Ch. 13 & 14 Flashcards
What 2 metabolic disorders can seriously affect pregnancies?
Diabetes mellitus and thyroid.
Are pregnancies complicated by diabetes treated any differently?
Yes, they are considered high risk.
What is gestational diabetes?
Any degree of glucose intolerance with onset or recognition during pregnancy.
When should GDM be re-evaluated?
6 weeks post partum.
Can insulin cross the placenta?
No. Glucose can. The fetus secretes its own insulin by 10 weeks.
What happens to the fetus if the mother’s blood glucose rises?
Fetal glucose levels are increased resulting in increased fetal insulin production and secretion.
What is a BPP and when is it ordered in regards to a diabetic mother?
Biophysical profile. If the mother’s blood sugar is high, started at 32 weeks.
What metabolic disorder is often 1st diagnosed in pregnancy?
Thyroid.
Which is rare in pregnancy, hypothyroidism or hyperthyroidism?
Hypothyroidism. The mother usually has this disease before pregnancy.
What labs are indicative of Hyperthyroidism?
Elevated T4 and low TSH.
What metabolic disorder is a known cause of fetal mental retardation?
Phenylketonuria. It is elevated levels of phenylalanine hydrolase.
When is fetal cardiovascular disease determined?
At 3 months and again at 7-8 months.
What does rheumatic heart disease damage?
Valves.
Does heparin cross the placenta?
No. It’s molecules are too large.
If a pregnant woman is in cardiac arrest and must be resuscitated, where do the paddles go?
One rib interspace higher than normal.
What else should be planned for if the mother goes into cardiac arrest?
Plan for c-section delivery.
Anemia is a _____ of pregnancy.
Disorder.
What are normal Hgb and Hct levels for women, and what is normal when pregnant?
Normal Hgb = 12-16, in pregnancy < 11. Normal Hct = 37-47%, in pregnancy = 32%.
If a pregnant client is taking iron supplements, what condition must be monitored for?
Constipation.
Does pregnancy make women more susceptible to asthma attacks?
No.
What are the 4 F’s of cholelithiasis?
Female, forty, fair, fluffy.
What can be done about cholelithiasis during pregnancy?
Laprascopic cholecystectomy in the 2nd trimester.
What is striae gravidarem?
Stretch marks.
What is melisma (chloasma)?
Skin discoloration of the face.
What is condyloma acuminata?
Genital warts.
What is PUPPPS?
Pruitic Urticarial Papules Plaques of Pregnancy. Itchy. Cause is unknown. more common when carrying boys. Goes away after the baby is born.
What should be done if a client with lupus becomes pregnant?
Stop medication regimen.
If a mother has HIV, what must be done when the child is born?
Baby is immediately wiped clean of all fluids and then bathed.
The mothers consent must be given to test her for drugs and alcohol, but what about the baby?
Can test newborns urine or merconium without consent.
When is breast feeding contraindicated?
If the mother is using and/or abusing drugs or alcohol.
How much do maternal insulin requirements grow as pregnancy continues?
They may quadruple.
What is administered to prevent HIV from being transmitted to the fetus?
HAART.
What are the most common MEDICAL complications of pregnancy?
Hypertensive disorders.
What ethnic group is more likely to have hypertensive disorders during pregnancy?
African Americans.
Hypertensive disorders rank second only to ______ as a cause for maternal morbidity.
Embolic events.
Name some hypertensive complications.
Renal and/or hepatic failure, HELLP syndrome, cerebral edema seizures, intrauterine death, LBW, preterm infants.
What usually causes maternal death in hypertensive cases?
Hepatic rupture, placental abruption, eclampsia.
What is the medical term for never having been pregnant, and is this a risk factor for hypertensive problems?
Nulliparity. Yes.
What are some risk factors for hypertensive problems?
Family hx of pre-eclampsia, hx of pre-eclampsia in previous pregnancy, obese, multifetal, poor outcome (IUGR, Oligo, demise), pre-existing medical conditions, HTN, renal, DM, thrombophilias, antiphospholipid antibodies syndrome.
How is HTN in pregnancy defined?
Systolic 140 and diastolic 90. Mean arterial pressure > 105. 2 measurements during pregnancy or within 24 hrs after birth.
Name a disease of reduced organ perfusion with presence of hypertension and proteinuria.
Pre-eclampsia. Formerly known as toxemia.
What kind of a disease is pre-eclampsia?
Vasospastic. Reduce organ perfusion.
What is HELLP an acronym for?
Hemolysis, Elevated, Liver enzymes, Low, Platelets.
When does preeclampsia usually occur?
After 20th week.
What labs show severe preeclampsia?
Proteinuria > +2. > 30mg/dL protein in 2 consecutive samples at least 6 hrs apart. > 300mg/L in 24 hr collection. Systolic > 160. Diastolic > 110.
If a woman has been diagnosed with preeclampsia, and has seizure or coma activity, what is it called then?
Eclampsia.
If hypertension is diagnosed before pregnancy, or before 20 weeks gestation, what type is it?
Chronic hypertension.
If chronic hypertension is diagnosed, and the mother develops preeclampsia, what is it called?
Chronic hypertension with superimposed preeclampsia.
What are some risk factors for preeclampsia?
Primigravidity, multifetal, obesity, under 20, over 40, previous preeclampsia.
How does the pathophysiology of preeclampsia differ from gestational hypertension?
Arteriolar vasospasm diminishes diameter of blood vessels, which impedes blood flow to all organs (including placenta) and increases BP. Function in placenta, kidneys, liver, and brain depressed as much as 40%-60%.
What can these vasospasms lead to and what is the cure?
Can lead to HELLP syndrome and delivery is the cure.
What lab results point to HELLP syndrome?
Elevated AST/ALT, LP < 100,000/mm3.
What is coagulopathy?
HELLP syndrome can lead to coagulopathy, which is any blood clotting problem.
What does HELLP increase a mothers risk for?
Placental abruption, renal failure, pulmonary edema, ruptured liver hematoma, DIC, Fetal/maternal death.
What can be done for severe preeclampsia?
Hospital care, MSo4, control BP, bed rest in lateral recumbent, high protein/low salt diet.
What kind of room would a patient with severe preeclampsia need?
A dark, quiet room near the nurses station.
What 2 BP medications can be given to a nursing mother?
Methyldopa and hydralazine.
What differentiates hyperemesis from plain old emesis? What is its etiology?
Greater than 5% weight loss. Unknown, possibly psychological.
What disorders are an emergency and what are its complications?
Hemorrhagic disorder. Risk for hypovolemia, anemia, infection, preterm labor and/or birth.
What is incompetent cervix?
A painless thinning, shortening, dilation of the cervix.
What can be done to stop incompetent cervix?
Bed rest, anti-inflammatory drugs, antibiotics, Shirodcar/Mcdonald procedures, prophylactic cerclage at 12-15 weeks.
Where do most ectopic pregnancies occur?
95% in fallopian tubes.
Where else can an ectopic pregnancy occur?
Ovary, abdominal cavity, cervix.
What are some risk factors for ectopic pregnancy?
PPBTL, STDs, reversal of BTL, PID.
What are some s/s of ectopic pregnancy?
Missed period, adnexal fullness, dark red/brown vaginal bleeding.
What is a molar pregnancy?
A form of trophoblastic disease. 2 kinds. Complete (egg has empty nucleus), partial (2 sperm-normal ovum).
Is induction of labor with oxytocin and/or prostaglandins recommended for a molar pregnancy?
No.
What is GTN? How many types?
Gestational trophoblastic neoplasia. 3 types. Nonmetatastic, metatastic low risk, metatastic high risk.
What are the chances of being cured of these?
100% with non-metatastic and metatastic low risk.
When does GTN appear?
50% after hydatiform mole, 30% after ectopic pregnancy, 20% after normal birth.
How is GTN monitored?
Serial B hCG is monitored until level drops to 0. No pregnancy for 1 year.
What is it called when the placenta attachment is over the cervical os? Name 3 types.
Placenta previa. Complete, partial, marginal.
What arethe s/s of placenta previa?
Painless vaginal bleeding and fetal distress.
How is this diagnosed and what is most important to remember about treatment?
Diagnosed by ultrasound. No digital exams!!! Cesarean birth.
What is placental abruption?
Premature separation of the placenta. Grades 1, 2, 3.
What are the s/s of placental abruption?
Painful bleeding, uterine contractions, abnormal FHR.
In abruptio placentae, what are the mother and baby at risk for?
Mother - hemorrhage #1 cause of death. Fetus - hypoxia, pre term birth, IUGR, high risk for neurological defects.
What is velamentous cord insertion? Risks?
Cord doesn’t insert directly into placenta. Vessels can tear causing stillbirth.
Name 2 clotting problems that, if not treated, can cause bleeding during pregnancy.
DIC and Von Willenbrand’s disease. VW is a type of hemophilia that affects women.
During trauma, blood is shunted to vital organ to insure survival. Does this include the uterus?
No.
If a pregnant woman was in an auto accident, when might you expect abruption to occur?
24-48 hours later.
What is the leading cause of mortality during pregnancy?
Hypertensive disorders.
What causes preeclampsia? Are there tests that can reliably predict it?
The cause is unknown and there are no tests to predict it.
Do the pathologic changes of preeclampsia/eclampsia happen suddenly at the first sign of symptoms?
No. They happen well in advance and are multisystem in nature.
What kind of therapeutic interventions are done for preeclampsia?
Palliative-bedrest and diet. Underlying pathology continues.
What part of the preeclampsia/eclampsia progression is considered life threatening?
HELLP syndrome, which usually becomes apparent in 3rd trimester.
What drug is used for eclampsia, what is it’s antidote?
Magnesium sulphate, an anticonvulsant. Calcium gluconate. Monitor carefully!!!
What is the intent of emergency intervention for eclampsia?
Prevent self-injury, ensure adequate O2, reduce aspiration risk, control with MS04.
What is another significant cause of maternal and infant mortality?
Ectopic pregnancy.
What differentiates abruptio placentae and placenta previa?
Previa = painless bleeding, tonicity normal. Abruptio = painful bleeding, tonicity, rigid uterus and abdomen
What is the most common cause of death among US women of childbearing age?
Trauma from accidents.
What does fetal survival depend on?
Maternal survival.
What is minor trauma during pregnancy associated with?
Major complications of pregnancy - abruptio, hemorrhage, pre term labor and/or birth, fetal death.
