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247 > Ch 19, 20, 21 > Flashcards

Ch 19, 20, 21 Flashcards

1
Q

Biophysical risk factors for women

A

Genetic conditions
Chromosomal abnormalities
Multiple pregnancies
ABO incompatibility
Large fetus
Medical and oB conditions
Preterm
Cardiovascular disease (HTN)
Cervical insufficiency
Placental abnormalities
INfection, diabetes
Maternal collagen disease
Thyroid, asthma
Post term preg
Hemoglobinopathies
Nutritional status
Underweight/overweight
Hematocrit less than 33%

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2
Q

Psychosocial risk factors affecting womens pregnancy

A

Smoking
Caffeine
Alcohol and substance abuse
Maternal obesity
Inadequate support system
Situational crisis
History of violence
Emotional distress
Unsafe cultural practices

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3
Q

Sociodemographic risk factors affecting womens pregnancy

A

Poverty
Lack of prenatal care
Younger than 15, older than 35
Parity - all 1st and more than 5
Matiral statis - increased risk for unmarried
Ethnicity - increased risk for non-white women

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4
Q

Environmental risk factors affecting womens pregnancy

A

Infections
Radiation
Pesticides
Illicit drugs
industrial pollutants
Second hand cig smoke
Personal stress

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5
Q

Abortion

A

Loss of early pregnancy, usually before week 20

Can be spontaneous or induced

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6
Q

Spontaneous abortion

A

Loss of fetus resulting from natural causes

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7
Q

Stillbirth

A

Loss of fetus after 20th week

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8
Q

Miscarriage

A

Loss before week 20

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9
Q

What are the maternal conditions that can contribute to spontaneous abortions in 2nd trimester?

A

Cervical insufficiency, congenital or aquired anomaly of uterine cavity, hypothyroidism, DM, Chronic nephritis, cocaine, thrombophilias, lupus, PCOS, HTN, acute infection - rubella, cytomegalovirus, herpes, BV and toxoplasmosis.

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10
Q

Ectopic preg occur 1 in every ____

A

50

2% of preg in US

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11
Q

What medications are used for ectopic pregnancy?

A

Methotrexate
Prostaglandins
Misoprostol
Actinomycin

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12
Q

What is methotrexate typically used for

A

Chemotherapeutic treatment of leukemia, lymphomas, and carcinomas

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13
Q

Linear salpingostomy

A

used to preserve the tube - important for women who want to keep their fertility for future

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14
Q

The complete mole is assoc with development of

A

Choriocarcinoma

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15
Q

Partial mole has __karyotype?

A

triploid 69 chromosomes bc two sperm cells provided a double contribution by fertilization ovum

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16
Q

How does a complete mole present

A

uterine enlargement greater than expected, hyperemesis and pre-eclampic symptoms

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17
Q

What happens in molar pregnancy?

A

Trophoblastic cells that normally would form placenta proliferate and chorionic villi become edematous. They become grapelike clusters

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18
Q

What are 5 remarkable features of molar pregnancy?

A

Ability to invade into the wall of uterus
Recur in subseq pregnancies
Poss develop into choriocarcinoma
Influence of nutritional factors, protein def
Affect older women more

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19
Q

Symptoms of choriocarcinoma

A

SOB - indicative of metastasis to the lungs (most common site)

*asian, native and African increased risk

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20
Q

What is the patho for cervical insufficiency

A

Increased relaxin, when pressure of expanding uterus becomes greater than ability of cervical sphincter, cervix relaxes, allowing effacement and dilation

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21
Q

What is possibly the reason for cervical insufficiency

A

Congenital cervical hypoplasia, inutero DES exposure, trauma to cervix, amputation, OB lacteration, forced cervical dilation, prolonged 2nd stage of labor, increased relaxin and profesterone, increased uterine volume

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22
Q

Cervical cerclage

A

Sewing closed the cervix

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23
Q

Cervical pessary

A

a round silicone device at mouth of cervix

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24
Q

Complications assoc with cervical cerclage

A

suture displacement
rupture of membranes,
chorioamnionitis

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25
Q

How is cervical shortening viewed on ultrasound

A

as funneling. Amount can be determined by dividing funnel length by cervical length

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26
Q

Placenta accreta

A

placenta directly attached to myometrium

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27
Q

Placenta increta

A

Placenta penetrated into myometrium

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28
Q

Placenta percreta

A

Placenta invade myometrium into peritoneal covering, causing rupture of uterus

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29
Q

What are the risks for placental abruption

A

Ob hemorrhage, need for blood transfusions, em hysterectomy, DIC, sheehan syndrome, pp gland necrosis, renal failure

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30
Q

If a women develops DIC treatment focuses on

A

underlying cause
replacement therapy by transfusion of fresh frozen plasma factors along with cryoprecipitate

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31
Q

What is DIC

A

bleeding disorder characterized by an abnormal reduction in elements involved in blood clotting resulting from widespread intravascular clotting

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32
Q

DIC can occur secondary to

A

placental abruption, amniotic fluid embolism, endotoxin sepsis after abortion, retained fetus, posthemorrhagic shock, hydatidiform mole, HELLP syndrome, gyn malignancies

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33
Q

Complications of DIC

A

acute kidney failure
hepatic dysfunction
cardiac tamponade
gangrene
loss of digits
shock
death

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34
Q

What labs assist in diagnosis of DIC

A

Decreased fibrinogen and platelets
prolonged PT and aPTT
Positive D-dimer test and fibrin degradation products

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35
Q

Signs and symptoms of DIC

A

Bleeding gums
tachycardia
oozing from IV insertion site
petechiae

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36
Q

When is placenta accreta typically diagnosed

A

after birth

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37
Q

What are the theories for hyperemesis gravidarum

Endocrine
Metabolic
Genetic
Psycholigical

A

Endocrine - high level of hCG and estrogen
Metabolic - vit b def
Genetic - may predispose
Psycholigical - stress increase symptoms

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38
Q

What is the first choice for fluid replacement for hyperemesis gravidum

A

Normal saline which aids in preventing hyponatremia, which vitamins b6 and electrolytes added

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39
Q

What are nonpharmacological methods to treat myeremesis gravidum

A

Acupressure, hypnosis, massage, therapeutic touch, ginger, wear se-bands,

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40
Q

What happens if hyperemesis gravidum goes untreated?

A

can lead to neurological disturbances, renal damage, dehyrdation, ketosis, hypokalemia, retinal hemorrhage and/or death

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41
Q

What do the following lab tests tell about hyperemesis gravidum

Liver enzymes
CBC
Urine keytones

A

Liver enzymes - rule out hepatitis, pancreatitis, cholestasis; elevation of aspartate aminotrasnferase (AST) and (ALT) are usually present
CBC - elevated rbc and hematocrit - dehydration
**Urine keytones **- postive when body breasks down fat with inadequate intake

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42
Q

What do the following lab tests tell about hyperemesis gravidum

TSH and T4
Blood urea nitrogen
Urine specific gravity
serum electrolytes
Ultrasound

A

**TSH and T4 **- rule out thyroid disease
**Blood urea nitrogen **- increased in presence of salt and water depletion
Urine specific gravity - greater than 1.025 - linked to inadequate fluid intake or excessice loss, ketouria
serum electrolytes - decreased levels of potassium, sodium, and chloride, hydrochloric acid
Ultrasound - eval for molar preg or muliple gestation

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43
Q

Chronic HTN

A

exists prior to preg or develops before 20wks with bp greater than 140/90

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44
Q

Gestational htn

A

New onset bp elevation (140/90) id after 20 wks without proteinuria; bp returns to normal by 12 weeks pp

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45
Q

PreE/E and HELLP

A

develops with proteinuria after 20wks
Multisystem of:
elevated creatinine, liver involvement, epigastric or ab pain, neurological complications, hematologic and ueteroplacental dysfunction

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46
Q

Chronic htn w. superimposed pE

A

Develops afte 20wks
increased maternal / fetal morbidity rates

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47
Q

Risk factors for development of preE

A

Multifetal gestation, prev preg with preE, renal disease, autoimmune disease, DM, 1st preg, periodontal disease, chronic HTN, obesity

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48
Q

Define proteinuria

A

300mg or more of urinary protein per 24hrs more than 1+ protein by chemical reagent strip or dipstick of at least 2 random urine samples collected at least 4-6 hours apart

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49
Q

What to monitor when giving mag sulf

A

Serum mag levels
Assess DTRs, check for ankel clonus
Monitor for signs of toxicity, flushing, sweating, hypotension, cardiac and CNS dep

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50
Q

What to monitor when giving hydralazine hydrocholride

A

Use parenteral form immediate after opening , withdrawl slowly,
Monitor for palpitations, headache, tachycardia, anorexia, nausea, vomit, diarrhea

51
Q

What to monitor when giving labetalol hydrochloride

What does drug do?
Monitor for?

A

drug lowers bp w/o decreasing maternal hr or C/o
Monitor for gastric pain, flatulence, constipation, dizzy, vertigo, fatigue

52
Q

What to monitor with nifedipine

A

dizzy, peripheral edema, angina, diarrhea, nasal congestion, cough

53
Q

W

What to monitor with sodium nitroprusside

A

Apprehension, restlessness, retrosternal pressure, palpitations, diaphoresis, ab pain

54
Q

What to monitor with furoesmide

A

dizzy, veritgo, orthostatic hypo, anorexia vomit, electrolyte imbalance, muscle cramp and spasm

55
Q

What are signs of mag toxicity

A

RR less than 12
absence of DTRs
decrease in urinary output (less than 30ml.hr)

56
Q

Mag levels
4-7mEq
8
10
15
25

A

4-7mEq - therapeutic
8 - toxic
10 - possible loss of DTR
15 - possible respiratory dep
25- possible cardiac arrest

57
Q

Monozygotic

A

identical twins
developed from a sinlge fertilizated ovum that splits during 1st 2 weeks after conception

58
Q

Dizygotic twins

A

Not identical / fraternal
2 sperm fertilizing 2 ovum - separate amnions, chorions and placentas are formed

59
Q

What happens if membranes were ruptures more than 24 hours

A

increased risk for infection

60
Q

When is gestational DM usually diagnosed

A

2nd or 3rd trimester

61
Q

WHat are 2 key components of gestational DM

A

Pancreatic beta cell dysfunction prior to preg
unmasking of problem by development of insulin resistance during pregnancy

62
Q

What criteria do moms need to meet to not be screened for DM at their first visit?

A

-No history of glucose intolerance
-Younger than 25
-NOrmal body weight
-No family history of DM
-No history of poor oB outcomes
-Not from a ethnic/race group of high DM

63
Q

What are ADA and ACOG glucose targets

A

Fasting - less than 95
at 1 hr - 140
at 2 hr - 120
at 3 hr - 95

64
Q

WHat are short acting insulins?

A

lispro (humalog)
Aspart (novolog)
*do not cross placenta
**may help episodes of hypoglycemia betweeen meals

65
Q

Women with gestational DM are at increased risk for what conditions?

A

PreE
hypoglycemia
hyperglycemia
ketoacidosis
fetal macrosomia

66
Q

What do you do to care for a laboring women with DM

A

-adjust IV rate and insulin based on glucose levels
-Monitor blood glucose q 1-2 hrs
-Keep syringe of 50% dextrose solution bedside
-Monitor FHR
-Assess maternal vitals q 1hr w/ output

after birth
-monitor blood glucose q 2-4 for 48hrs
-encourge breastfeeding

67
Q

What congential heart conditions should avoid pregnancy

A

uncorrected tetrlogy of fallot
transposition of great arteries
Severe pulmonary htn
aortic valve stenosis
marfan syndrome
peripartum cardiomyopathy
eisenmenger syndrome
defect w/ both cyanosis and pulmonary htn

68
Q

What is cardiac decompensation

A

refers to hearts inability to maintain adequate circulation

69
Q

Severe persistent asthma has been linked to what in pregnancy

A

maternal htn
low birth weight
preterm birth
PreE
placenta previa
uterine hemorrhage
oligohydramnios

70
Q

Untreated TB has what affect on newborn

A

underweight
low APGAR
perinatal death

71
Q

ANemia

HGB below ___ in 1st and 3rd ti?
below ____ in 2nd?

A

redution in rbc, measured by hematocrit or a decrease in concentration of hemoglobin in peripheral blood. results in reduced capacity of blood to carry O2 to vital organs

Hgb below 11g/dl in 1st and 3rd tri
below 10.5 g/dl in 2nd

72
Q

What are maternal and fetal consequences of iron deficiency anemia

A

Preterm, perinatal mortility, post partum depression. Low birth weight, cardiovascular strain, intellectual disability, poor mental and psychomotor performance

risk for hemorrhage and infection

73
Q

What are 3 roles of iron

A

Transport of O2 and CO throughout body
aids in production of RBC
Plays role in immune response

74
Q

What are maternal/fetal outcomes of sickle cell disease

A

PreE, E, preterm, UTI, placental abruption, IUGR, low birth weight, maternal mortalities. life expectancy shortened. Renal, cardiac damage and infection

75
Q

To be diagnosed with systemic lupus erythematosus what are the 11 criteria and how many do they have to meet?

A

4/11

Red rash on face
photosensitivity
oral ulcers
arthritis
serositis
renal disease
Seizures
Fatique
weight changes
anemai
positive antinuclear antibody test

76
Q

What can lupus inflammation do to pregnancy

A

inflammation of connective tissue of decidua can result in placental implantation problems and poor functioning

77
Q

Nonimmune fetal hydrops

A

serious abnormal accumulation of fluid in 2 or more fetal compartments, including ascites, pleural effusion, pericardial effusion and skin edema

78
Q

AIDS

A

progressive debilitating disease that suppresses cellular immunity. predisposing infected person to opportunistic infections

CD4 count below 200

79
Q

Stages of HIV

Stage 1

A

Acute infection

Early stage w/ pervasive viral production
Flu-like symptoms 2-4 wks after exposure
Weight loss, low grade fever, fatique, sore throat, night sweats, myalgia

-ability to spread, highest at this point

80
Q

Stages of HIV

Stage 2

A

Asymptomatic infection / clincal latency

Viral replication continues within lymphatics, but slows down
usually free of symptoms; lymphadenopathy

81
Q

Stages of HIV

Stage 3

A

Persistent generalized lymphadenopathy

Possibly remaining in this stage for years; AIDS develops mostly within 7-10years
Opportunistic infections occur

82
Q

Stages of HIV

Stage IV

A

End stage (AIDS)

Severe immune deficiceny, very vulnerable to infections
High viral load, low CD4 count
Bacterial, viral, fungal opportunistic infections, fever, wasting syndrome, fatique, neoplasms, cognitive changes

83
Q

What BMI is sever obesity

A

over 40 kg.m

84
Q

What BMI is obesity in preg

A

30kg/m

85
Q

Alcohol effect on pregnancy

A

Spontaneous abortion, inadequate weight gain, IUGR, FASD

86
Q

Caffeine effect on pregnancy

A

Vasoconstriction, mild diuresis in mother, fetal stimulation

87
Q

Nicotine effect on pregnancy

A

VAsoconstriction, reduced uteroplacental blood flow, decreased birth weight, abortion, prematurity, placental abruption, fetal demise

88
Q

Cocaine effect on pregnancy

A

VAsoconstriction, gestational HTN, placental abruption, abortion, CNS defects, IUGR

89
Q

Marijuana effect on pregnancy

A

Anemia, inadequate weight gain, amotivational syndrome, hyperactive startle reflex, newborn tremors, prematurity, IUGR

90
Q

Opiates/narcotics effects on pregnancy

A

Maternal/fetal withdrawal, placental abruption, preterm labor, PROM, perinatal asphyxia, newborn sepsis and death. intellectual impairment, malnutrition

91
Q

Sedatives effect on pregnancy

A

CNS depressionn, newborn withdrawl, maternal seizures in labor, neonatal abstinence syndrome, delayed lung maturity

92
Q

Characteristics of FASD

A

Caraniofacial dysmorphia (thin upper lip, small head circumference, small eyes)
IUGR, microcephaly, congenital anomalies such as limb abnormalities and cardiac defects

93
Q

Dystocia

A

abnormal progression of labor

94
Q

During what phase does dystocia become apparent?

A

DUring active phase

95
Q

Frank breech

A

buttock as presenting part, hips flexed, legs and knees extended upward

96
Q

Complete breech

A

Buttock as presenting part, with hips flexed and knees flexed in a “cannonball” position

97
Q

Footling or incomplete breech

A

one or two feet as the presenting part, with one or both hips extended

98
Q

Infants born prematurely are at risk for what

A

respiratory distress syndrome
infections
congenital heart defects
thermoregulation problems
acidosis, weight loss,
intrventricular hemorrhage
jaundice, hypoglycemia, feeding difficulties, neurological disorders
numerous lifelong diabilities

99
Q

Indomethacin is contraindicated in

A

less tha 32 weeks preg
fetal growth restriction
history of asthma, urticaria or allergic type reactions to aspirin or NSAID

100
Q

Fetal fibronectin

Define?
Present up to —wks and –?
not detected between – & —?

A

glycoprotein produced by chorion, found at the junction of chorion and decidua

Acts as biologic glue attaching fetal sac to uterine lining

normally present up to 22 wks and at end of preg / cannot be detected between 24-34 wks unless there is a disruption between chorion adn deciduas

101
Q

What is fetal fibronectin a useful marker for

A

impending membrane rupture within 7-14 days if level increases to more than 0.5mcg/ml

Accuracy decreased in presence of lubricants, blood, recent intercourse or cervical manipulation within previoud 24hrs

102
Q

What 3 parameters are evaluted during a transvaginal ultrasound

Cervical length of 3cm or more indicates?
Women with a short cervical lenght of 2.5cm or less during 3rd tri are at greater risk for?

A

Cervical lenth and width
Funnel width and length
% of funneling

  • cervical lenght of 3cm or more indicates delivery in next 14 days unlikely
  • ** women with short cervical lenght of 2.5cm during mid tri greater risk of birth prior to 35 wks
103
Q

Contraindications to tocolytics

A

intrauterine infection
active hemorrhage
fetal distress
fetus before viability
fetal growth restriction
severe preE
heart disease
PPROM
intrauterine demise

104
Q

Fetal risks assoc with post-term preg

A

macrosomia, shoulder dystocia, brachial plexus injuries, low apgar, postmaturity syndrome (loss of subQ fat and muscle and meconium stanining)

as placenta ages = perfusion decreases = olighydraminos, fetal hypoxia, cord compression, aspiration of meconium

105
Q

Cervical ripening

A

process by which cervix softens via the breakdown of collagen leading to its elasticity and distensibility preceding cervical dilation

106
Q

Alternative methods for cervical ripening

A

primrose oil, black haw, black and blue cohosh, red respberry leaves, castor oil, hot baths, enemas, sexual intercorse

107
Q

What are mechanical methods for cervical ripening

A

Application of local pressure = stims the release of prostaglandins to ripen cervix

Indwelling foley catheter
**hygroscopic dilators **- absorb endocervical tissue fluids, they expand cervix and provide pressure
Natural osmotic (laminaria -dry seaweed) & synthetic containing mag (lamicel, dilapn) - expand over 12-24hrs

108
Q

What are the surgical methods for cervical ripening

A

**Stripping of membranes **- inserting finger through internal cervical OS and moving it in circular motion
amniotomy- inserting a cervical hook through cervical os to deliberaly rupture membranes - pressure of presenting part on cervix and stims increase in prostaglandin

Risks - cord prolapse or compression, infection ,FHR decel, bleeding

109
Q

VBAC

Contraindicated in?

A

Vaginal birth after C-section

Contra - prior classic uterine incision, prior transfundal uterine surgery, obesity, short stature, macrosomia, over 40, gestational DM, contracted pelvis

110
Q

Intrauterine fetal demise

A

death that occurs after 20 wks gestation but before birth

111
Q

Umbilical cord prolapse

A

Rare. When cord precedes fetus / Presenting part doesnt fill pelvis

Fetal perfusion deteriorates rapidly

Risk - multiparity, noncephalic presentations, long cord, preterm, low birth weight, placement of cervical ripening balloon

Often first sign - sudden fetal bradycardia or recurrent variable decls

112
Q

Nurse mgmt for cord prolapse

A

call for help
membranes ruptured
relieve compression
change womens position to sims, trendelenburg, or knee chest
Do Not place cord back into uterus
Monitor FHR, bed rest and O2

113
Q

Placenta previa

define
symptoms

A

complete or partial covering of uterine internal os or cervix

Signs - sudden painless bleeding, anemia, pallor, hypoxia, low bp, tachycardia, soft and nontender uterus, rapid weak pulse

114
Q

Placental abruption

define
Risks?

A

premature separation of normally implanted placenta from maternal myometrium

Risk - preE, gestational HTN, serizure, over 34, uterine rupture, trauma, smoking, cocain, coag defects, chorioamnionitits, PPROM, fetal growth restriction, hydramnios, breech,

115
Q

Uterine rupture

A

Castastrophic tearing of uterus at site of previous scar into ab cavity

Marked b y sudden fetal bradycardia / treat with rapid surgery

116
Q

Anaphylactoid Syndrome of pregnancy
Aka Amniotic fluid embolism

A

unforseeable, life-threatening complication of childbirth
-Sudden onset of hypotension, cardiopulmonary collapse, hypoxia and coagulopathy
-Amniotic fluid enternal maternal circulation and obstructs pulmonary vessels, causing respiratory distress and circulatory collapse

117
Q

What are predisposing factors assoc with amniotic fluid embolism

A

placental abruption, uterine overdistension, fetal demise, eclampsia, amnmiocentesis, uterine trauma, oxytocin-stimulated labor, multiparity, advanced maternal age, ruptured membranes

118
Q

What are the 4 cardinal signs of ASP

A

Respiratory failure
Altered mental status
Hypotension
DIC

119
Q

What is nursing mgmt for ASP

A

-Resucitation and 100% Oxygenation
-Intravenous fluids, inotropic agents to maintain cardiac output and bp
-oxytocic agents to control uterine atony and bleeding
-seizure precautions
-admin of steriods to control inflam response

Monitor vitals, pulse ox, skin color, observe for signs of coagulopathy (vag bleed, bleed from IV site, bleed from gums)

120
Q

Forceps or vaccum assisted birth

A

apply traction to fetal head or provide a method of rotating head during bith

121
Q

Forceps

-outlet
-low

A

Stainless steel instruments with rounded edges that fit around fetus head

OUTLET foceps are used when head is crowning
LOW forceps are used when head is at 2+ or lower but not yet crowning

122
Q

Vaccum extractor

A

Cup shaped instrument attached to a suction pump used for extraction of head

Used to create negative pressure of apprx 50-60mmHg

123
Q

What are indications of use for forceps or vaccum

A

Prolonged 2nd stage, distressed FHR, failure of presenting part to fully rotate and descend, limiited sensation and inability to push effectively due to regional anesthesia, fetal distress, maternal heart distress, acute pulm edema, intrapartum infection, maternal fatique, infection

124
Q

What are the risks of forceps or vaccum

A

Maternal - Tissue trauma, lacerations, hematoma, extension of episiotomy into anus, hemorrhage and infection

Newborn - ecchymoses, lacerations, facial nerve injury, cephalohemoatomoa, caput succedaneum

247 (11 decks)

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