquired factors like cervical trauma, inflammation or surgical damage
  • assessing cervical length using ultrasound helpful.
  • for shorter cervixes, cerclage has no been shown to be effective in preventing preterm birth
43
Q

Tx for cervical insufficiency

A
  • cerclage placed at 11-15 wks
  • continue BR
  • oral tocolytics if needed
  • monitoring
  • hydration
  • report to hospital if CTX less than 5 min apart, SROM, or urge to push occurs
44
Q

TAC

A

Trans-abdominal Cerclage is a more morbid procedure than transvaginal cerclage. It usually requires a laparotomy for placement and delivery by cesarean

45
Q

Spontaneous Abortion

A
  • up to 15% end in miscarriage
  • miscarriage is spontaneous abortion less than 20 wks
  • 90% occur before 8 weeks and may be r/t fetal anomalies, endocrine disturbances, infections including chlamydia, and systemic disorders
46
Q

Patient care following spontaneous abortion

A
  • threatened: BR and support
  • inevitable/incomplete: D and C with pre-post op care
  • late miscarriages may require prostaglandins and oxytocin to prevent hemorrhage
  • shower for 2 weeks
  • introduce nothing into vagina until bleeding stops
47
Q

Diet for spontaneous abortion

A
  • high in protein and Fe

- plenty of rest

48
Q

Avoid becoming pregnant for at least _____ after miscarriage

A

2 months

49
Q

Expected outcomes following a spontaneous abortion

A
  • patient does not develop excessive bleeding or infection
  • verbalizes relief from pain
  • identify and utilize support systems
  • mother and family can discuss impact of loss on their lives
50
Q

Gestational Diabetes

A

-carbohydrate intolerance with onset first recognized in pregnancy

51
Q

Preconception counseling for women with pre-gestational DM

A
  • increased risk of spontaneous abortion
  • birth defects directly related to glucose control at conception and during fetal development
  • counseling and diabetes control improves pregnancy outcomes
52
Q

Macrosomia with GDM

A

greater than 4000gm birth weight

about 25 percent of pregnancies

53
Q

HTN and preeclampsia with GDM

A

rates increased

54
Q

Hydramnios with GDM

A

rates 10x greater

-a condition in which excess amniotic fluid accumulates during pregnancy.

55
Q

Infection with GDM

A

rates higher (UTI and yeast) and result in higher insulin resistance and ketoacidosis

56
Q

Ketoacidosis with GDM

A

r/t diabetogenic effects of pregnancy (women with type 1)

57
Q

Retinopathy with GDM

A

diabetes complication that affects eyes. It’s caused by damage to the blood vessels of the light-sensitive tissue at the back of the eye (retina).

women with type 1

58
Q

Stillbirth and GDM

A

-after 36 wks r/t poor maternal glucose control

59
Q

Insulin needs during 1st trimester

A

insulin needs may drop due to decreased maternal food intake

60
Q

insulin needs during 2nd trimester

A

insulin needs begin to raise as human placental lactogen (hPL) rises and causes maternal insulin resistance

61
Q

insulin needs during 3rd trimester

A

insulin needs may double or more due to increasing insulin resistance

62
Q

insulin needs after delivery

A

with delivery, insulin needs drop abruptly and initially may be less than pre-pregnancy needs (for women with pre-gestational diabetes)

63
Q

As many as ____ of women with GDM develop Type 2 DM later in life

A

50 percent

64
Q

When is GDM often diagnosed?

A

2nd or 3rd trimester

65
Q

Risk factors for GDM

A
  • prior births over 4500gm
  • over 30 y/o
  • obesity
  • family hx type 2 DM
  • hydramnios
  • unexplained stillbirth
  • screen high risk women much earlier
66
Q

Screening for GDM

A
  • screen low risk patients at 24-28 weeks with a 1 hour 50 gram glucose test
  • if value greater than 130-140, proceed to diagnostic 3 hour 100 gm glucose tolerance test
  • if two or more values of GTT are elevated, GDM is diagnosed
67
Q

Tx for GDM

A
  • maintain FBS of less than 95
  • maintain 2 hour post-prandial value less than 120
  • self glucose monitoring FBS and 2 hours post prandial
68
Q

Diet for GDM

A
  • ADA mealplan appropriate for pregnancy and DM, with avoidance of concentrated CHO
  • CHO counting if patient on intensive insulin regimen
69
Q

Tx: GDM and Type 2

A

glyburide may be used to control maternal blood glucose

-insulin may be needed to control blood glucose

70
Q

Tx: GDM and Type 1

A

insulin required

71
Q

Fetal Surveillance with GDM

A
  • est. EDD
  • screen for fetal neural tube defects in early 2nd trimester
  • screen for fetal cardiac malformations by week 22
  • by 28 wks, NST weekly
  • in presence of non-reactive NST, a CTX test or BPP is ordered
72
Q

Classifications of HTN

A

(140/90)

  1. chronic HTN
  2. gestational HTN
73
Q

Chronic HTN

A

onset occurs before pregnancy and continues for at least 42 days postpartum or longer

74
Q

Gestational HTN

A

pt is hypertensive after 20 weeks gestation without proteinuria

-BP returns to normal range 3 months after birth

75
Q

GH is leading cause of…

A

maternal mortality and is a leading medical complication of pregnancy

76
Q

GH contributes to…

A

fetal death and perinatal mortality and morbidity

77
Q

Incidence by race

A 
NA: 46.5/1000
AA: 41.5/1000
W: 38.1/1000
Hisp: 26.3/1000
Asian: 20.8/1000
78
Q

Anti-HTN Meds

A
  • Labetalol
  • Nifedipine
  • Methyldopa
79
Q

Labetalol

A

avoid if patient has hx of asthma

80
Q

Nifedipine

A

useful in treating preterm labor also

81
Q

Methyldopa

A

“Aldomet” an old standard

82
Q

When are Anti-HTN meds used…

A

when systolic is greater than 150-160 and diastolic is greater than 100

83
Q

Preeclampsia

A

HTN frequently with proteinuria

  • most commonly occurring between 25-30 weeks and up to 48 hours after delivery
  • edema is almost always present
  • can be mild or severe
84
Q

Risk factors for Preeclampsia

A
  • fam hx
  • hx of HTN, renal dz, DM
  • NA and AA
  • Poor nutrition, esp severe protein deficiency
  • age less than 20 and greater than 40
  • obesity
  • Rh incompatibility
85
Q

BP differences in mild and severe preeclampsia

A

mild: 140/90 x2 4 hrs apart
severe: 160/110 x2

86
Q

UO differences in mild and severe preeclampsia

A

mild: Output matches intake, 30mL/hr
severe: 20mL/hr or less than 400/24 hr

87
Q

Proteinuria differences in mild and severe preeclampsia

A

mild: trace to 1+ dipstick
severe: greater than 2+ dipstick

88
Q

Epigastric pain differences in mild and severe preeclampsia

A

mild: absent
severe: present

89
Q

Reflexes differences in mild and severe preeclampsia

A

mild: may be normal
severe: hyperreflexia, clonus

90
Q

Headache differences in mild and severe preeclampsia

A

mild: absent
severe: severe HA with visual problems

91
Q

Platelets differences in mild and severe preeclampsia

A

mild: normal
severe: low

92
Q

Tx of Preeclampsia

A
  • home care with close f/u if BP stable and urine protein less than 2+
  • teach self monitoring of BP, weight, urine dipstick, fetal kick counts daily
  • healthy diet, avoid high salt and drink 8-10 cups water/day
  • coping with anxiety and BR
  • identify support systems for family
  • home care, remote NST
93
Q

Magnesium Sulfate

A

(IV)

  • position patient and inform her of drug effects
  • O2 support and placment of foley
  • monitor VS, DTRs, FHR, and fetal well being and CTX continuously with bolus, then q 15-30 until stable
  • hourly strict I&O checking urine protein
  • periodic monitoring of serum mag and chemistries
  • continue infusing 24 hrs portpartum
94
Q

antidote to mag

A

calcium gluconate

95
Q

IV Labetalol and Apresoline

A
  • critical to monitor maternal response closely

- if less severe, PO labetalol or Nifedipine may be ordered

96
Q

Caring for postpartum is focused on…

A
  • assessing BP q4 for 2 days
  • fundal checks
  • observing lochia amount administering oxytocin or prostaglandins if bleeding occurs
  • observing and facilitating maternal bonding
  • grief counseling if outcome is poor
97
Q

Eclampsia

A
  • seizure state following uncontrolled HTN
  • severe HTN affects both fetus and mother
  • may require emergency C/S once patient is stable
  • birth is the cure for pre-eclampsia
98
Q

HELLP

A

H: HEMOLYSIS
E: ELEVATED
L: LIVER ENZYMES L: LOW
P: PLATELET COUNT

  • most common in older caucasian multips who may present with several days fatigue, abdominal pain and often N/V
  • symptoms of severe eclampsia
  • lab, not clinical diagnosis as previously described
  • BUN and creatinine also elevated
99
Q

Maternal consequences of HELLP

A
  • mortality rates as high as 24 percent

- increased risk for abruptio placenta, DIC, cerebral, hemorrhage, liver failure, acute renal failure

100
Q

Fetal consequnces

A
  • IUGR
  • increased risk for fetal demise. try to delay delivery in preterm infants until L/S ratio is 2 to 1 or BMS is given to mother
101
Q

Tx HELLP Syndrome

A
  • interventions include seizure precautions, educating mother and family about disorder and treatment plan and associated risks
  • maintain strict BR
  • incorporate stress reducers in plan of care
  • prepare for birth, recovery, discharge, and followup with aim of extending pregnancy as long as is feasible
102
Q

HTN in pregnancy could…

A

induce long-term metabolic and vascular abnormalities that might increase the overall risk of CVD later in life.

MIN Exam 2 (6 decks)

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