Complicated Pregnancy Flashcards
Maternal and Fetal Risks with Multiple Pregnancy
Maternal:
- Hyperemesis
- Anemia
- Miscarriage
- Preterm labor
- GHTN/Cardio Complications
- APH, PPH, uterine dysfunction
- Placenta abruption
- Poly/olihydramnios
- Malpresentation
- Prolapsed Cord
- Instrumental Delivery
Fetal:
- Preterm
- Stillborn
- LBW, IUGR
- Congenital abnormality
- Cord Accident
- Placenta Abnormality
What is Discordant Twins?
And Managment?
The size difference is >20%
Restricted Growth develops in late 2nd trimester to early 3rd trimester
Earlier discordance l/t higher risk for fetal demise
Management:
- Monitored by u/s, BPP, Umbilical cord Doppler Velocimetry
What is Twin-To Twin Transfusion?
Only in MCMA (monochorionic, monoamnionic)
Donor: Anemic, growth restricted, oligo
Recipient:
- Polycythemic/circulatory overload (hydrops)
- Heart Failure, hyperbilirubinemia (Kernicterus)
What are the Nursing Interventions for Multiple Fetus Pregnancy?
- Gain 9.1-13.6kg by 20 weeks
- Monitor as a collab team
- Education on risks/appointment/ u/s
- Goal: reach 36-37 weeks
What are the risk factors for Hyperemesis Gravidarum?
- Young Maternal Age
- Nulliparous
- Low SES
- Unplanned Pregnancy
- High BMI
- Smoking
- Previous hx
What are the interventions for Hyperemesis Gravidarum?
- Health/ob hx
- Recent n&v
- IV fluids, I&O, urine dip
- TPN
- Fetal Monitoring
Placenta Previa
- What is it?
- Types?
- Interventions?
- Blastocyst implants in the lower segment, over or close to the internal cervical os
Type 1: lateral or low lying
Type 2: Marginal
Type 3; Partial
Type 4: Complete
Interventions:
- Expectant vs Active management
- Active after 36 weeks
- Planned c/s at 37-38 weeks
- U/s
- Diagnosed after APH episode
- Hospitalization (monitor for APH)
- Blood group/screen
- NO SVE/Speculum/Vaginal Exam
What are the types of Invasive Placentas?
Accreta: To the myometrium
Increta: Chorionic Villi invade myometrium
Percreta: Through myometrium, adhere to uterus
What is Placenta abruption?
- Types?
- S/s?
- Interventions?
- Premature separation of the placenta from the uterine wall (decidua basalis)
Types:
- Marginal (Separation at edge): See blood, see deterioation
- Concealed (Separation close to centre): don’t see blood, BP drops, MHR spikes, FHR drops
S/s: painful, abdomen tightness
Interventions:
- Monitor FHR, MVS
- Concealed may mask MVS (little changes)
- Blood group/screen, Coags, CBC
What is Gestational Diabetes?
And what is it increase the risk of?
No pre-existing diabetes
Carb intolerance in pregnancy
Increase risk of:
- Macrosomia
- Congenital Anomalies
- SA (spontaneous abortion)
- Microvascular damage. accelerated (to kidneys, eyes, nerves)
What is GTT?
Stands for Glucose Tolerance Test
Test @ 24-28 weeks
If >10.3 = GDM
7.8-10.2 = pre-diabetes, test again with 70g
<7.8 = normal
What is the normal metabolism for glucose?
- Fetus requires maternal glucose (have their own insulin), so mom is a bit hyperglycemic
-Placental hormones alter effects of and resistance to insulin and glucose tolerance
What happens to glucose and insulin levels in each trimester?
1st Trimester: Rise in hormones production and response to insulin (Insulin needs to decrease)
2nd and 3rd Trimester: hPL increase resistance to insulin l/t decrease glucose tolerance (insulin needs to increase 2-3%x)
Antepartum and Labor Interventions for GDM
Antepartum:
- Diet and exercise
- BGMS
- Mediations (insulin or metformin)
- FHS
- Education
Labor:
- Keep between 4-7mmol/L
- If >7, insulin d5w infusion
- Postpartum: BGMs
- Breastfeeding until 3m will reduce risk of diabetes
What is pre-existing vs gestational HTN?
What is preeclampsia and eclampsia?
Pre-existing: before 20 weeks
Gestational: after 20 weeks
Preeclampsia: HTN after 20 weeks with proteinuria
Eclampsia: medical emergency (like a seizure, acutely high risks, stroke, high BP)
What are the s/s of Gestational HTN?
- Headache
- Visual Disturbance
- Epigastric pain
- N&V
- Chest pain
- Abn labs
- Decreased FM
- Edema
- Weight gain
- Hypertonic reflexes
What are the interventions for GHTN?
- BP
- Blood work
- FHA
- Reflexes
- Urine dip
- Fluid balance
- Rest
- Pharm: anti-hypertensive, anti-seizures
What is normal Placental Development vs GHTN placental development?
Normal:
- Secondary invasion (16-18 weeks) transforms spiral arterioles of the uterine lining into vein-like structures with loss of smooth muscles. LOW RESISTANCE OF BLOODFLOW
GHTN Placental Development
-Secondary invasion is impaired. Spiral arterioles remain arterial therefore HIGH RESISTANCE BLOODFLOW (high BP)
What happens when vasospasm occurs?
Vasospasm of the maternal arterioles
Results in organ perfusion: brain, kidney, liver
Damages the epithelial lining which activates coagulation process l/t abnormal fibrin deposition and platelet consumption
What is HELLP Syndrome?
Stands for: Hemolysis, elevated liver enzymes, low platelet counts
Complications of severe GHTN
Management is same as GHTN
What are the interventions for PPROM?
- Amniotic stick (yellow to purple), ferning slide
- Antibiotic
- Prevent Chorioamnionitis
- GBS. BV/Trich/Yeast, Gonorrhea/Chlamydia
- Antenatal steroid
- MgSO4
- FHS
During TPTL (threatened preterm labor), what interventions will resolve contractions?
- Rest
- Hydration
- Prevent UTI/STI/other infections
- Tocolysis
- ANS
During TPTL (threatened preterm labor), what is fetal fibronectin?
- Detects glycoprotein in amniotic membrane
- Normally found except during 24-34 weeks
- If present indication of imminent labor
- Done when cervix is less than 3cm
- Before SVE
What is TPTL (threatened preterm labor) Management?
- FHS
- Maternal Health
- Antenatal Steroids (betamethasone) 24-34 weeks
- Fluid
- Tocolysis
- MgSO4 for less than 33 weeks
