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WCF > Complications During Pregnancy > Flashcards

Complications During Pregnancy Flashcards

1
Q

Occur before 20 weeks gestation

A

Spontaneous Abortion (Miscarraige)

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2
Q

Three or more consecutive pregnancy losses

A

recurrent abortion

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3
Q

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

A

Placental abruption

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4
Q

Implantation over or near cervix

Dilation exposes villi – bleeding

Risk factors: prior C/S or uterine surgery, Grand Multiparity, Age

A

Placental previa

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5
Q

Abruption Mnemonic

DETACHED

A

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)

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6
Q

Previa Mnemonic

PREVIA

A

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

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7
Q

Hallmark signs of abruption

A

-Dark red vaginal bleeding
-Rigid Abdomen/painful
-Increasing abdominal size
-Fetal HR changes (late decels)

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8
Q

Hallmark signs of placenta previa

A

-Bright red vaginal bleeding
-Painless or w/ uterine activity
-Normal FHR pattern

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9
Q

Stable previa requires

A

pelvic rest

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10
Q

Fertilized egg implants outside of the uterine cavity

-Incompatible with life
-99% Implant in the fallopian tube

A

Ectopic pregnancy

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11
Q

A lower than normal human chorionic gonadotropin (hCG) may indicate

A

ectopic pregnancy

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12
Q

Treatment for ectopic pregnancy

A

Non-ruptured fallopian tube:
1) Methotrexate IM
2) Laparoscopy: Salpingostomy

Ruptured fallopian tube:
1) Laparotomy: Salpingectomy

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13
Q

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

A

Cervical insufficiency

(Incompetent cervix)

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14
Q

A surgical procedure in which the cervical opening is closed with stitches to prevent or delay preterm birth

A

cerclage

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15
Q

Nausea sometimes accompanied by vomiting, subsides at 12 weeks or soon after, vomiting does not cause severe dehydration

A

morning sickness

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16
Q

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

A

hyperemesis gravidarum

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17
Q

Treatment of hyperemesis gravidarum

A

IV fluids, NG tube, Medications (metoclopramide, antihistamines, anti-reflux medication), bed rest, acupressure, ginger or peppermint, hypnosis, homeopathic remedies

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18
Q

Polyhydramnios

A

Too much amniotic fluid

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19
Q

Oligohydramnios

A

Not enough amniotic fluid

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20
Q

Causes of Oligohydramnios

A

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)

21
Q

Onset < 20 weeks
BP >140/90
Persists after 12 weeks postpartum

A

Chronic hypertension (CHTN)

22
Q

New onset HTN after 20 weeks, no proteinuria, BP returns to normal by 6 weeks postpartum
BP >140/90

A

Gestational Hypertension (GHTN)

23
Q

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

A

Superimposed Preeclampsia

24
Q

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

A

Pre-eclampsia/Eclampsia

25
Q

-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

A

Preeclampsia with severe features

26
Q

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

A

HELLP Syndrome

27
Q

When does HELLP develop?

A

Usually during the third trimester (between 26 to 40 weeks gestation)

28
Q

Magnesium sulfate prevents

A

seizures

29
Q

Corticosteroids for

A

fetal lung development

30
Q

Preeclampsia and eclampsia nursing interventions

A

-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

31
Q

If maternal BP drops too low, it can cause

A

fetal decels

32
Q

Antihypertensive medication

A

Hydralazine/Labetalol IV Push

33
Q

Keep this on hand in case patient has respiratory depression from magnesium sulfate

(antidote to magnesium sulfate)

A

Calcium gluconate

34
Q

Signs of magnesium sulfate toxicity

A

Respiratory distress
Decreased level of consciousness
Absence of patellar deep tendon reflexes
Urine output less than 30 ml/hr
Cardiac dysrhythmias

35
Q

If mag. sulfate toxicity is suspected …

A

Discontinue magnesium sulfate immediately
Administer calcium gluconate (antidote)
Notify provider
Take actions to prevent respiratory or cardiac arrest

36
Q

Treatment for pre-existing diabetes (1 or 2)

A

-Insulin is the treatment of choice
-Glyburide is occasionally used for gestational diabetes
-In depth plan of care made at first prenatal appointment

37
Q

Ideal BG level during pregnancy is

A

70-110

38
Q

When does gestational diabetes usually develop?

A

2nd or 3rd trimester

39
Q

Contributing factors for GDM?

A

obesity, maternal age older than 25 yrs, family hx of DM, previous delivery of an infant who was large or stillborn

40
Q

GDM manifestations

A

Hypoglycemia: nervousness, HA, weakness, irritability, hunger, blurred vision

Hyperglycemia: thirst, nausea, Abd pain, frequent urination, flushed dry skin, fruity breath

41
Q

Pts with DM & GDM are at risk for

A

Macrosomia (birth trauma & shoulder dystocia), pre-eclampisa, polyhydramnios (preterm labor), congenital anomalies, fetal distress (stillborn & neonatal death)

42
Q

DM & GDM postpartum management

A

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

43
Q

Manifestations of cardiovascular disease

A

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

44
Q

Hematological disorder characterized by pathological form of clotting that consumes large amounts of clotting factors, leading to widespread bleeding externally/internally or both

A

Disseminated Intravascular Coagulation (DIC)

45
Q

Risk factors/causes of DIC

A

PPH, placental abruption, amniotic fluid embolism, severe preeclampsia/HELLP, fetal demise

46
Q

Nursing interventions for DIC

A

monitor bleeding, O2 administration, IV fluids, VS, strict I&Os, foley, expedite delivery

47
Q

Major causes of maternal mortality

A

hypertension, hemorrhage, and infection

unsafe abortion is also a major complication

48
Q

CPR in pregnancy

A

§ 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

WCF (12 decks)

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