Complications During Pregnancy Flashcards
Occur before 20 weeks gestation
Spontaneous Abortion (Miscarraige)
Three or more consecutive pregnancy losses
recurrent abortion
Separation of the Placenta from wall of Uterus before delivery of the baby
10 – 15% of perinatal deaths
Hemorrhage from the separation
Risk factors: Smoking, Cocaine, Trauma, Polyhydramnios, Age, Domestic Violence
Placental abruption
Implantation over or near cervix
Dilation exposes villi – bleeding
Risk factors: prior C/S or uterine surgery, Grand Multiparity, Age
Placental previa
Abruption Mnemonic
DETACHED
D - Dark red bleeding
E - Extended fundal height
T - Tender uterus
A - Abdominal pain; contractions
C - Concealed bleeding
H - Hard abdomen
E - Experience DIC (placenta is damaged so it releases thromboplastin, causing massive clotting)
D Distressed baby (placenta’s function is decreased)
Previa Mnemonic
PREVIA
P – Painless, bright red bleeding (vaginal)
R – relaxed, soft, non-tender uterus
E - episodes of bleeding
V - visible bleeding (not concealed)
I - inspect fetal heart rate
A - avoid vaginal exams
Hallmark signs of abruption
-Dark red vaginal bleeding
-Rigid Abdomen/painful
-Increasing abdominal size
-Fetal HR changes (late decels)
Hallmark signs of placenta previa
-Bright red vaginal bleeding
-Painless or w/ uterine activity
-Normal FHR pattern
Stable previa requires
pelvic rest
Fertilized egg implants outside of the uterine cavity
-Incompatible with life
-99% Implant in the fallopian tube
Ectopic pregnancy
A lower than normal human chorionic gonadotropin (hCG) may indicate
ectopic pregnancy
Treatment for ectopic pregnancy
Non-ruptured fallopian tube:
1) Methotrexate IM
2) Laparoscopy: Salpingostomy
Ruptured fallopian tube:
1) Laparotomy: Salpingectomy
Inability of the cervix to remain closed and support the growing pregnancy
Can be congenital or acquired (history of cervical trauma, previous spontaneous delivery in second trimester)
Associated with recurrent abortions and/or preterm births
Manifestations include increased pelvic pressure, pink-stained vaginal discharge or bleeding, uterine contractions
Cervical insufficiency
(Incompetent cervix)
A surgical procedure in which the cervical opening is closed with stitches to prevent or delay preterm birth
cerclage
Nausea sometimes accompanied by vomiting, subsides at 12 weeks or soon after, vomiting does not cause severe dehydration
morning sickness
Nausea accompanied by severe vomiting, nausea does not subside, vomiting that causes severe dehydration and electrolyte disturbance, weight loss of 5% or more of pre-pregnancy weight, may require hospital stay
hyperemesis gravidarum
Treatment of hyperemesis gravidarum
IV fluids, NG tube, Medications (metoclopramide, antihistamines, anti-reflux medication), bed rest, acupressure, ginger or peppermint, hypnosis, homeopathic remedies
Polyhydramnios
Too much amniotic fluid
Oligohydramnios
Not enough amniotic fluid
Causes of Oligohydramnios
premature rupture of membranes, placental insufficiencies, HTN, Preeclampsia, Diabetes, maternal dehydration, twin-to-twin transfusion syndrome, certain medications, like ACE inhibitors (they can cause fetal renal impairment)
Onset < 20 weeks
BP >140/90
Persists after 12 weeks postpartum
Chronic hypertension (CHTN)
New onset HTN after 20 weeks, no proteinuria, BP returns to normal by 6 weeks postpartum
BP >140/90
Gestational Hypertension (GHTN)
Preeclampsia complicating hypertension of another cause, most commonly chronic or “essential” hypertension.
New onset proteinuria in woman with HTN but no proteinuria before 20 weeks
Superimposed Preeclampsia
Onset > 20 weeks
BP >140/90 on 2 occasions at least 4 hours apart or BP >160/110
And >1+ proteinuria
Or in the absence of proteinuria, new-onset hypertension/ with new onset of any of the following:
-Thrombocytopenia: platelets < 100,000
-Renal insufficiency
-Impaired liver function
-Pulmonary edema
-New-onset headache unresponsive to medication
Pre-eclampsia/Eclampsia
-BP >160/110 on 2 separate occasions 4 hours apart
-Thrombocytopenia: platelets < 100,000
-Impaired liver function: elevated liver function, or severe persistant right upper quadrant or epigastric pain unresponsive to medications.
-Renal insufficiency: Serum creatinine > 1.1 mg/dl
-Pulmonary edema
-Protein/Creatinine Ratio > 0.3g
-New onset headache unresponsive to medications
-Visual disturbances
-Swelling in hands and face
Preeclampsia with severe features
A life threatening complication of pregnancy
Hemolysis of RBCs resulting in anemia and jaundice (destruction of red blood cells)
Elevated Liver Enzymes (elevated ALT and AST, epigastric pain, N/V)
“Low Platelets” (less than 100,000/mm3)- Resulting in thrombocytopenia abnormal bleeding and clotting time, bleeding gums, petechiae, and possible DIC
HELLP Syndrome
When does HELLP develop?
Usually during the third trimester (between 26 to 40 weeks gestation)
Magnesium sulfate prevents
seizures
Corticosteroids for
fetal lung development
Preeclampsia and eclampsia nursing interventions
-Monitor BP
-Administer medications
-Discuss nutrition
-Perform maternal assessment (daily weights, I & O, reflexes, CNS)
-Obtain fetal assessments (serial ultrasound, doppler, NST, BPP, contraction stress test, fetal kick count)
-Encourage bedrest
-Initiate seizure precautions
-Provide quiet environment
-Monitor for HELLP and DIC (with severe preeclampsia/ eclampsia)
-Immediately after a seizure, the patient may be confused and combative- do not leave patient alone
If maternal BP drops too low, it can cause
fetal decels
Antihypertensive medication
Hydralazine/Labetalol IV Push
Keep this on hand in case patient has respiratory depression from magnesium sulfate
(antidote to magnesium sulfate)
Calcium gluconate
Signs of magnesium sulfate toxicity
Respiratory distress
Decreased level of consciousness
Absence of patellar deep tendon reflexes
Urine output less than 30 ml/hr
Cardiac dysrhythmias
If mag. sulfate toxicity is suspected …
Discontinue magnesium sulfate immediately
Administer calcium gluconate (antidote)
Notify provider
Take actions to prevent respiratory or cardiac arrest
Treatment for pre-existing diabetes (1 or 2)
-Insulin is the treatment of choice
-Glyburide is occasionally used for gestational diabetes
-In depth plan of care made at first prenatal appointment
Ideal BG level during pregnancy is
70-110
When does gestational diabetes usually develop?
2nd or 3rd trimester
Contributing factors for GDM?
obesity, maternal age older than 25 yrs, family hx of DM, previous delivery of an infant who was large or stillborn
GDM manifestations
Hypoglycemia: nervousness, HA, weakness, irritability, hunger, blurred vision
Hyperglycemia: thirst, nausea, Abd pain, frequent urination, flushed dry skin, fruity breath
Pts with DM & GDM are at risk for
Macrosomia (birth trauma & shoulder dystocia), pre-eclampisa, polyhydramnios (preterm labor), congenital anomalies, fetal distress (stillborn & neonatal death)
DM & GDM postpartum management
Decrease insulin requirements IMMEDIATELY.
TYPE I: recalculate caloric and insulin needs
TYPE II: may not need insulin. Possible oral euglycemic use
Discuss risk reduction strategies, promote follow up with healthcare provider
Manifestations of cardiovascular disease
o Subjective: dizziness, SOB, Weakness, Fatigue, Chest pain on exertion, Anxiety
o Objective: Arrythmias/irregular HR/ Tachycardia, heart murmur, JVD, Cyanosis, lung crackles, edema, diaphoresis, increased Resp. intrauterine growth restriction, decreased amniotic fluid, FHR w/ decreased variability
Hematological disorder characterized by pathological form of clotting that consumes large amounts of clotting factors, leading to widespread bleeding externally/internally or both
Disseminated Intravascular Coagulation (DIC)
Risk factors/causes of DIC
PPH, placental abruption, amniotic fluid embolism, severe preeclampsia/HELLP, fetal demise
Nursing interventions for DIC
monitor bleeding, O2 administration, IV fluids, VS, strict I&Os, foley, expedite delivery
Major causes of maternal mortality
hypertension, hemorrhage, and infection
unsafe abortion is also a major complication
CPR in pregnancy
§ Pads one rib space higher
§ Prevent supine hypotension – displace uterus >20 wks
§ 2nd nurse is crucial
§ Tissue laxity (loose joints) makes it easy to hyperextend the airway
§ Careful when positioning airway
§ Rescue breaths
§ Monitor fetus if possible when pt has a pulse
§ Consider emergency perimortem cesarean
