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NURS 4500 > Class 3: complicated pregnancy > Flashcards

Class 3: complicated pregnancy Flashcards

1
Q

in canada major causes of maternal death (3)

A

Hypertensive disorders
Pulmonary and amniotic embolism
Hemorrhage

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2
Q

Factors strongly related to maternal death

A

Age (<20, >35 years)
Lack of prenatal care
Low education level

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3
Q

maternal mortality is highly ________________

A

preventable

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4
Q

why are hypertensive disorders on the rise in canada as a cause for maternal morbidity?

A

more stress and other lifestyle factors, and higher maternal age

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5
Q

__________ and __________ are leading causes of newborn morbidity and mortality

A

preterm, multiple birth rates

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6
Q

four other causes of newborn death (besides preterm and muliples)

A

low birth weight, resp distress syndrome, SID, effects of maternal complications

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7
Q

what is usually the cause of death with hypertensive disorders in pregnancy?

A

rupture of the liver, placental abruption, and eclampsia (from cerebral edema)

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8
Q

what is severe hypertension in pregnancy?

A

Severe hypertension is a systolic blood pressure of ≥ 160 mmHg or a diastolic blood pressure of ≥ 110 mmHg

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9
Q

its considered “gestational hypertension” when it happens after ___ weeks

A

20

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10
Q

chronic hypertension carries a small increased risk of __________ and ________

A

poor fetal growth, stillbirth

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11
Q

about _____ % of chronic hypertension patients develop preeclampsia

A

25

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12
Q

25% of those with gestational hypertension go on to develop _________

A

preeclampsia

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13
Q

what is preeclampsia?

A

Pre-eclampsia is a hypertensive disorder accompanied by new-onset proteinuria and, potentially, other end-organ dysfunction” (Basso, 2022, p. 266). ​

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14
Q

Pre e is a multisystem, vasospastic disease process – main pathogenic factor is what?

A

poor perfusion as a result of vasospasm, not an increase in BP

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15
Q

how do we diagnose protienuria?

A

A concentration of 0.03g/L or more in a least two random urine specimens collected at least 6 hours apart where there is no evidence of UTI (Basso, 2022)​

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16
Q

what would happen next under any of the following circumstances?
Eclampsia​
Posterior reversible encephalopathy syndrome (PRES)​
Cortical blindness or retinal detachment​
Stroke or TIA​
GCS <13

A

immediate delivery regardless of gestational age

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17
Q

adverse conditions that require close ongoing monitoring to determine need for delivery

A

headache, visual disturbances

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18
Q

define ecplampsia

A

Seizures in a woman diagnosed with preeclampsia, with no other history that would explain the seizures.​

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19
Q

what is hyperflexia?

A

when reflexes (like knee) barely require stimulus to activate. sign of explampsia

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20
Q

what hematological thing will i monitor with preeclampsia?

A

platelet count

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21
Q

what happens when platelet count is <50x10^9/L?

A

immediate birth required

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22
Q

what is HELLP syndrome?

A

-Hemolysis (dying RBCs)
-Elevated
-Liver enzymes
-Low
-Platelets

happens with preeclampsia

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23
Q

can HELLP syndrome occur after childbirht?

A

yes

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24
Q

how high is the mortality rate of HELLP?

A

as high as 25%

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25
Q

is HELLP always preceded by HTN or protienuria?

A

NO

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26
Q

Teach pt with HTN who is managing it at home to report what?

A

Headache, visual disturbances, RUQ/epigastric pain, chest pain / dyspnea, nausea / vomiting​
- decreased fetal activity

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27
Q

what labs will i observe for hospital managed pt with preeclampsia?

A

CBC (platelets), serum creatinine, liver enzymes (AST or ALT), INR/APTT​

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28
Q

what is given for seizure prevention?

A

magnesium sulfate

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29
Q

what is important about patients receiving magnesium sulfate?

A

should not be left alone!

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30
Q

what to do during convulsion/seizure?

A

Maintain patent airway​
Call for help – do not leave bedside​
Protect from injury if possible​
Observe and record activity/timing

31
Q

aside from IVs, what might I probably be inserting in eclampsia pt?

A

urinary catheter for accurate I&Os

32
Q

what might happen during a seizure that I would want to check after?

A

if membranes ruptured, and signs of placental abruption

33
Q

why do we want good control of blood sugars before conception?

A

risk of miscarriage and complications with fetus

34
Q

what kind of medication puts someone at risk for GDM?

A

corticosteroids

35
Q

if non=fasting glucose (routine) is 11.5 mmol/L, will pt need to do second test?

A

no, this is enough to dx them with GDM

36
Q

there is lots to teach someone with GDM. what are some things? (total of 9 points)

A

​
-Importance of following management plan to optimize blood glucose control (nutrition & exercise, monitoring of blood glucose; +/- medications)​
-Kick counts​**
-Signs/symptoms of infection, HTN​
-Refer to Dietician for nutrition counseling​
-How to self-monitor blood glucose ​
-Insulin therapy (self-injections), hypoglycemia signs/symptoms & treatment​
-Importance of carrying diabetic supplies and snacks with them everywhere​
-Importance of attending all prenatal & specialist appointments, and completing lab work and diagnostic tests​
-Encourage partner & family participation and support

37
Q

when should someone with GDM stop insulin and diebetic diet?

A

Immediately after birth

38
Q

for someone with T2DM, there is a higher risk of _________ in first and second trimester, and ________ in third trimester

A

HYPOglycemia, HYPERglycemia

39
Q

be alert for signs of ________ _______ during birth with T2DM

A

shoulder dystocia

40
Q

_____% of bleeding in the 3rd trimester is placenta previa or abruption

A

50

41
Q

lab tests for miscarriage:

A

serum BhCG x2 over 48 hrs, CBC prn based on symptoms,, blood type and screen

42
Q

this can lead to recurrent preterm births

A

premature dilation of the cervix

43
Q

what is placenta previa?

A

Placenta implants in lower uterine segment near or over the internal cervical os

44
Q

what is a marginal placenta previa?

A

when placenta has formed low in the uterus, no overlap seen, unknown relationship to cervix

45
Q

risk factors for palcenta previa?

A

-previous PP
-previous c section
- suction curettage
- multiparity
- smoking
- 35 + age
- living at higher altitude (lower 02 levels = bigger placenta)

46
Q

pt has painless bright red vaginal bleeding at 33 weeks. what is this a manifestation of?

A

placenta previa

47
Q

placenta previa is usually diagnosed when?

A

during routine 20w ultrasound

48
Q

what treatmetn may be required if a placenta previa attaches abnormally?

A

hyterectomy

49
Q

what do we NOT do for a placenta previa pt?

A

pelvic/vaginal exam

50
Q

which cases of placenta previa might be allowed to atttemp vaginal birth?

A

partial or marginal with minimal bleeding

51
Q

what is placental abruption?

A

Detachment of part or all of the placenta from its implantation site… after 20 weeks gestation and before the birth of the baby” (Basso, 2022, p. 291)

52
Q

plancental abruption risk factors (7)

A

–Hypertensive disorders of pregnancy​
-Cocaine use​
-Blunt external abdominal trauma (MVA / maternal battering)​
-Smoking​
-Previous hx​
-Preterm premature rupture of membranes​
-Thrombophilia

53
Q

describe the type of bleeding with placental abruption

A

painful, dark red, not clotty (port wine)

54
Q

labs for placental abruption

A

hgb and hct (decreased), abnormal clotting studies, and of course test rh type

55
Q

about 7% (and its increasing) of pregnancies are affected by ___________ _______

A

hypertensive disorders

56
Q

what is the fetus of the pre=eclamptic patient at risk for (4 things)

A

-placental abruption
- preterm birth
- intrauterine growth restriction (IUGR)’
- acute hypoxia

57
Q

patient has factor V leiden mutation. what does that put them at risk for?

A

pre-eclampsia

58
Q

a patient has OSA. what does that put them at risk for?

A

pre-E

59
Q

a patient has antiphospholipid antibody syndrome. what are they at risk for?

A

pre-E

60
Q

patient has renal disease. what are they at risk for?

A

pre-e

61
Q

patient has posterior reversible encephalopathy syndrome. do we monitor closely or delivery right away?

A

deliver

62
Q

besides headache, which symptoms can proceed eclampsia?

A

severe epigastric pain, hyperreflexia

63
Q

patient with pre-e has chest pain and dyspnea. do we deliver right away or closely monitor?

A

closely monitor

64
Q

what is the protocol for immediate delivery for severe uncontrolled HTN?

A

unresponsive for over 12 hours despite use of 3 antihypertensive agents

65
Q

pt has pulmonary edema. do we closely monitor or deliver immediately?

A

deliver

66
Q

patient has to be put on digoxin. do we deliver immediately?

A

yes

67
Q

if we need to do a transfusion for pre-e, what would happen next?

A

immediate delivery

68
Q

what’s the difference (for me) between absent or reveresed end diastolic flow vs absent/reversed ductus venosus A wave by doppler velocemitry?

A

end diastolic flow requires close monitoring, absent A wave = immediate delivery

69
Q

which antihypertensives should be avoided in preganancy?

A

ACE inhibitors, ARBs

70
Q

if pregnancy is between 24 and 34 +6 weeks and pre-E and delivery is expected within 7 days, what will be ordered?

A

steroids to promote fetal lung maturity

71
Q

7 things to do for a pre-e pt managed in hospital

A

-labs (cbc, creatinine, livers, INR/PT)
-accurate I&O
-prep for birth/induction if ordred
-continuous EFM
-antepartum steroids if indicated
-calm environment
-seizure precautions

72
Q

describe monitoring of pt on magnesium sulphate

A

vitals q30, reflexes and u/o q i hr

73
Q
A

NURS 4500 (8 decks)

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