antipardum exam Flashcards
adaptations of pregnancy - cardio - arteries and blood volume (not thicken)
Main uterine artery doubles in size
Increased blood volume by 40-50%
adaptations of pregnancy - skeletal
Shifting center of gravity
Increase lordosis
Loosening of the ligaments of the pubic symphysis and sacroiliac joints
Muscles of abd stretch and lose tone. Can lead to diastasis recti abdominis
adaptations of pregnancy - integumentary (melatropin in niagra)
Decreases in melanotropin- increase in areas of pigmentation (areolas and nipples)
Chloasma (melasma)
Striae gravidarum- stretch marks
Linea nigra (dark line down abdomen)
adaptations of pregnancy - GI (just relaxed)
Relaxed GI leads to constipation
Bleeding gums due to increase in vascularity
adaptations of pregnancy - GU - renal pelvis (hyper renal is relaxed)
Renal pelvis and ureters dilate: smooth muscle walls of the ureters undergo hyperplasia and hypertrophy (enlargement) and muscle tone relaxes.
adaptations of pregnancy - respiratory - increase or decrease?
Major change in shape to make room for growing uterus and fetus inside
Increased O2 consumption
Increased RR
adaptations of pregnancy - reproductive
Amenorrhea
Endometrium grows to support the embryo and fetus.
Increase in elastic properties
adaptations of pregnancy - reproductive - vagina (mucosa vault)
Vagina: increased mucosa, loosening of connective tissue, lengthening of the vaginal vault, increased vascularity,
What is GBS and when is screening done? (Diabetic in your 30s)
Group B Strep, a gram + organism that colonizes in the female genital tract and rectum; present in 10-30% of all healthy women, asymptomatic but can cause GBS disease of the newborn
Screening btw 36 - 38 weeks
Nonstress test (NST) (don’t stress the heart) - at what age is it recommended, and for who? (don’t stress 28 days later)
Nonstress test (NST) (lasts 20 minutes) is the most common method of prenatal testing used. Provides an indirect measurement of uteroplacental function. Recommended twice weekly, after 28 weeks gestation (3rd trimester), for clients with diabetes and other high-risk conditions. It measures the heart rate of the unborn baby (fetus) in response to its movements. In most cases, the heart rate of a healthy baby increases when the baby moves.
Nonstress test (NST) - results (stressed in 15 and 15)
Reactive = 2 accelerations in 20 minutes; accelerations are FHR equal or greater than 15 BPM over baseline lasting 15 seconds or more, occurs twice during NST (called acceleration)
Non-reactive = abnormal, does not meet criteria; indicates the need for more testing
What are good sources of iron?
Raisins! Red meat, chicken, fish, green leafy vegetable, soy products, nuts and dried fruit, dried beans, eggs, fortified grains
What are good sources of calcium?
Dairy products (milk, cheese, and yogurt), cereals; broccoli, spinach, and kale; salmon
What foods should the woman NOT eat while pregnant?
Artificial sweeteners: risk for higher newborn weight and childhood obesity
Mercury in fish: dangerous in high amounts; contribute to pregnancy complications and developmental problems in the infant
Listeriosis - raw dairy, fruit, fish
GDM/DM in pregnancy (Gestational diabetes mellitus) - fetus
macrosomia (large fetus) resulting from hyperinsulinemia stimulated by fetal hyperglycemia
Hypoglycemia
Childhood obesity
Hyperbilirubinemia
birth trauma due to shoulder dystocia (mechanical problems during delivery)
Congenital anomaly due to hyperglycemia in the 1st trimester (cardiac problems, neural tube defects, skeletal deformities, and genitourinary problems)
Premature birth secondary to polyhydramnios (too much amniotic fluid) and an aging placenta; places the fetus in jeopardy
Fetal asphyxia secondary to fetal hyperglycemia and hyperinsulinemia
Intrauterine growth restrictions secondary to maternal vascular impairment and decreased placental perfusion, which restricts growth
Perinatal death due to poor placental perfusion and hypoxia
Respiratory distress syndrome resulting from poor surfactant production
Polycythemia (a blood disorder) due to excessive RBC production in response to hypoxia
GDM/DM in pregnancy (Gestational diabetes mellitus) - maternal (the 2 big ones) (think of your pt)
preeclampsia and cesarean birth; greater risk of developing cardiovascular disease
Gestational hypertension of unknown etiology
Ketoacidosis due to uncontrolled hyperglycemia
Preterm labor secondary to premature membrane rupture
stillbirth in pregnancies
Hydramnios
Hypoglycemia as glucose is diverted to the fetus (in 1st trimester)
UTIs resulting from excess glucose in the urine
Chronic monilial vaginitis due to glucosuria (promotes yeast growth)
Difficult labor
tetarogens
Teratogens are substances that may produce physical or functional defects in the human embryo or fetus after a pregnant woman has been exposed. Can cause physical deformities, problems in the behavior or emotional development of the child, and decreased IQ. susceptibility depends on the timing of the exposure and the developmental state of the embryo or fetus
alcohol
Alcohol: spontaneous abortion, inadequate weight gain, IUGR (intrauterine growth restriction), FASD (fetal alcohol syndrome)
opiates (pre-opiates)
maternal and fetal withdrawal, placental abruption, preterm labor, premature rupture of membranes, perinatal asphyxia, newborn sepsis and death, malnutrition and intellectual impairment
meth
risk of preterm birth, low birth weight, placental abruption, fetal growth restrictions, and congenital abnormalities
cigarettes
nicotine causes vasoconstriction, and can transfer across the placenta reducing blood flow to the fetus and contributing to fetal hypoxia. Increases risk for spontaneous abortion, tubal ectopic pregnancy, preterm labor and birth, fetal growth restriction, stillbirth, premature rupture of membranes, low fetal iron stores, maternal hypertension, SIDS, cardiac arrhythmias, placenta previa, and placental abruption. Perinatal death rate is higher in infants of smokers. Increased risk of cleft lip and palate, clubfoot, asthma, middle ear infections, reduced head circumference, altered brain stem development, and cerebral palsy. Risk factor for low birth weight, cognitive deficits especially in language, reading, and vocabulary; poorer performances on tests of reasoning and memory; behavioral problems such as increased activity, ADHD, impulsivity, opposition and aggression
Toxoplasmosi
caused by a parasite; cats primary host; spread by contaminated soil, raw meats, and unwashed fruits and veg. Fetus is high risk for preterm labor and stillbirth; low birth weight, enlarged liver and spleen, visual problems, cerebral palsy, hearing loss, seizures, chorioretinitis, jaundice, IUGR, hydrocephalus, microcephaly, neurologic damage and anemia
STIs - effects on baby
depends on the type but effects include: eye infections, pneumonia; low birth weight, stilllbirth, preterm birth; intrauterine growth restrictions; intellectual disabilities, blindness, seizures, premature birth, death; skin ulcers, weakness or hoarse cry, deafness, swollen liver and spleen, amnesia, various deformations; HIV positive status; warts in throat; premature rupture of membranes
Rh factor incompatibility - where is it found? (R loves R)
Rh factor is a protein found on the surface of RBCs
ABO incompatibility - which blood type for mom?
Blood type incompatibility; when a mother with type O blood has become pregnant with a fetus with a different blood type (Type A, B, or AB). Mothers serum contains naturally occurring anti-A and Anti-B which can cross the placenta and hemolysis fetal RBCs
Teen pregnancy - nutritional needs
Nutritional needs
Mothers likely to have poor maternal weight gain, iron-deficiency anemia, poor eating habits and inadequate nutrition
Teen pregnancy - psych
Contributes to loss of self-esteem, societal discrimination, a destruction of life projects, and the prolonging of poverty
Faced with ethical dilemmas and decisions
They lack information, skills, and services necessary to make informed choices related to their sexual and reproductive health
Pregnancy can exacerbate their feeling of loss of control and helplessness
7/10 will drop out of school; more than 75% will receive public assistance within 5 years of having their 1st child
Babies are at greater risk of preterm birth, low birth weight, child abuse, neglect, poverty, and death
The younger the mother, the more likely she is to have another child in her teens; client is at risk for obstetric complications, STIs, poor maternal weight gain, preeclampsia, iron-deficiency anemia, poor eating habits and nutrition, and postpartum depression
teen pregnancy - psychological risk
Pregnant adolescents experience a higher rate of domestic violence and substance abuse (which contributes to low birth weight, fetal growth restrictions, preterm birth, newborn addiction, and sepsis)
More likely to abuse substances, receive inadequate prenatal care, and have lower pregnancy weight
Many clients are from minority backgrounds and live below the poverty line
teen pregnancy - what % want to be pregnant?
80% do not want to be pregnant, fragile body image, immaturity, conflict btw their own needs and the babies, limited knowledge of child development
teen pregnancy - physiologic - younger than 15 yrs old?
Cephalopelvic disproportion, increased nutrition needs for mom and baby, increased risk of preeclampsia, increased risk of anemia, increased risk of STIs, <15 has 60% greater mortality rate
teen pregnancy - sociological
Increased incarceration rates and health care costs; less likely to receive prenatal care or is late care; more likely to suffer domestic violence; higher infant mortality related to immaturity, may have less support
advanced age - risk
Female infertility, pregnancy loss, fetal abnormalities, stillbirth, and obstetric complications (gestational diabetes and hypertension, preeclampsia, small-for-gestational-age infants, spontaneous late preterm births, postpartum hemorrhage, genetic disorders and chromosomal abnormalities, placenta previa, fetal growth restrictions, low Apgar score, and cesarean section
What are the risk factors for developing pre-e?
Multifetal gestations, previous pregnancy w/ preeclampsia, renal disease, autoimmune disease, diabetes, first pregnancy, periodontal disease, chronic hypertension, and obesity
What is HELLP? (help Yolanda’s liver and platelets)
Hemolysis elevated liver enzymes low platelets
Variant of the pre/-eclampsia syndrome; development of an abnormal trophoblastic (abnormal cells) invasion due to inadequate maternal immune tolerance
What is Mag Sulfate given for?
Prevention and treatment of eclamptic seizures
What are the assessments of a patient on Mag Sulfate? (maggie, everything is going down)
Monitor for signs of toxicity including hypotension, areflexia (loss of deep tendon reflexes DTR), respiratory depression and arrest, oliguria, SOB, chest pain, slurred speech, hypothermia, confusion, circulatory collapse
What are the side effects of Mag Sulfate? (the usual, except…)
Allergic rxn (skin rash, itching, hives; swelling of face, lips, tongue or throat; confusion, drowsiness, facial flushing, redness, sweating, muscle weakness, fast or irregular heartbeat, trouble breathing, low BP
What is S&S of Mag Sulfate toxicity in babies (maggie doesn’t like milk for babies)
Newborn monitored for respiratory depression, muscle weakness, neurologic depression, loss of reflex, hypocalcemia, and hypotonia (decreased muscle tone); decreased fetal heart rate variability may occur
how to administer Mag Sulfate? (maggie is 4)
Nursing interventions:
Administer loading dose of 4-6 g by IV in 100 mL of fluid, over 15-30 minutes followed by a maintenance dose of 1-2 g as continuous IV infusion;
Spontaneous Abortions (spontaneous at 20)
Spontaneous Abortions: loss of fetus before 20 weeks. signs could be lower backpain
abortion management
bedrest, fluids (threatened); D & D or suction curettage; D & E (2nd trimester); antibiotics (missed, septic); misoprostol; pain medications; PhoGAM (RH-)
abortion s/s
vaginal bleeding. Abd pain, cramping, pelvic pressure, low back pain
Threatened abortions - s/s (NOT threatened by dilation or cervix)
S/S: early vaginal bleeding (often slight); no cervical dilation or change in cervical consistency; mild abd cramping; closed cervical os (?); no passage of fetal tissue. usually can’t keep the baby.
Inevitable abortion (everything is inevitably strong)
S/S: vaginal bleeding (greater than w/ threatened); rupture of membranes; cervical dilation; strong abd cramping; possible passage of products of conception
Incomplete abortion
S/S: intense abd cramping; heavy vaginal bleeding; cervical dilation; passage of some of the products of conception, but some still remains in uterus. pain and bleeding main reason women come to hospital
complete abortion - what decreases?
S/S: Hx of vaginal bleeding and abd pain; passage of tissue w/ subsequent decrease in pain and significant decrease in vaginal bleeding
missed abortion - definition and s/s (missed abortion is irregular)
(nonviable embryo retained in utero for at least 6 weeks)
S/S: absent uterine contractions; irregular spotting; possible progression to inevitable abortion
reccurent abortion (3 C’s in recccurent)
(habitual): will start treating early, could be a hormone issue. 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period. infection could be an issue.
sexuality in pregnancy = What are the contraindications? (push, pid, hemorrage)
Complications of sex during pregnancy include preterm labor, pelvic inflammatory disease, antepartum hemorrhage in placenta previa, and venous air embolism. Generally sexual relations are concidered safe, abstinence is recommended for high-risk patients (risk for preterm labor or for antepartum hemorrhage due to placenta previa)
Hyperemesis Gravidarum - when does it begin? linked to what hormone? (you know this)
Hyperemesis Gravidarum is a severe form of N/V during pregnancy that begins 9 weeks gestation,which could lead to hospitalization; could be linked to higher and extended levels of hCG
morning sickness - how to treat
are the relatively mild symptoms of pregnancy
During 1st trimester, cause is unknown but may be hormonal; treatment involves eating dry carbs in the AM, avoid empty stomach and fatty/fried foods, do frequent small meals, eat ginger; PNV (?), Vit B6, doxylamine
Hyperemesis Gravidarum:
s/s - how much weight loss?
Hyperemesis Gravidarum:
severe, persistent, and uncontrolled N/V, dehydration, weight loss (> 5% of pre pregnancy body weight), electrolyte imbalance and nutritional imbalances and ketosis
Morning Sickness:
s/s
Morning Sickness:
mild N/V, only in 1st trimester
How is Hyperemesis Gravidarum diagnosed?
Diagnosis of exclusion, associated with symptoms. Looks for fluid and electrolyte imbalances, weight loss, uncontrolled N/V that extends passed the 1st trimester; multiple theories so look for Vitamin B6 deficiency (metabolic theory), genetic predisposition (genetic factors), and high levels of hCG and estrogen (endocrine theory)
From lecture slides: look to exclude → is V from other causes?
What are the nursing assessments and interventions for Hyperemesis Gravidarum?
Health history *R/O other causes ex. Gastroenteritis, pyelonephritis, pancreatitis, cholecystitis, hepatitis, thyroid
Onset, duration and course of N/V
Hyperemesis Gravidarum - nursing assessment (anything related to dehydration)
Weight loss
Inspect mucus membranes for dryness, check skin turgor, BP changes (hypotension that may suggest fluid volume deficit)
Complaints of weakness, fatigue, activity intolerance, dizziness, mood changes, and decreased ability to concentrate
From lecture slides: assess for dehydration [hypotension, I/O, U/A (specific gravity); skin turgor, mucous membranes, electrolyte imbalances (labs, S/s of hypokalemia), Bit B1, B6 and B12 deficiencies (Wernicke-Korsakoff syndrome)]; IV fluids and electrolyte replacement, NPO
Hyperemesis Gravidarum - tests (and what for specific gravity?)
Liver enzymes: rule out hepatitis, pancreatitis, and cholestasis; elevation of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) usually present
CBC: elevated RBC and hematocrit, indicates dehydration
Urine ketones: + when body breaks down fat to provide energy in the absence of adequate intake
TSH and T4: rule out thyroid disease
BUN: increased in the presence of salt and water depletion
Urine specific gravity: > 1.025, could indicate concentrated urine; ketonuria
Serum electrolytes: decreased levels of potassium, sodium, and chloride resulting from excessive vomiting and loss of hydrochloric acid in stomach
ultrasound
Hyperemesis Gravidarum - nursing management
Promote comfort and nutrition; initially withhold oral flood and fluids, maintain NPO status to allow GI tract to rest
Antiemetics
IV fluids and electrolyte replacement therapy
Monitor I/O
Provide support and education, reduce stress
ectopic pregnancy
Any pregnancy in which the fertilized ovum implants outside the uterine cavity (includes the fallopian tubes, cervix, intestine, and abd cavity). The embryo grows and draws its blood supply from the site of abnormal implantation. As it gets bigger it creates the potential for organ rupture because only the uterus is designed to expand to accommodate a growing fetus. Can lead to massive hemorrhage, infertility and death
What are the signs and symptoms of an Ectopic Pregnancy - triad
Triad of symptoms are abdominal pain, amenorrhea, and vaginal bleeding. Only half of women present with all three symptoms
ectopic pregnancy - How is it diagnosed? (Hugs for ectopic)
Urine pregnancy test to confirm pregnancy, beta-hCG concentration to exclude a false-negative urine test, and a transvaginal ultrasound to visualize the misplaced pregnancy
ectopic pregnancy - when do symptoms begin? (Ectoplasm is unlucky number 7)
Physical exam
Assess for S/S of ectopic pregnancy, usually begin ~7th week of gestation
ectopic pregnancy - health hx
Previous ectopic pregnancy, history of STIs, fallopian tube scarring from PID, in utero exposure to DES, endometriosis, previous tubal or pelvic surgery, infertility and treatments, uterine abnormalities such as fibroids, presence of intrauterine contraception, use of progestin-only mini pill, postpartum or post abortion infection, altered estrogen and progesterone levels (interferes w/ tubal motility), age > 35 years, cigarette smoking
From slides: Hx of STIs or PID, previous ectopic pregnancies, endometriosis, IUDs, assisted reproduction (in vitro)
ectopic pregnancy - lab tests
Transvaginal ultrasound to visualize misplaced pregnancy
ectopic pregnancy - nursing management - how long to use contraceptives?
Nursing management - Analgesics for pain
Teach about S/S of rupture is outpatient care (sever, sharp, stabbing, unilateral abd pain; vertigo/fainting; hypotension; and increased pulse). Advice to seek medical care immediately
Emotional support
Use of contraceptives for at least 3 menstrual cycles to allow for healing and repair
What is the usual treatment of women with HIV who are pregnant?
The standard treatment is oral antiretroviral drugs given daily until giving birth, IV administration during labor, and oral zidovudine (AZT) for the newborn within 6 to 12 hours of birth. Some reports suggest that cesarean birth may reduce the risk of HIV infection (King et al., 2019). Efforts to reduce instrumentation, such as avoiding the use of an episiotomy, fetal scalp electrodes, and fetal scalp sampling, will reduce the newborn’s exposure to body fluids
HIV behavioral (fluids, rest)
getting adequate sleep each night (7 to 9 hours)
avoiding infections (e.g., staying out of crowds, practicing good hand hygiene)
decreasing stress
consuming adequate protein and vitamins
increasing her fluid intake to 2 L daily to stay hydrated
planning rest periods throughout the day to prevent fatigue
HIV - How is it transmitted from mother to fetus/baby?
from mother to fetus during pregnancy or breast-feeding and amniotic fluid during childbirth.
- 1st trimester:*Urinary frequency - treatment (you know this)
Urinary frequency or incontinence: woman decrease her fluid intake 2 to 3 hours before bedtime and limit her intake of caffeinated beverages. Increased voiding is normal, but encourage the client to report any pain or burning during urination. Kegel exercises.
1st trimester - fatigue
arrange work, child care, and other demands in her life to permit additional rest periods. Using pillows for support in the left-side–lying position relieves pressure on major blood vessels that supply oxygen and nutrients to the fetus when resting. Relaxation techinques.
1st trimester - N/V - what to eat? (n/v loves B6)
eat small, frequent meals that are bland and low in fat. Eat dry crackers, Cheerios, or cheese or drinking lemonade before getting out of bed in the morning and increasing her intake of foods high in vitamin B6, such as meat, poultry, bananas, fish, green leafy vegetables, peanuts, raisins, walnuts, and whole grains, or making sure she is receiving enough vitamin B6.
1st trimester - breast tenderness
wear a larger bra with good support can help alleviate this discomfort. Advise her to wear a supportive bra, even while s1leeping.
1st trimester - constipation
● Eat fresh or dried fruit daily.
● Eat more raw fruits and vegetables, including their skins.
● Eat whole-grain cereals and breads such as raisin bran or bran flakes.
● Participate in physical activity every day.
● Engage in pelvic floor exercises, stretching exercises, and yoga daily.
● Eat meals at regular intervals.
● Establish a time of day to defecate, and elevate feet on a stool to avoid straining.
● Drink six to eight glasses of water daily.
● Decrease intake of refined carbohydrates.
● Drink warm fluids upon arising to stimulate bowel motility.
● Decrease consumption of sugary sodas.
● Avoid eating large amounts of cheese.
1st trimester - Leukorrhea (increased vaginal discharge):
keep the perineal area clean and dry, washing the area with mild soap and water during her daily shower. Cotton underwear. Wear nightgown. Avoid tampons and douching.
2nd trimester - Backache:
heat and ice, acetaminophen, massage, proper posturing, good support shoes, and a good exercise program for strength and conditioning. Pillow between legs when sleeping. Maintain correct posture with head up and shoulders back.
2nd trimester - leg cramps
gently stretch the muscle by dorsiflexing the foot up toward the body. Wrapping a warm, moist towel around the leg muscle can also help the muscle relax. Advise the client to avoid stretching her legs, pointing her toes, and walking excessively. Stress the importance of wearing low-heeled shoes and support hose and arising slowly from a sitting position. Elevate legs.
2nd trimester - varicose veins
supportive hose, elevate her legs above her heart while lying on her back for 10 minutes before she gets out of bed in the morning, elevate both legs above the level of the heart for 5 to 10 minutes at least twice a day.
2nd trimester - hemmroids
increasing fiber intake and drinking at least 2 L of fluid per day. warm sitz baths, witch hazel compresses, or cold compresses. Elevate feet on stool when deficating.
2nd trimester - bloating
avoid gas-forming foods, such as beans, cabbage, and onions, as well as foods that have a high content of white sugar. Adding more fiber to the diet, increasing fluid intake, and increasing physical exercise. Don’t chew gum
3rd trimester - dypnea
adjust her body position to allow for maximum expansion of the chest and to avoid large meals. emphasize that lying on the left side will displace the uterus off the vena cava and improve breathing. avoid exercise that precipitates dyspnea, to rest after exercise, and to avoid overheating in warm climate.
3rd trimester - heartburn
imit or avoid gas-producing or fatty foods and large meals. maintain proper posture and remain in the sitting position for 1 to 3 hours after eating to prevent reflux. maintain proper posture and remain in the sitting position for 1 to 3 hours after eating to prevent reflux. avoid foods that act as triggers such as caffeinated drinks; greasy, gas-forming foods; citrus; spiced foods; chocolate; coffee; alcohol; and spearmint or peppermint. avoid late-night or large meals and gum chewing and avoid lying down within 3 hours after eating. Elevate HOB to 10 - 30 degrees while sleeping.
3rd trimester - edema (walking? and avoid what foods?)
● Elevate your feet and legs above the level of the heart periodically throughout the day.
● Wear compression stockings when standing or sitting for long periods.
● Change position frequently throughout the day.
● Walk at a sensible pace to help contract leg muscles to promote venous return.
● Avoid foods high in sodium, such as lunch meats, potato chips, and bacon.
● Avoid wearing knee-high stockings.
● Drink six to eight glasses of water daily to replace fluids lost through perspiration.
● Avoid high intake of sugar and fats because they cause water retention
3rd trimester - braxton hicks - how to lay?
typically in the 3rd trimester. keep herself well hydrated and to rest in a left-side–lying position to help relieve the discomfort. Breathing techniques. (brax is false)
GBS - baby - most common cause of what? (Don has gbs)
(strep) Although GBS is rarely serious in adults, it can be life-threatening to newborns. GBS is the most common cause of sepsis and meningitis in newborns and is a frequent cause of newborn pneumonia.
GBS - mom
GBS colonization in the mother is thought to cause chorioamnionitis, endometritis, and postpartum wound infection
BPP - Biophysical Profile (BPP) (my bio is a o2 ultrasound)
uses a real-time ultrasound and NST to allow
assessment of various parameters of fetal well-being that are sensitive to hypoxia. measures health of fetus. HR, muscle tone, breathing action, and how much amniotic fluid. also a non-stress test.
BPP - (TB MAN)
h) Body movements: three or more discrete limb or trunk movements
i) Fetal tone: one or more instances of full extension and flexion of a limb or trunk
j) Fetal breathing: one or more fetal breathing movements of more than 30 seconds
k) Amniotic fluid volume: one or more pockets of fluid measuring 2 cm
l) NST: normal NST = 2 points; abnormal NST = 0 points
AFI - normal fluid amount? (AFI is 25 yrs old)
AFI - (amniotic fluid index) measures the vertical depths of the largest pocket of amniotic fluid in all four quadranultts surrounding the maternal umbilicus and totaled. 5 - 25 cm is normal fluid amount.
utrasound
ultrasound technician or doctor will introduce a probe into the vagina. It may be mildly uncomfortable, but will not hurt. The probe is covered with a condom and a gel. The probe transmits sound waves and records the reflections of those waves off body structures. Abdominal - also soundwaves.
NST
provider will move the device over your abdomen until the baby’s heartbeat is found. The baby’s heart rate will be recorded on a monitor, while your contractions are recorded on paper. You may be asked to press a button on the device each time you feel your baby move.
CST (contraction stress test) - how long does the test take?
To trigger contractions, your doctor may give you a dose of the drug oxytocin through an IV in your arm. Or your doctor may suggest that you rub your nipples through your clothing, which can start contractions. Then you wait while the monitors record contractions and your baby’s heartbeat. The test takes about 2 hour.
fundal height
lay back on the exam table. Then, your healthcare provider will extend a paper or plastic tape measure from the top of your symphysis pubis (pubic bone) to your uterus (fundus). The distance between these two spots is your fundal height.
kick counts - how many is normal? (kicking at 10)
daily movement counts - should be performed same time every day. lay on left side, hand on stomach, and lay for an hour and count. should be around 10 kicks an hour. best time is after meals.
AFI - findings (amniotic fluid index) - either what or what?
AFI: either polyhdraminos or oligohyraminos -
ultrasound findings
used for many things - wellbeing - usually looks at movement, heartbeat, and RR, can see baby move, can see diaphragm. Abdominal or transvaginal. usually abdominal. if looking for anomalies, will do transvaginal.
NST findings
Demonstrates findings of fetal jeopardy manifested by late decelerations or bradycardia.?
CST findings
can fetus tolerate contractions?
fundal height - findings - determines what?
determines SGA?
NST test
Evaluate fetal HR during movement;
can be reactive (2 acceleration in 20 minutes) or nonreactive
Accelerations: >50 over a baseline lasting 15 seconds or more (over 32 weeks gestation)
Less than 32 weeks gestation >10 over 10 seconds
Nonstress test (NST) - is it common?
(lasts 20 minutes) is the most common method of prenatal testing used. Provides an indirect measurement of uteroplacental function.
weight gain - Normal BMI
Normal BMI: 25-35 lb
weight gain - low BMI (low at 28 weeks)
28-40 lb
weight gain - high BMI (numbers for overweight and obese)
15-25 lb for overweight, and 11-20 lb for obese
What are good sources of iron?
raisins, Red meat, chicken, fish, green leafy vegetable, soy products, nuts and dried fruit, dried
beans, eggs, fortified grains
What are good sources of calcium?
Dairy products (milk, cheese, and yogurt), cereals; broccoli, spinach, and kale; salmon
DM - risk factors in baby - what about albumin?
- macrosomia (large fetus) resulting from hyperinsulinemia stimulated by fetal
hyperglycemia - Hypoglycemia
- Childhood obesity
- Hyperbilirubinemia
- birth trauma due to shoulder dystocia (mechanical problems during delivery)
- Congenital anomaly due to hyperglycemia in the 1st trimester (cardiac problems, neural
tube defects, skeletal deformities, and genitourinary problems) - Premature birth secondary to polyhydramnios (too much amniotic fluid) and an aging
placenta; places the fetus in jeopardy - Fetal asphyxia secondary to fetal hyperglycemia and hyperinsulinemia
- Intrauterine growth restrictions secondary to maternal vascular impairment and decreased
placental perfusion, which restricts growth - Perinatal death due to poor placental perfusion and hypoxia
- Respiratory distress syndrome resulting from poor surfactant production
- Polycythemia (a blood disorder) due to excessive RBC production in response to hypoxia
DM - risk factors mom (think of your pt)
preeclampsia and cesarean birth; greater risk of developing cardiovascular disease
- Gestational hypertension of unknown etiology
- Ketoacidosis due to uncontrolled hyperglycemia
- Preterm labor secondary to premature membrane rupture
- stillbirth in pregnancies
- Hydramnios
- Hypoglycemia as glucose is diverted to the fetus (in 1st trimester)
- UTIs resulting from excess glucose in the urine
- Chronic monilial vaginitis due to glucosuria (promotes yeast growth)
- Difficult labor
How does the physiological changes of pregnancy affect women with existing DM in each trimester? How does it contribute to the development of Gestational Diabetes? (gabrielle is Hypo before hyper)
1st trimester: Hypoglycemia as glucose is diverted to the fetus
Late pregnancy: hyperglycemia; insulin peaks in last trimester to provide more nutrients to the fetus, causing an increase demand on the mother pancreas, and glucose levels rise
What are additional risk factors for developing GDM in pregnancy?
● Previous infant with congenital anomaly (skeletal, renal, central nervous system, cardiac)
● History of gestational diabetes or polyhydramnios in a previous pregnancy
● Family history of diabetes
● Medications like corticosteroids or antipsychotics
● Age 35 years or older
● Polycystic ovary syndrome
● Multiple pregnancy (twins, triplets)
● Previous infant weighing more than 9 lb (4,000 g)
● Previous unexplained fetal demise or neonatal death
● Maternal obesity (body mass index [BMI] over 30)
● Hypertension before pregnancy or in early pregnancy
● Hispanic, Native American, Pacific Islander, or African American ethnicity
● Recurrent monilia infections that do not respond to treatment
● Signs and symptoms of glucose intolerance (polyuria, polyphagia, polydipsia, fatigue)
● Presence of glycosuria or proteinuria (Farahvar et al., 2019).
What are the risks and consequences to Mom and/or Baby of both GDM and DM?* mom (gabrielle is hyra, hyper, and hyper)
- Hydramnios due to fetal diuresis caused by hyperglycemia
- Gestational hypertension of unknown etiology
- Ketoacidosis due to uncontrolled hyperglycemia
- Preterm labor secondary to premature membrane rupture
- Stillbirth in pregnancies complicated by ketoacidosis and poor glucose control
- Hypoglycemia as glucose is diverted to the fetus (occurring in first trimester)
- Urinary tract infections resulting from excess glucose in the urine (glucosuria), which
promotes bacterial growth - Chronic monilial vaginitis due to glucosuria, which promotes growth of yeast
- Difficult labor, cesarean birth, postpartum hemorrhage secondary to an overdistended uterus
to accommodate a macrosomic infant
What are the risks and consequences to Mom and/or Baby of both GDM and DM?* baby
Cord prolapse secondary to polyhydramnios and abnormal fetal presentation
* Congenital anomaly due to hyperglycemia in the first trimester (cardiac problems, neural
tube defects, skeletal deformities, and genitourinary problems)
* Macrosomia resulting from hyperinsulinemia stimulated by fetal hyperglycemia
* Birth trauma due to increased size of fetus, which complicates the birthing process (shoulder
dystocia)
* Preterm birth secondary to polyhydramnios and an aging placenta, which places the fetus in
jeopardy if the pregnancy continues
* Fetal asphyxia secondary to fetal hyperglycemia and hyperinsulinemia
* Intrauterine growth restriction secondary to maternal vascular impairment and decreased
placental perfusion, which restricts growth
* Perinatal death due to poor placental perfusion and hypoxia
* Respiratory distress syndrome resulting from poor surfactant production secondary to
hyperinsulinemia inhibiting the production of phospholipids, which make up surfactant
- Polycythemia due to excessive red blood cell (RBC) production in response to hypoxia
- Hyperbilirubinemia due to excessive RBC breakdown from hypoxia and an immature liver
unable to break down bilirubin - Neonatal hypoglycemia resulting from ongoing hyperinsulinemia after the placenta is
removed - Subsequent childhood obesity and carbohydrate intolerance
Toxoplasmosis:
caused by a parasite; cats primary host; spread by contaminated
soil, raw meats, and unwashed fruits and veg. Fetus is high risk for preterm labor and stillbirth; low birth weight, enlarged liver and spleen, visual problems, cerebral palsy, hearing loss, seizures, chorioretinitis, jaundice, IUGR, hydrocephalus, microcephaly, neurologic damage and anemia
STIs:
depends on the type but effects include: eye infections, pneumonia; low birth weight, stilllbirth, preterm birth; intrauterine growth restrictions; intellectual disabilities, blindness, seizures, premature birth, death; skin ulcers, weakness or hoarse cry, deafness, swollen liver and spleen, amnesia, various deformations; HIV positive status; warts in throat; premature rupture of membranes
RH factor
Mom can be rH + or -; if baby is positive, and mom is -, mom will make antibodies against baby which can be dangerous if they cross over to the fetus and start destroying the RBCs
- If mom gets pregnancy again, they will get rogan
preeclampsia - stage 1 (pre-e is a spaz first)
Preeclampsia is a two-stage event; the underlying mechanisms involved are vasospasm and hypoperfusion. In the first stage, the key feature is widespread vasospasm. In addition, endothelial injury occurs, leading to platelet adherence, fibrin deposition, and the presence of schistocytes (fragments of erythrocytes).
preeclampsia - what happens
a. generalized vasospasm results in elevation of blood pressure and reduced blood flow to the brain, liver, kidneys, placenta, and lungs.
b. decreased brain perfusion leads to small cerebral hemorrhages and symptoms of arterial vasospasm such as headaches, visual disturbances, blurred vision, and hyperactive deep tendon reflexes
c. hypertension
d.decreased kidney perfusion reduces the glomerular filtration rate, resulting in decreased urine output and increased serum levels of sodium, blood urea nitrogen (BUN), uric acid, and creatinine
e. reduction of plasma colloid osmotic pressure and moves more fluid into extracellular spaces; this leads to pulmonary edema and generalized edema
f. Poor placental perfusion resulting from prolonged vasoconstriction contributes to intrauterine growth restriction, placental abruption, persistent fetal hypoxia, and acidosis
What are the risk factors for developing pre-e (yolanda bed)
Multifetal gestations, previous pregnancy w/ preeclampsia, renal disease, autoimmune disease, diabetes, first pregnancy, periodontal disease, chronic hypertension, and obesity
pre-e risks - what can happen? (yolanda baby)
Increases risk of placental abruption, preterm birth, intrauterine growth restriction, and fetal distress during childbirth
pre-e treatment
Oxytocin and magnesium sulfate can be given simultaneously via infusion pumps to ensure both are administered at the prescribed rate. Magnesium sulfate is given IV via an infusion pump.
pre-e nursing managements (yolanda pillows)
The woman with preeclampsia with severe features usually requires hospitalization. Keep the client on complete bed rest in the left lateral lying position. Ensure that the room is dark and quiet to reduce stimulation. Give sedatives as ordered to encourage quiet bed rest. The client is at risk for seizures if the condition progresses. Therefore, institute and maintain seizure precautions, such as padding the side rails and having oxygen, suction equipment, and a call light readily available to protect the client from injury
before abortion - nursing management
Report varying degrees of vaginal bleeding, low back pain, abdominal cramping, and passage of products of conception tissue
ask the woman about the color of the vaginal bleeding (bright red is significant) and the amount—for example, question her about the frequency with which she is changing her peripads (saturation of one peripad hourly is significant) and the passage of any clots or tissue.
save any tissue or clots passed and bring them with her to the health care facility.
d. obtain a description of any other signs and symptoms the woman may be experiencing, along with a description of their severity and duration.
e. assess her vital signs and observe the amount, color, and characteristics of the bleeding.
f. Rate pain level Ask her to rate her current pain level, using an appropriate pain assessment tool.
g. Rate amount and intensity of the woman’s abdominal cramping or contractions, and assess the woman’s level of understanding about what is happening to her
during abortion - nursing management (just monitor)
d. provide continued monitoring and psychological support because the family is
experiencing acute loss and grief. Reassure pt.
e. Monitor the amount of vaginal bleeding through pad counts and observe for
passage of products of conception tissue.
f. Rate pain
h. Assist in preparing the woman for procedures and treatments such as surgery to evacuate the uterus or medications such as misoprostol or prostaglandin E2 (PGE2). If the woman is Rh-negative and not sensitized, expect to administer RhoGAM within 72 hours after the abortion is complete.
after abortion - nursing managemetn
physical and emotional support.
e. Encourage friends and family to be supportive but give the family space and time to work
through their loss.
f. Referral to a community support group for parents who have experienced a loss can be
helpful during this grief process.
EAB (elective abortion)
EAB (elective abortion) - Purposeful interruption of a pre-viable pregnancy.
TAB (theraputic abortion) –
TAB (theraputic abortion) – Abortion for maternal/fetal disorder.
FES
When a fetus is exposed to alcohol during development, it can result in a variety of adverse developmental effects including physical, neurological, and behavioral defects
- Defects include
- facial features: flattened philtrum, groove in upper lip up to nose; thin upper lip,
short palpebral)
- growth deficit: weight, height and BMI
- structural/function CNS dysfunction: microcephaly, intellectual disability,
psychiatric conditions, language, motor and memory disorders
pregnancy - cardio - HR and CO
Heart rate increases by 10-15 bpm
CO increases by 30-50%
Vasodilation of the blood vessels
pregnancy - cardio - BP and coagulation (BP and when does it return to normal?) what hormone causes BP to change?
BP decreases initially (due to progesterone which relaxes smooth muscle and placenta, decreasing resistance) until 32 weeks when it returns to normal
Hyper coagulation to prevent hemorrhage, also contributes to edema
6x increased risk for CV disease
Dependent edema
pregnancy - cardio - hypertrophy and murmurs (what causes hypertrophy? is it normal?)
Cardiac hypertrophy: displaced by the enlarged uterus which pushes up on the diaphragm; 95% of women develop systolic murmurs, palpitations and arrhythmias *monitor women w/ preexisting conditions
pregnancy - anemia (and when is it most common?) (tu in 2nd trimester)
Anemia due to hemodilution, the increase in blood volume which is greater than the increase in RBCs circulating; most dramatic in 2nd trimester
values considered anemic (Tu and heman at 32)
Values < 11 g/dl in 1st or 3rd trimester, or < 10.5 g/dl in 2nd, considered anemic; Hct 32% or less considered anemic
pregnancy - hypotension (what side to lie on?)
Supine hypotension, inferior vena cava syndrome; have pt lie on L sidea
adaptations for GI - Ptyalism
Ptyalism- increase in saliva production
Morning sickness
Decreased GI peristalsis
adaptations for GI - heartburn (and what hormone? Prodigy w/ heartburn)
Heartburn due to pressure of uterus on gut and progesterone (stomach doesn’t empty properly so acid builds up)
adaptations for GI - gallbladder
Gall bladder does not empty normally, can produce gallstones (hypercholesterolemia)
adaptations for GI - morning sickness - when? (sickness in the beginning)
Morning sickness (N/V at 4-6 weeks), decreased GI peristalsis, hemorrhoids, ptyalism (increased saliva production), bleeding gums, heartburn
adaptations in pregnancy - uterus
The ureters elongate, become tortuous, and form single or double curves
pregnancy blood flow to kidneys
Increase in blood flow and GFR to kidneys
Increase in urination: production and due to pressure from the uterus
Risk for urinary stasis and pyelonephritis (due to curves in ureters)
adaptations of pregnancy - diaphragm and chest
Diaphragm pushed up to make room for uterus
Chest expands more- rib cage relaxes (estrogen), decreased resistance (progesterone)
adaptations of pregnancy - co2
Increase of CO2 blown off
Increase of the secretion of bicarbonate (remove acidity) from the kidneys
Capillary engorgement from express blood volume
Renal pelvis and ureters dilate-
adaptation of pregnancy - ureters
Baby pushes down on ureters- ureters from kidney to bladder have curves which hold urine and can cause UTIs
Baby pushes down on ureters- ureters from kidney to bladder have curves which hold urine and can cause UTIs
adaptations of pregnancy - 02
Increased O2 consumption (20-40%), increased RR,
adaptations of pregnancy - bicarbonate
increased bicarbonate secretion from the kidneys;
adaptations of pregnancy - capillaries and tidal volu
capillary engorgement (bloody nose and nasal stuffiness)
Increased tidal volume (30-40%), vital capacity unchanged, inspiratory volume increased, expiratory volume decreased, total lung capacity unchanged
adaptations of pregnancy - reproductive - Hegar’s sign (Hegar is soft now)
Hegar’s sign: softening of the lower uterine segment known as Hegar’s sign – probable sign of pregnancy @ 6 weeks
Increase in uterine blood flow
adaptations of pregnancy - braxton hicks (brighton is false)
Braxton Hicks contractions: painless and intermittent and do not cause any cervical changes
adaptations of pregnancy - quickening (quick for 18)
Quickening: “fluttering feeling” when the woman first feels the fetus move; usually not until the eighteenth week or later; multiparous women may feel it as early as 14 weeks
adaptations of pregnancy -Growth of the uterus
Growth of the uterus is dramatic - increasing vascularity, production of new muscle fibers and fibroelastic fibers and enlargement of pre-existing muscles account for the rapid growth of the uterus in the first trimester. After the first trimester the growth of the uterus is primarily due to the growth of the fetus
After 20 weeks, gestational age of fetus should correspond w/ height of the fundus, when measured from the symphysis pubis
adaptations of pregnancy - reproductive - plug, secretions
chadwick sign (chad is blue) 6-8 weeks); formation of mucus plug (operculum); acid vaginal secretions (susceptible to yeast infections)
adaptation of pregnancy - breasts - colustrum when? (cluster f at 16)
Breasts: larger, mammary glands grow in 2nd and 3rd trimester, increased pigmentation, montgomery tubercles (sebaceous and sweat glands which lubricate and prevent infection during breastfeeding) more pronounced, estrogen increases vascularity, colostrum at 16 weeks
hyperemisis gravitum - treatments
Medications or treatments currently going on
Diet history
Ptyalism (excessive salivation), anorexia, indigestion, and abd pain or distention; any blood or mucus in stool
hyperemisis gravitum - risk factors
Review risk factors: young age, N/V with previous pregnancies, history of intolerance of oral contraceptives, nulliparity, trophoblastic disease, multiple gestation, emotional or psychological stress, gastroesophageal reflux disease, primigravida status, obesity, hyperthyroidism, and H. pylori seropositivity
Dehydration and electrolyte levels **from lecture
Make NPO (give the GI a rest, and give IV fluids for fluid and electrolyte replacement
preeclampsia stage 2 (Yolanda’s symptoms on stage 2)
The second stage of preeclampsia is the woman’s response to abnormal placentation, when symptoms appear (i.e., hypertension, proteinuria, headache, nausea and vomiting, retinal vascular changes causing blurred vision, and hyperreflexia due to hypoperfusion)
how is HELPP diagnosed?
Diagnosis: elevated liver enzymes, low platelet counts, and hemolysis
Bleeding precaution
what to monitor on magnesium sulfate?
monitor serum magnesium levels; assess DTRs and check for ankle clonus; have antidote available; monitor for S/S of toxicity
antidote for magnesium sulfate
Antidote is Calcium gluconate (10mL of a 10% solution IV over 3 minutes)
spontaneous abortion s/s
S/S: vaginal bleeding, abd pain, cramping, pelvic pressure, low back pain
sponteous abortion - risk factors
Risk factors: congenital malformations (1st trimester, 50% occur from chromosomal abnormalities; majority before 12 weeks), maternal infection, maternal endocrine problems, AMA, previous loss
morning sickness risk factors (thyroid and DM are sick in the a.m.)
Risk factors: hyperthyroid disorders, molar pregnancy, multiple gestation, DM, GI disorders, previous pregnancy
hyperemesis gravidum - Patient teaching
avoid noxious stimuli, avoid tight clothing; eat small, frequent meals; separate fluids from solids; avoid lying down at least 2 hrs after eating; use high protein supplement drinks, avoid foods high in fat; get fresh air; herbal teas with peppermint or ginger; avoid fatigue and manage stress
Make NPO (give the GI a rest, and give IV fluids for fluid and electrolyte replacement
Small frequent meals eventually
Antiemetics
ectopic pregnancy - Physical exam findings (fetus in my shoulder)
tender abdomen, painful vaginal exam, cervical motion tenderness, and possible adnexal mass (growth around uterus).
From lecture slides: missed period, tenderness, pain, shoulder pain (internal bleeding), vaginal bleeding, and shock
ectopic pregnancy - assessment - Hallmark symptom (ectoplasm is in pain in shoulders)
Missed period, adnexal fullness, and tenderness may indicate an unruptured tubal pregnancy
HALLMARK symptoms: abd pain w/ spotting within 6-8 weeks after a missed period
Symptoms after rupture or hemorrhage: severe, sharp and sudden pain in lower abd; faintness, referred pain to shoulder (indicates bleeding in abd caused by phrenic nerve irritation), hypotension, marked abd tenderness w/ distention, hypovolemic shock
ectopic pregnancy - lab test - beta-hCG test - levels? (ectoplasm is low on hg tv)
beta-hCG test (low serum levels suggest ectopic pregnancy) *w/ “normal” pregnancy levels typically double every 2-4 days until peak value is reached 60-90 days after conception
ectopic pregnancy - nursing management (slides)
Lecture slides: methotrexate (stops cells from growing causes abortion), emergency surgery (salpingectomy), attempt to preserve tube, serial hCG levels (3-6 weeks)
HELPP is what disorder?
pre-E
3rd trimester - edema - how to lie? (always on the side)
● When taking a long car ride, stop to walk around every 2 hours.
● When standing, rock from the ball of the foot to the toes to stimulate circulation.
● Lie on your left side to keep the gravid uterus off the vena cava to return blood to the heart.
GBS - babies - early and late (Don got pneumonia, then meningitis)
Newborns with early-onset (within a week after birth) GBS infections may have pneumonia or sepsis, while late-onset (after the first week) infections often manifest in meningitis
BPP scoring (biophysical profile) (BPP is perfect)
Maximum score of 10. For the test to be judged abnormal and a score of zero awarded for the absence of fetal movement, fetal tone, or fetal breathing movements, a period of not less than 30 minutes must have elapsed. a score of 8 to 10 is considered normal if the amniotic fluid volume is adequate. A score of 6 or below is suspicious, possibly indicating a compromised fetus.
trimesters (tri 13)
first trimester – conception to 12 weeks. second trimester – 13 to 27 weeks. third trimester – 28 to 40 weeks.
NST test
early, late and variable deceleration
NST - top and bottom graph
top - fetal HR
bottom - mom’s contractions
early deceleration
***Mom’s contractions will mirror baby’s HR (happen at the same time) look at mom’s contractions first - compare with baby. compare peak of mom’s peak and look at baby’s HR.
late deceleration
baby’s HR responds after mom’s contraction. upside down U. uteral placental insufficiency.
variable deceleration
not uniform. baby’s HR will respond at different times. means cord compression. causes little Vs.
what deceleration is normal?
early decelerations. always check the HR. anything below 120 is not normal.
CST test - what type of oxytocin?
Endogenous or Exogenous Oxytocin, Evaluate FHT with contractions,
CST - negative (3 is negative here)
Negative: No decelerations with 3
UC’s lasting 40-60 seconds in 10 minutes,
CST - positive
Positive: Decelerations with 50% or more of UC’s (we don’t want a positive) (we want negative)
AFI - Polyhydraminos - number and associated with what?
Polyhydraminos: > 2,000ml
32-36 weeks
2% of pregnancies
Associated with DM (on test) Fetal anomalies
Risk for Preterm labor, PPROM, PROM
AFI - Oligohydraminos - number and associated with what?
Oligohydraminos:
<500ml
32-36 weeks
4% of pregnancies
Fetus unable to make urine or something blocks the urination Poor pregnancy outcomes
NST - at how many weeks is it recommended? (NST 28 weeks later)
Recommended twice weekly, after 28 weeks gestation (3rd trimester), for clients with diabetes and other high-risk conditions
NST - reactive
Reactive = 2 accelerations in 20 minutes; accelerations are FHR equal or greater than 15 BPM over baseline lasting 15 seconds or more, occurs twice during \
NST - nonreactive
NST (called acceleration) Non-reactive = abnormal, does not meet criteria; indicates the need for more testing
how to give mag and oxytocin for pre-e? (yolanda is 46)
A loading dose of 4 to 6 g is given over 15 to 30 minutes, followed by an infusion of 1 to 2 g/hr as a continuous infusion. If overdosage occurs, calcium gluconate (10 mL of a 10% solution injected intravenously (10 mL of a 10% solution injected IV over 3 minutes) is an effective antidote.
hematocrit and hemoglobin go up or down during pregnancy
DOWN
fundal height
Between 12 and 14 weeks’ gestation, the fundus can be palpated above the symphysis pubis. The fundus reaches the level of the umbilicus at approximately 20 weeks and measures 20 cm. Fundal measurement should approximately equal the number of weeks of gestation until week 36. For example, a fundal height of 24 cm suggests a fetus at 24 weeks’ gestation. After 36 weeks, the fundal height then drops due to lightening and may no longer correspond with the week of gestation
live vacccines
MMR, varicella
placental abruption - causes (just 2 - the pressure is abrupt)
hypertension and preeclampsia
placental abruption can cause what to happen?
clotting issues (DIC)
eclampsia - what is BP
over 160
poly and olighydraminos
greater than 2,000 and less than 500 mL
PROM and PROMM
after 37 weeks, and before 37 weeks
diabetes - what numbers?
Fasting blood glucose level: Less than 95 mg/dL
At 1 hour: Less than 140 mg/dL
At 2 hours: Less than 120 mg/dL
At 3 hours: Less than 95 mg/dL
does insulin cross the placenta?
no
who is at risk for diabetes? (pocs for diabetes)
PCOS, advanced age, steroids, antipsychotics, large baby
NST is at what age? (not stopping at 32)
greater than 32 weeks. Less than 32 weeks is 10 bpm over baseline and lasting 10 seconds.
contraction stress test - what should the results be?
we don’t want a positive because that means the fetal HR is going down with contractions = baby not getting enough O2
placenta previa (previa is above)
placenta is over top of cervix. placenta won’t attach where there is a scar, so c-section is at higher risk. multiple gestation because it gets too heavy.
NST - acceleration
you want this - 15 bpm above baseline for at least 15 seconds
NST - minimal variability
around 5 bpm above baseline (can go up or down) . minimal could be baby is asleep or got sedatives.
NST - moderate variability
this is good - between 6-25 bpm
NST - marked variability
above 25 bpm - can’t see the baseline. baby is trying to get more 02, or cardiac issues.
what makes an NST reactive?
2 accelerations in 15 min. we want this.
what makes an NST non-reactive (negative)?
no increase in BPM. can give mom sugar to wake up baby.
spontaneous abortion - how many weeks?
loss before 20 weeks. also called miscarriage.
IUFD or stillbirth
after 20 weeks (intrafetal uterine demise)
who is at risk for spontaneous abortions?
advanced age
premature dilation of the cervix. when does it happen? (dilate 2 eyes)
2nd trimester
tocoyltics
slow down contractions
what causes ectopic pregnancies? (STI w/ ectoplasm)
STIs and PID
shoulder pain?
ectopic pregnancy
hydataform mole
dark brown bleeding, large uterus, high Hcg levels, hyperemesis, pre-e
hydataform mole - 1st sign (mole is short of breath)
SOB - has moved to lungs
hydataform mole - how long after can you get pregnant?
1 year
hyperemesis gravidarum - one cause
hyperthyroidism, diabetes
right upper quandrant pain is what?
usually pre-e (the liver)
what is BP with pre-e?
160/110 THIS IS AN EMERGENCY (gestational hypertension is 140/90). you need 2 readings in 4 hours - they both have to be high.
thrombocytopenia (low platelets)
is pre-e
pre-e drugs
lobetalol or hydralazine
magnesium - how often to check vitals?
every 5 min
normal mag levels
1.3 to 2.1 mEq/L
does magnesium cross placenta?
yes
when is fetus above pubis?
12-14 weeks
endometritis symptoms
lower abd. pain, temp greater than 100.4, foul smelling lochia, and flu like symptoms
PP psychosis - when is it diagnosed?
within 1 year of delivery
