chapter 19: Pregnancy Related Complications Flashcards
Abruptio placenta classifications
Separation of placenta leading to compromised blood supply to fetus
Mild/grade 1: minimal bleeding 1500, severe separation more than 50%, profound shock, dark vaginal bleeding, agonizing abdominal pain, decreased BP, significant tachycardia, DIC
painful, dark red blood
Placenta previa
Placenta implants over cervical os
Total: internal os is completely covered
Partial: os partially covered
Marginal: at the edge of the os
Low lying: in the lower uterine segment but does not reach the os
Painless, soft uterus, bright red blood
Mild preeclampsia
>140/90 after 20 weeks Greater than 1+urine on dip No seizures No hyperreflexia Mild facial or hand edema Weight gain
Severe preeclampsia
>160/110 3+ urine on dip No seizures Hyperreflexia Headaches Oliguria Blurred vision, scotomata(blind spots) Pulmonary edema Thrombocytopenia Cerebral disturbances Epigastric or RUQ pain HELLP
Eclampsia
>160/110 Marked proteinuria Seizures and coma Hyperreflexia Severe headache General edema RUQ or epigastric pain Visual disturbance Cerebral hemorrhage Renal failure HELLP
HELLP acronym
Hemolysis Elevated Liver enzymes Low Platelet count
Variant of preeclampsia. Life threatening. Causes liver distention, rupture, hemorrhage, DIC, death mom and baby, stroke, cardiac arrest, seizure, pulmonary edema, respiratory distress, renal damage, sepsis, encephalopathy. S&S nausea, malaise, epigastric RUQ pain, edema
Trtmt: rapid lower BP, prevent seizures, steroids for fetal lungs (betamethasone or dexamethasone), birth. May delay birth for 96 hrs for lungs to get steroid.
Management same as severe preeclampsia
Hydatiform mole - molar pregnancy
Is a form of gestational trophoblastic disease in which is benign neoplasm of the chorionic villa degenerate and become vesicles. It is associated with development of choriocarcinoma. Signs and symptoms include vaginal bleeding, anemia, enlarged uterus, preeclampsia, and hyper emesis. Inability to detect FHR after 10-12 wks, ovarian enlargement, fluid retention, extremely high HCG levels, explulsion of grapelike vesicles in some women.
Immediate D&C is the treatment for this. If any tissue remains afterwards, the hCG level will not drop. Extensive follow-up and birth control is used for 12 months. Patient should avoid pregnancy. Monitoring it includes the hCG level, chest x-rays for metastasis, and pelvic ultrasound.
Gestational hypertension
Above 140-90 on 2 occasions at least 6 hours apart, after the 20th week of pregnancy. Resolved by 12 wks postpartum.
Chronic occurs before 20 weeks.
Magnesium sulfate
prevent and treat preeclamptic seizures
Works by vasodilation and blocks neuromuscular transmit
Load with 4-6 g IV in 100ml overr 15-20 minutes. maintenance is 2 g. Monitor levels 4-7 therapeutic, Assess DTR and ankle clonus.
Calcium gluconate for toxicity ( R < 12, absent DTR, urine < 30 mL-hr, flushing, sweating, hypotension, and cardiac and CNS depression).
Preeclampsia presents with hyperreflexia
Toxicity - diminished or absent reflexes. 2+ and 3+ are normal reflexes.
Clonus is a sign of preeclampisa rhythmic involuntary contractions in the ankle. It indicated CNS involvement.
Reflexes
None 0 hypo-sluggish 1 normal in lower half of range 2 normal in upper half of range 3 hyper-brisk, clonus 4
spontaneous abortions
before 20 weeks. Natural causes.
1st trimester most common cause is genetic abnormalities; 2nd trimester is maternal disease.
Bright red blood is significant.
Reassure that they are usually because of an abnormality and her actions did not cause it.
Types of spontaneous abortions
Threatened: slight vaginal bleeding, mild cramping. Possible reduction in activity and conservative support
Inevitable: Vaginal bleeding, rupture of membranes, cervical dilation, cramping, possible passing of products. Vaccum curettege if products are not passed. Misoprostol to help empty tissue
Incomplete: passage of some products, intense pain, cramping, heavy bleeding, dilation, D&C or prostaglandin analog
Complete: Passage of all products, history of bleeding, decreased pain when tissue passes.
Missed: Nonviable embryo retained at least six weeks. Irregular spotting. Suction curretage for first trimester, D&C in second trimester. Possible induction of labor.
Habitual: History of three or more consecutive spontaneous abortions. Trying to identify the cause. Cervical cerclage in the second semester if incompetent cervix is the cause
Ectopic pregnancy
Any pregnancy in which the ovum implants outside the uterine cavity, usually in the fallopian tubes. Usually is from conditions that obstruct or slow the passage of the egg through the fallopian tube such as scarring from PID, previous tubal surgery, infertility, genital/pelvic inflammatory disease, previous pregnancy loss, IUD, fibroids, smoking, douching.
Hallmark sign is abdominal pain with spotting 6-8 wks after missed period.
Methotrexate is nonsurgical management and inhibits cell division. Must not have rupture.
Surgery if ruptured. Severe, sharp, stabbing, unilateral abdominal pain, vertigo, fainting, hypotension, rapid pulse. Hypovolemic shock may occur.
BC for at least 3 cycles
Monitor hCG levels to make sure all tissue is gone
Complications include hemorrhage, infertility, death
Gestational hypertrophic disease
Hydatiform mole and choriocarcinoma. Brownish vaginal bleeding, anemia, no fetal heart rate after 10 to 12 weeks, severe morning sickness, fluid retention, larger than expected uterus, preeclampsia, enlarged ovaries, expulsion of grape like vesicle
Risk for mothers carrying twins
They are at high risk for preterm labor, hydramnios, hyperemesis gravidarum, anemia, preeclampsia, antepartum hemorrhage.
Complications include anemia, excessive weight gain, proteinuria, edema, vaginal bleeding, hypertension, placenta accreta, preterm labor,
The fetal risks include prematurity, respiratory distress syndrome, for asphyxia/perinatal depression, congenital anomalies, twin to twin transfusion syndrome, IUGR, conjoined
