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Womens Health Exam 1 > Complicated Pregnancies Part 2 > Flashcards

Complicated Pregnancies Part 2 Flashcards

1
Q

What is chronic hypertension?

A

BP 140/90 or high

PRIOR to pregnancy or before 20th week of gestation

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2
Q

What is gestational hypertension?

A

BP 140/90 or higher

AFTER 20 weeks, no proteinuria (40% will progress to pre eclampsia)

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3
Q

What is the early problem of preeclampsia? (How does it start?)

A

Defect of trophoblastic invasion due to exaggerated maternal immune response = small placenta, more fibrous blood vessels, intermittent blood flow to placenta

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4
Q

What is the later problems of preeclampsia?

A

Growing fetus places demand on placenta as a struggles with an adequate blood flow= hypoxia

Hypoxia triggers and immune response

Immune response leads to the generalized inflammation and endothelial vasospasms and capillary injury

Science and symptoms of pre-eclampsia begin

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5
Q

When do we give low dose aspirin

A

Should be initiated between 12 weeks and 28 weeks of gestation and continued daily until delivery

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6
Q

What type of patient would get ASA regarding prevention of preeclampsia?

A

History of preeclampsia

Renal disease

Auto immune disease

Type I or type II diabetes

Chronic hypertension

First pregnancy

Maternal age of 35 years or older

BMI > 30

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7
Q

What are some maternal complications of preeclampsia?

A

Seriously impacts cardiovascular system, kidneys, liver, lungs, placenta function

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8
Q

What are fetal complications of preeclampsia?

A

Small for gestational age (SGA)

Fetal hypoxia

Fetal death related to placenta abruption

Prematurity related to pre term labour

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9
Q

Define mild preeclampsia

A

BP> 140/90 on at least 2 occasions 6 hours apart

Proteinuria 1+ to 2+

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10
Q

What are worsening signs of preeclampsia?

A

Increase in generalized edema and/or NV

Worsening HA and/or blurred vision

Epigastric/shoulder or RUQ pain

Decreased UO

Hyperreflexia

Disorientation/confusion

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11
Q

How to diagnose severe preeclampsia?

A

BP> 160/110 on two occasions at least 6 hours apart while the woman is on bedrest

PLUS

Proteinuria > 5g/L in 24 hours: Two 3+ urine dip stick readings at least 4 hours apart

PLUS

one or more of the following:

Headache or visual disturbance
Pulmonary edema, or cyanosis
Epigastric or RUQ pain
Elevated liver enzymes (ALT,AST)
Elevated creatine
Thrombocytopenia (<100,000)

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12
Q

What does HELLP syndrome stand for?

A

H- Hemolysis (decreased H&h)

EL- Elevated Liver enzymes

LP- Low Platelets (thrombocytopenia)

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13
Q

What is HELLP syndrome?

A

A complication of severe preeclampsia

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14
Q

How do you care for severe preeclampsia

A

Bed rest, reduce stimuli

Magnesium sulfate IV for seizures prophylaxis

Bethamethasone IM <34 weeks for fetal lung maturity

Deliver at 34 weeks or sooner for maternal or fetal indications

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15
Q

What is the “cure” for preeclampsia

A

Delivery! Induction of labour at 37 weeks if mild, sooner if severe

C section

Magnesium sulfate for seizure prevention for severe PIH

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16
Q

What is eclampsia

A

Woman has a seizure

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17
Q

What does PROM stand for?

A

Premature rupture of membranes

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18
Q

What is PROM

A

Spontaneous rupture of membranes at/after 37 weeks, but prior to labor

19
Q

What is pre term PROM

A

PPROM is PROM less than 37 weeks

20
Q

What is maternal risk and fetal risk of PROM

A

Maternal — infection

Fetal — complications of prematurity and neonatal infection

21
Q

How to tell if patient is ruptured?

A

Fluid check with nitrazine paper

Sterile speculum exam for pooling and collection of swabs for
-fern test

Ultrasound

22
Q

What is the amnisure test?

A

99% accurate in diagnosing ruptured membranes

Detects a protein present in amniotic fluid

Takes 2-10 mins

23
Q

What is fetal fibronectin (fFN)

A

This sticky glue (glycoprotein) where the maternal and fetal areas touch.

If we see it then it’s a direct biochemical predictor for preterm birth

24
Q

Why is fetal fibronectin an excellent negative predictor of pre term labour?

A

Negative results mean a 96% chance of NOT delivering in the next two weeks.

25
Q

What does it mean when the fetal fibronectin test is positive?

A

That doesn’t mean she’s going to deliver right away.

Only 30-40% will deliver within the next 2 weeks

26
Q

Define enfacement?

A

The gradual thinning, shortening and drawing up of the cervix measured in percentages from 0 to 100%

27
Q

How do you diagnose PTL?

A

Contractions every 5 minutes for 20 mins… or.. 8 contractions in 60 mins

AND

Documented cervical change like 80% effaced… or… cervical dilation > 1 cm

28
Q

How do you manage PTL

A

Goal: stop or slow labour

Bed rest/hydration

Betamethasone

Tocolytics
-mag sulfate for fetal neuro
protection for 2 days
-procardia after the 2 days

29
Q

What is hyperemesis

A

Excessive vomiting during pregnancy, in which NV are so severe, that they affect maternal hydration and nutritional status

30
Q

How do you diagnose hyperemesis?

A

Unmanageable vomiting in the first half of pregnancy

Dehydration

Ketonuria

Weight loss of 5% pre-pregnancy weight

31
Q

How do you manage hyperemesis?

A

Control vomiting

Correct dehydration

Restore electrolyte balance

Nutrition maintenance

Small meals/ simple carbohydrates

32
Q

What happens if mom is Rh - and fetus is Rh +

A

Some fetal Rh+ blood enter the mother’s blood

First time exposure causes development of maternal immunoglobulin M (IgM).

33
Q

What happens the second time an Rh - mom has a fetus that is Rh+

A

Rapid production of maternal IgG which is small enough to cross the placenta

Fetus is attacked by these antibodies causing hemolysis of fetal RBC = fetal anemia

34
Q

What is erythroblastosis fetalis

A

Presence of nucleated RBCs related to fetal response to the anemia

35
Q

What is the biophysical profile?

A

Represents an assessment of five fetal bio physical variables:

Fetal breathing
Fetal movements
Fetal tone
Amniotic fluid volume
Reactive FHR

36
Q

How do we test the biophysical profile?

A

Feel breathing, fetal movements, fetal tone, amniotic fluid volume are all determined by ultrasounds

Reactive fetal heart rate is assessed by the non stress test (NST) which is just an external fetal monitor

37
Q

How is the biophysical profile scored?

A

Each normal finding is a score of 2
Each abnormal finding is scored 0

Total scores of 8-10 (with normal amniotic fluid) are considered normal

38
Q

What is a poor scoring on the BPP?

A

A score of 6 is questionable.

A score of 4 indicates that delivery should be imminent

If amniotic fluid is 0 or BPP is 0 or 2, then delivery should be considered regardless of other points

39
Q

What is a non stress test (NST)

A

The NST is the most common test performed, and consists of using an electronic fetal monitor to obtain a tracing of the fetal heart rate, and observing the accelerations of the FHR with movement

40
Q

What does the acceleration of FHR indicate?

A

It indicates an intact central and autonomic nervous system that is not being affected by intrauterine hypoxia

41
Q

Why do we perform an NST?

A

The primary goal of the test is to measure the heart rate of the fetus in response to its own movements

After 30-32 weeks the NST is a non invasive good indicator of current fetal well being, but it is not a good predictor of future outcomes

42
Q

How can we tell if a reactive NST is good?

A

At least 2 FHR accelerations of at least 15 bpm above the baseline lasting at least 15 seconds within 20 mins

43
Q

What is amniocentesis

A

Insertion of a needle through the maternal abdomen into the uterine cavity to obtain an amniotic fluid sample

44
Q

What is the point of patient counseling regarding fetal testing?

A

Make sure the client understands why testing is needed

Risk to mother/fetus versus benefits of information

What type of information may be obtained? And what we will do with this info

Womens Health Exam 1 (6 decks)

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