Class 3: complicated pregnancy

Question 1

in canada major causes of maternal death (3)

Answer 1

Hypertensive disorders
Pulmonary and amniotic embolism
Hemorrhage

Question 2

Factors strongly related to maternal death

Answer 2

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

Question 3

maternal mortality is highly ________________

Answer 3

preventable

Question 4

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

Answer 4

more stress and other lifestyle factors, and higher maternal age

Question 5

__________ and __________ are leading causes of newborn morbidity and mortality

Answer 5

preterm, multiple birth rates

Question 6

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

Answer 6

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

Question 7

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

Answer 7

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

Question 8

what is severe hypertension in pregnancy?

Answer 8

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

Question 9

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

Answer 9

20

Question 10

chronic hypertension carries a small increased risk of __________ and ________

Answer 10

poor fetal growth, stillbirth

Question 11

about _____ % of chronic hypertension patients develop preeclampsia

Answer 11

25

Question 12

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

Answer 12

preeclampsia

Question 13

what is preeclampsia?

Answer 13

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

Question 14

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

Answer 14

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

Question 15

how do we diagnose protienuria?

Answer 15

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)​

Question 16

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

Answer 16

immediate delivery regardless of gestational age

Question 17

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

Answer 17

headache, visual disturbances

Question 18

define ecplampsia

Answer 18

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

Question 19

what is hyperflexia?

Answer 19

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

Question 20

what hematological thing will i monitor with preeclampsia?

Answer 20

platelet count

Question 21

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

Answer 21

immediate birth required

Question 22

what is HELLP syndrome?

Answer 22

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

happens with preeclampsia

Question 23

can HELLP syndrome occur after childbirht?

Answer 23

yes

Question 24

how high is the mortality rate of HELLP?

Answer 24

as high as 25%

Question 25

is HELLP always preceded by HTN or protienuria?

Answer 25

NO

Question 26

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

Answer 26

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

Question 27

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

Answer 27

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

Question 28

what is given for seizure prevention?

Answer 28

magnesium sulfate

Question 29

what is important about patients receiving magnesium sulfate?

Answer 29

should not be left alone!

Question 30

what to do during convulsion/seizure?

Answer 30

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

Question 31

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

Answer 31

urinary catheter for accurate I&Os

Question 32

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

Answer 32

if membranes ruptured, and signs of placental abruption

Question 33

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

Answer 33

risk of miscarriage and complications with fetus

Question 34

what kind of medication puts someone at risk for GDM?

Answer 34

corticosteroids

Question 35

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

Answer 35

no, this is enough to dx them with GDM

Question 36

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

Answer 36

​ -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

Question 37

when should someone with GDM stop insulin and diebetic diet?

Answer 37

Immediately after birth

Question 38

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

Answer 38

HYPOglycemia, HYPERglycemia

Question 39

be alert for signs of ________ _______ during birth with T2DM

Answer 39

shoulder dystocia

Question 40

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

Answer 40

50

Question 41

lab tests for miscarriage:

Answer 41

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

Question 42

this can lead to recurrent preterm births

Answer 42

premature dilation of the cervix

Question 43

what is placenta previa?

Answer 43

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

Question 44

what is a marginal placenta previa?

Answer 44

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

Question 45

risk factors for palcenta previa?

Answer 45

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

Question 46

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

Answer 46

placenta previa

Question 47

placenta previa is usually diagnosed when?

Answer 47

during routine 20w ultrasound

Question 48

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

Answer 48

hyterectomy

Question 49

what do we NOT do for a placenta previa pt?

Answer 49

pelvic/vaginal exam

Question 50

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

Answer 50

partial or marginal with minimal bleeding

Question 51

what is placental abruption?

Answer 51

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)

Question 52

plancental abruption risk factors (7)

Answer 52

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

Question 53

describe the type of bleeding with placental abruption

Answer 53

painful, dark red, not clotty (port wine)

Question 54

labs for placental abruption

Answer 54

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

Question 55

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

Answer 55

hypertensive disorders

Question 56

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

Answer 56

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

Question 57

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

Answer 57

pre-eclampsia

Question 58

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

Answer 58

pre-E

Question 59

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

Answer 59

pre-E

Question 60

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

Answer 60

pre-e

Question 61

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

Answer 61

deliver

Question 62

besides headache, which symptoms can proceed eclampsia?

Answer 62

severe epigastric pain, hyperreflexia

Question 63

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

Answer 63

closely monitor

Question 64

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

Answer 64

unresponsive for over 12 hours despite use of 3 antihypertensive agents

Question 65

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

Answer 65

deliver

Question 66

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

Answer 66

yes

Question 67

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

Answer 67

immediate delivery

Question 68

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

Answer 68

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

Question 69

which antihypertensives should be avoided in preganancy?

Answer 69

ACE inhibitors, ARBs

Question 70

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

Answer 70

steroids to promote fetal lung maturity

Question 71

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

Answer 71

-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

Question 72

describe monitoring of pt on magnesium sulphate

Answer 72

vitals q30, reflexes and u/o q i hr