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NURS 4500: Midterm Material > Class 3: Complicated Pregnancy > Flashcards

Class 3: Complicated Pregnancy Flashcards

1
Q

when can pregnancy complications occur? who can they impact?

A
  • any time throughout pregnancy
  • can be a concern for the fetus, pregnant person, or both
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2
Q

what is important to prevent complications in pregnancy

A
  • identification of risks, with appropriate and timely interventions
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3
Q

decisions about management of pregnancy complications involve…

A
  • a balance between gains in fetal maturity and maternal/fetal consequences of continuing w the pregnancy
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4
Q

what are some major causes of maternal death (6)

A
  • infection
  • hemorrhage
  • hypertensive disorders
  • complications from the birth
  • unsafe abortion
  • pulmonary and amniotic embolism
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5
Q

what factors are strongly related to maternal death (3)

A
  • age (<20, >35)
  • lack of prenatal care
  • low education level
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6
Q

what are leading causes of newborn morbidity and mortality (2)

A
  • preterm
  • multiple birth rates
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7
Q

what are other causes of newborn death (4)

A
  • low birth weight
  • resp distress syndrome
  • sudden infant death
  • effects of maternal complications
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8
Q

infant death rate is high if mother is…

A
  • of lower socioeconomic status
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9
Q

what are the metabolic functions of the placenta (4)

A
  • respiration (diffusion of O2 and CO2) = fetal gas exchange
  • nutrition
  • excretion
  • storage
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10
Q

placental function is dependent on… what does this mean?

A
  • maternal blood pressure supplying circulation
  • therefore, interference with circulation to the placenta = placenta cannot supply the fetus
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11
Q

what cause interference w circulation to the placenta? (4)

A
  • vasoconstriction/vasospasm
  • hyperstimulation of the uterus (contractions)
  • decreased maternal blood pressure
  • decreased cardiac output
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12
Q

what can cause vasoconstriction/vasospasm, and therefore interfere w circulation to the placenta? (3)

A
  • HTN
  • cocaine use
  • diabetes
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13
Q

what can cause decreased maternal blood pressure? (2)

A
  • maternal compression of the vena cava = supine hypotension
  • hypotensive episode – epidural admin
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14
Q

what can cause decreases cardiac output (2)

A
  • infection
  • antepartum hemorrhage
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15
Q

decreased circulation to the uterus/placenta may lead to what 2 categories of outcomes?

A
  • fetal outcomes
  • neonatal outcomes
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16
Q

what fetal outcomes might decreased circulation to the uterus/placenta lead to? (4)

A
  • intrauterine growth reduction (IUGR)
  • fetal hypoxia
  • metabolic acidosis
  • still birth (fetal death)
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17
Q

what neonatal outcomes might decreased circulation to the uterus/placenta lead to? (5)

A
  • small for gestational age/low birth weight
  • metabolic acidosis
  • seizures (d/t low oxygen)
  • cerebral palsy
  • neonatal mortality
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18
Q

describe the connection between placental function and gestational age

A
  • placental function decreases as the placenta ages (postdates concerns)
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19
Q

what is the purpose of antepartum testing

A
  • detection of fetal compromise, primarily in the 3rd trimester
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20
Q

why/when is beta hCG assessed in antepartum testing (3)

A
  • routine prenatal care
  • confirmation of pregnancy
  • vaginal bleeding <20 weeks
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21
Q

why is CBC assessed with antepartum testing (6)

A
  • routine prenatal care
  • present to triage w complains of fatigue/feeling unwell
  • signs/symptoms of infection
  • prenatal bleeding
  • history of anemia
  • HTN disorders of pregnancy (decreased plts associated w adverse maternal outcomes, RBC, HELLP)
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22
Q

When (1) and why (3) is amniocentesis done as an assessment in antepartum testing

A
  • diagnostic test (performed after 14 weeks gestation)
  • to diagnose fetal chromosomal abnormalities
  • determining fetal lung maturity
  • fetal hemolytic disease
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23
Q

why might liver function tests (AST, ALT) and renal function (serum creatinine and uric acid) be completed in antepartum testing?

A
  • HTN disorders of pregnancy (increase associated w adverse maternal outcome)
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24
Q

why might INR/aPTT be assessed in antepartum testing

A
  • HTN disorders of pregnancy –> can be increased when DIC is present
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25
Q

why might blood type, Rh, and antibody screen be assessed in antepartum testing (4)

A
  • routine prenatal care
  • present w vaginal bleeding, abdominal trauma, S&S of placental abruption
  • severe anemia
  • previous history of PPH
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26
Q

why might a UA be assessed in antepartum testing? (5)

A
  • routine prenatal care –> 1st prenatal visit and prn (screen for asymptomatic bacteruria)
  • HTN disorders of pregnancy (proteinuria)
  • diabetes
  • suspicious of infection
  • hyperemesis gravidarium
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27
Q

When (1) and why (1) might MSU and C&S be assessed in antepartum testing

A
  • routine prenatal care
  • suspicion of infection
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28
Q

why might a US be used in antepartum testing? (10)

A
  • routine prenatal care 2nd trimester (placental placement, fetal anatomy, fetal growth, gestational age, # of fetuses)
  • confirm viability
  • prenatal bleeding (detect placenta previa or placental abruption)
  • decreased fetal movement (assessment fetal wellbeing, BPP)
  • assess fetal size (macrosomia, IUGR)
  • determine fetal position (breech, cephalic)
  • assess amniotic fluid volume
  • doppler flow studies
  • detect placental maturity
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29
Q

why might OGTT 50gm test be done in antepartum testing (2)

A
  • routine prenatal care to screen for GDM
  • can be performed at any time prior to 24 weeks in pregnancy if risk for GDM
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30
Q

when might GBS vaginal/perianal swab be done in antepartum testing (2)

A
  • routine prenatal care, normally around 35-37 weeks gestation
  • if pt presents w suspicion of labour/rupture of membranes and swab not yet completed (i.e if less than <35 weeks)
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31
Q

why is gestational age from 1st day of late menstrual period (LMP) / EDD by assessed in antepartum testing?

A
  • at each prenatal encounter to determine gestational age at presentation
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32
Q

when is obstetrical history & GTPAL assessed w antepartum testing (2)

A
  • at initial prenatal visit
  • reviewed at each prenatal encounter
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33
Q

why (2) and when (2) is social history assessed w antepartum testing

A
  • at initial prenatal visit
  • screened at each prenatal encounter
  • IPV – placental abruption?
  • substance use (i.e cocaine) – placental abrutpion?
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34
Q

what is included in HTN disorders of pregnancy focused assessment? (5)

A
  • headache
  • visual disturbances (seeing stars, blurriness)
  • RUQ/epigastric pain
  • deep tendon reflexes
  • clonus
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35
Q

why is a speculum exam completed w antepartum testing (2)

A
  • c/o vaginal discharhe/ordour –> rupture of membranes? infection (chorioamnioitis)?
  • vaginal bleeding –> placental previa? placental abruption?
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36
Q

why is a pelvic exam done with antepartum testing (3)

A
  • labour?
  • assess labour progress
  • cervical assessment for induction of labour
37
Q

When (1) and why (2) are VS and pain assessment done w antepartum testing

A
  • routinely at all prenatal and pregnancy encounters, throughout labour and postpartum
  • blood pressure to screen for HTN disorders, for targets and effectiveness of antiHTN drugs
  • temp to screen for infection
38
Q

When and why is fundal height assessed w antepartum testing? (2)

A
  • routine prenatal care –> indicates fetal growth, should correlate w gestational age (at 18 week onward)
  • fundal height outside expected parameters can indicate anomalies (ex. multifetal gestation, IUGR, oligo or polyhydramnios)
39
Q

why is a nitrazine test/Ferning test done with antepartum testing?

A
  • confirmation/rule out rupture of membranes
40
Q

when (2) is FHR assessed w antepartum testing? Why is FHR important to assess?

A
  • routinely at all prenatal and triage visits
  • intrapartum care
  • normal rate and rhythm are an indication of fetal wellbeing
41
Q

when (3) is fetal movement assessed w antepartum testing? Why is it important?

A
  • routine prenatal care
  • all pregnant people should be aware of their regular daily fetal movements from week 26 onward
  • daily “kick count” advised for pregnancies w additional risk factors, performed daily starting at 26 weeks
  • indicates fetal wellbeing
42
Q

Nonstress testing (NST) is considered in pregnant persons w risk factors for adverse perinatal outcomes: (6)

A
  • decreased fetal movements
  • HTN disorders of pregnancy
  • diabetes
  • previous history of stillbirth
  • prenatal bleeding
  • postdates
43
Q

a biophysical profile (BPP) is recommended in pregnant persons with risk factors for adverse potential outcomes, where expertise exists: (6)

A
  • decreased fetal movement
  • HTN disorders of pregnancy
  • diabetes
  • previous hisotry of stillbirth
  • prenatal bleeding
  • postdates
44
Q

umbilical artery doppler (doppler flow analysis) is indicated for assessment of the fetal placental circulation in pregnant persons when placental insufficiency is suspected. such as: (4)

A
  • postdates
  • HTN disorders of pregnancy
  • decreased fetal mvmt
  • IUGR
45
Q

what are some common maternal and fetal indications for antepartum testing (11)

A
  • diabetes
  • HTN disorders of pregnancy
  • renal disease
  • cholestasis of pregnancy, class 2
  • multiple gestation
  • oligohydramnios
  • preterm premature rupture of membranes
  • post date or post-term gestation
  • previous stillbirth
  • fetal growth restriction (IUGR)
  • decreased fetal movement
46
Q

what impact can diabetes have on the amt of amniotic fluid? size of fetus?

A
  • polyhydramnios
  • intrauterine growth restriction ( maternal)
47
Q

what impact do HTN disorders of pregnancy have on amt of amniotic fluid? fetal growth?

A
  • oligohydramnios
  • intrauterine growth restriction (maternal)
48
Q

HTN disorders of pregnancy are risk factors for (2)

A
  • oligohydramnios
  • intrauterine growth restriction (maternal)
49
Q

what impact do renal diseases have on fetal growth

A
  • intrauterine growth restriction (maternal)
50
Q

what impact does post-term gestation have on amt of amniotic fluid

A
  • oligohydramnios
51
Q

what impact might IUGR have on amt of amniotic fluid

A
  • oligohydramnios
52
Q

what is the goal of 3rd trimester testing for fetal wellbeing? (2)

A
  • determine if the intrauterine enviro is supportive to fetus
  • supports the determination of the timing of childbirth especially for those at risk for uteroplacental insufficiency
53
Q

what are risks for uteroplacental insuff? (3)

A
  • HTN disorders of pregnancy
  • postdates
  • diabetes
54
Q

decreased placental function results in.. (2)

A
  • inadequate nutrient delivery to the fetus –> IUGR
  • compromised resp function –> fetal hypoxia
55
Q

what is included in 3rd trimester assessment (4)

A
  • fetal movement counting (kick counts)
  • antepartum assessment using electronic fetal monitoring
  • biophysical profile (BPP)
  • doppler blood flow analysis
56
Q

what are examples of antepartum assessments using electrical fetal monitoring (3)

A
  • nonstress test (NST)
  • contraction stress test (CST)
  • fetal responses to hypoxia and asphyxia (variability)
57
Q

what is a NST? why is it used?

A
  • assesses fetal movement associated w FHR accelerations
  • reasoning: the normal fetus produces characteristic FHR patterns in response to movement –> in a health fetus w intact CNS = gross fetal body movements = FHR accelerations
58
Q

describe the evidence r/t NST

A
  • poor evidence that its use decreases perinatal morbidity and mortality
59
Q

describe the procedure for NST (4)

A
  • empty bladder
  • seated or semi-fowlers position w slight left tilt
  • 20 min
  • assess FHR/uterine activity/fetal movements
60
Q

in NST, assess FHR for: (4)

A
  • baseline –> 110-160 beats/min
  • variability –> 6-25 beats/min, <5bpm for <40 min
  • decelerations –> none or occassional variable (<30 sec)
  • accelerations –> 2 accelerations w acme of >15 bpm, lasting 15 sec < 40 min of testing (>40 min = concern)
61
Q

what should be done if the NST test is normal and there are no risk factors?

A
  • daily fetal movement counting
62
Q

what should be done if the NST is normal and there are risk factors or suspicion of IUGR or oligohydramnios? (2)

A
  • US for either biophysical profile or amniotic fluid volume assessment within 24 hrs
  • AND daily fetal movement counting
63
Q

what should be done if the NST is atypical/abnormal

A
  • further testing –> ex. biophysical profile, amniotic fluid vol
64
Q

what is a CST

A
  • evaluates the response of the fetus to induced contractions and designed to identify poor placental function
65
Q

what are 2 ways a CST is performed

A
  • nipple-stimulated contraction test
  • oxytocin-stimulated contracxtion test
66
Q

what does a positive CSt result mean

A
  • signs of decreased placental fnxn
67
Q

what risks are associated w CST (2)

A
  • hyperstimulation
  • labour/birth
68
Q

d/t the risks associated w CST, when should a CST test never be done

A
  • if we aren’t okay with them potentially going to birth
69
Q

what is a desirable result with CST

A
  • 3 contractions, lasting 1 min each, within a 10 min period
70
Q

what does a BPP measure (4)

A

test completed by fetal assessment team that is performed over 30 min using ultrasound to measure:
- fetal breathing movements
- fetal movements
- fetal tone
- amniotic fluid volume (AFV)

71
Q

what impact does low placental perfusion have on AFV

A
  • low placental perfusion = low AFV
72
Q

what should the fetal tone of the fetus be?

A
  • well flexed, not flaccid
73
Q

describe the scoring of BPP

A

each component provides a score of
- 0 = absent
- 2 = present

  • scored out of 8, or out of 10 if NST included
74
Q

the presence of normal fetal biophysical activities indicate:

A
  • that the CNS is functional
75
Q

what is an amniotic fluid index (AMI)? what is considered normal?

A
  • an estimate of the amniotic fluid volume in a pregnant uterus
  • normal = 10-25 cm
76
Q

what is polyhydramnios?

A
  • condition characterized by excessive accumulation of amniotic fluid in the uterus during pregnancy
77
Q

what indicates polyhydramnios? (3)

A
  • AFI > 25 cm
  • US: single deepest pocket >8 cm
  • fundal height will be large for dates
78
Q

what potential fetal complication can polyhydramnios lead to?

A
  • umbilical cord prolapse with rupture of membranes = UC between head and cervix = compression of cord = impaired gas exchange = emergency
79
Q

what potential maternal complications can polyhydramnios lead to?

A
  • increased pressure of the uterus = dyspnea and edema of lower extremities
80
Q

what is oligohydramnios

A
  • a medical condition in pregnancy characterized by a deficiency of amniotic fluid
81
Q

what indicates oligohydramnios? (4)

A
  • AFI < 5cm
  • US: single deepest pocket <2 cm
  • fundal height may be small for dates
  • may see prominent fetal parts
82
Q

what can cause oligohydramnios (2)

A
  • uteroplacental insufficiency (ex. preeclampsia)
  • renal
83
Q

oligohydramnios should query/need to rule out…

A
  • rupture of membranes
84
Q

what potential fetal complications can oligohydramnios lead to? (5)

A
  • cord compression (no cushion to protect from)
  • fetal anomalies
  • IUGR
  • adverse fetal outcomes/distress in labour
  • underdevelopment of the fetal lungs
85
Q

what does doppler blood flow analysis show

A
  • systolic/diastolic flow ratios and resistance to estimate blood flow in various arteries
86
Q

umbilical artery doppler is indicated when?? What are 3 examples of when placental insufficiency is suspected?

A
  • to assess placental circulation when placental insufficiency is suspected (not routine)
    ex. with preeclampsia, post dates, suspected IUGR
87
Q

Reduced, absent, or reservsed umbilical artery end-diastolic flow is an indication for? (2)

A
  • enhanced fetal surveillance or delivery
  • delivery may be delayed in order to gain fetal maturity and admin glucocorticoids to the pregnant person to improve fetal lung maturity
88
Q

what is included in management of pregnancy complications and assessments (2)

A
  • birth may be indicated
  • continued fetal/maternal monitoring
89
Q

what is included in continued fetal/maternal monitoring (2)? where could it take place?

A
  • fetal movement counts
  • could include regular NST, BPP assessments
  • location: at home (antenatal homecare program), admission to hospital antepartum unit)

NURS 4500: Midterm Material (19 decks)

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