complications during pregnancy and assessment of fetal well being Flashcards
spontaneous abortion- sab
when a pregnancy ends as the result of natural causes before 20 weeks of gestation
risk factors for sab
Chromosomal abnormalities, expectant illness (DM- not well controled), AMA, premature cervical dilation, infection, trauma, substance use, antiphospholipid syndrome
s/s of sab
lower Abd pain/cramping, ROM (leakign fluid), cervical dilation, fever, s/s hemorrhage
AMA
advanced maternal age >35
ROM
rupture of membranes
s/s of hemmorage
hard abd, low bp, increase hr, rr increase, diaphoertic, weak, dizziness, pale faint
ectopic prgen
The abnormal implantation of a fertilized ovum outside the uterine cavity, usually in the fallopian tube
ectopic preg risk factors
Tubal issues r/t STIs, assisted reproductive tech, surgery, IUDs
ectopic preg s/s
unilat lower abd pain/tenderness, missed period, vaginal spotting/bright red bleeding (if tube ruptured), referred shoulder pain (tubal rupture), hemorrhage/hypotensive shock
s/s of abd tubal rupture
rigid
rounded
bruising along umblilicord
SAB testing
H+H, Clotting factors, WBC, serum HCG, ultrasound, Vag speculum
sab procedure
Dilitation and curettage (D+C), Dilitation and evaculation (D+E), induction of labor
sab nurisng implications
- Assist with testing/procedures
- Avoid vaginal exams
- Monitor bleeding, vitals/assessment for hemorrhage
- Provide education and emotional support, refer to pregnancy loss support group
ectopic testing
Serum levels of progesterone and HCG to help determine pregnancy
ectopic procedures
Transvag ultrasound to confirm empty uterus, possible need for salpingostomy/laparoscopic salpingectomy (removal of tube/products of conception)
ectopic nursing implications
- May need to give methotrexate to dissolve pregnancy (stops cells from diving)
- obtain CBC, HCG levels, Liver enzymes, blood T+C
- replace fluids and maintain electrolytes,
- lots of client education, emotional care and support
- Refer to pregnancy loss support group
Hyperemesis Gravidarum
what does it cause
Excessive nausea and vomiting that is prolonged past 16 weeks that causes weight loss, dehydration, nutritional deficiencies, electrolyte imbalances, and ketonuria
gtd
gestational trophoblastic disease
risk factors of HG to fetus
intrauterine growth restriction, small of gestational age, or preterm birth
risk factors for HG
Expectant age <30, multifetal gestation, GTD, psychosocial issues r/t emotional stress, hyperthyroid disorders, diabetes, GI disorders, Family Hx, migranes
HIV/ AIDS meds
- antiretroviral therapy (ART)
- highly active antiretroviral therapy (HAART)
antiretroviral therapy
Orally throughout pregnancy and before onset of labor
Highly active antiretroviral therapy (HAART)
- Intrapartum- IV zidovudine 3 hr prior to C/S until birth
- Infant gets zidovudine at delivery and for 6 weeks following birth
HIV aids nursing care
- Goal is to keep CD4 count >500 cells/mm
- Encourage immunizations
- Planned C/S at 38 weeks for viral load for more than 1,000 copies/ml at 36 weeks
- Vaginal birth can be an option for viral load of less than 1,000 copies/ml at 36 weeks
- Infant should be bathed right after birth/skin to skin
c section w HIV
38 weeks for viral load for more than 1,000 copies/ml at 36 weeks
vagina birth for HIV
viral load of less than 1,000 copies/ml at 36 weeks
client teaching for HIV
- Discuss HIV and safe sex practices
- Do not breastfeed (developed nations)!
- See immunologist for HIV care/treatment
- HIV is a reportable disease, counsel client on mandatory reporting to health department
Placenta Previa
When the placenta implants in the lower uterine segment near or over the cervical os
Placenta Previa clinical manifestations
- **Painless, bright red vag bleeding in 2nd or 3rd trimester
- Uterus soft/non-tender
- Greater fundal height compared to gest age
- Fetus breech, oblique, or transverse lie
- ***Reassuring FHTs
- Vitals WNL
placenta abruption
The premature separation of the placenta from the uterus after 20 weeks, which can be a partial or complete detachment. High risk for expectant or fetal morbidity and mortality
placenta abruption risk factors
Pre- eclampsia, abd trauma (MVC or battery), cocaine use, smoking, premature rupture of membranes, multifetal pregnancy
placenta abruption clinical manifestations
- **Sudden onset of intense localized uterine pain with dark red vag bleeding
- ***Abd rigid and very tender
- Freq intense hypertonic contractions
- ***Fetal distress
- S/S of hypovolemic shock
GDM antepartum interventions
- Diet
- Exercise
- Monitoring blood glucose (fasting, 1 -2 hour postparandial: after first bite of food)
- Pharmacologic therapy: Insulin vs. oral hypoglycemics (Metformin or Glyburide)
- Fetal surveillance: DFMC, NST, assessing for degree of macrosomia
GDM intrapartum interventions
Glucose monitoring hourly: 80-110 mg/dl desired
Insulin infusion may be needed to maintain Bld. glucose levels
Avoid dextrose solutions
GDM after birth interventions
Most return to normal High risk for future GDM in pregnancy Increased risk of type 2 diabetes esp. with decreased exercise and diet control Reassess at 6-12 weeks PP Contraceptives: low dose OCPs or IUDs
hypertensive clinical manifestations
- Hypertension (140/90)
- Proteinuria
- Periorbital, facial, hand, abd edema, sacral edema
- Pitting edema
- Hyperreflexia:test deep tendon reflexes 3+
- Scotoma
- Epigastric pain
- RUQ pain
- Dyspnea
- Seizures
elevated labs for hypertensive
Elevated Liver Enzymes, increased protein- creatinine ratio, thrombocytopenia, lower Hgb, Increase bilirubin
preteinuria in hypertensive
Diagnosis: Dipstick for proteinurea or 24 hour urine collection for protein.
Significant proteinuria is defined as ≥0.3 g in a 24-hour urine specimen or protein/creatinine ratio ≥0.3 (mg/mg) (30 mg/mmol) in a random urine specimen or dipstick ≥1+ if a quantitative measurement is unavailable.
antihypertensive
Methyldopa (PO)
Nifedipine (PO)
Hydralazine (IV)
Labetalol (PO or IV)
client education for antihypertensive
Avoid ACE inhibitors or ARBs with the above meds
magnesium sulfate
Used as an anticonvulsant- to depress the CNS and prevent seizures in severe Pre-E or Eclampsia
magnesium sulfate dosage
Loading dose 4-6g IV over 20 min, Maintenance dose: 1-2 g continuous IV
3 reason to use MS
- seizure precautions
- uterine relaxed
- neuro protection
what to closely motior for MS
Vitals, LOC, headache, blurred vision, epigastric pain, DTRs, urine output via strict I+O, Mag level 5-8 mg/dL, UCs, FHTs
toxicity s/s for MS
Loss of DTR Urine output less than 30ml/hr ********Resps less than 12/min Decreased LOC Cardia dysrhythmias
normal s/s for MS
-Normal to feel flushed, hot, weak (like a wet, hot, noodle), may have burning at IV site
ms toxicity interventions
Stop Infusion!
Support ABCs
Administer antidote: Calcium Gluconate – 10mg IV over 10 min
hypertensive disorders in preg.. pt. .education
- Remain on bedrest if at home with expectant management
- Keep yourself distracted while on bedrest
- Avoid foods high in sodium
- Avoid alcohol and tobacco, limit caffeine intake
- Drink 6-8 glasses of water/day
- Keep a quiet environment, decrease stimuli
- Have family call 911 if you experience a seizure (they should roll you on your side and try to keep your airway clear)
- Take your antihypertensive meds as prescribed
preterm labor nursing implications
Activity Restriction
- Bedrest w BR privileges, lay on side
Ensuring hydration
- Prevents release of oxytocin which stimulates UCs
Identifying and treating infections
- Monitor temps and s/s of infection
Monitor FHT and contractions
Fetal tachycardia
- > 160/min can indicate infection
nifedipine
calcium channel blocker
Monitor for s/s of hypotension
Educate about s/s of hypotension
magesium
same dosage / info as in Pre-E
Monitor pt closely, look for s/s of toxicity
terbutaline
tocolytic (stops uterine contractions)
Can cause tachycardia (should not be given to pts with cardiac hx)
indomethacin
NSAID (blocks production of prostaglandins)
Shouldn’t be given after 32 weeks (premature closure of ductus arteriosus
for fetus: betamethasone
- for fetal lung maturity
- first dose: 12 mg IM initially
- 2nd dose: 12mg Im 2hr after 1st
- “window” 48 hr after initial dose
Amniocentesis
(aspiration of amniotic fluid by insertion of needle transabdominally)
Amniocentesis weeks gestation
After 14 weeks
(between 15- 20 weeks)
Amniocentesis interpretation of findings
- Presence of Alpha fetaloprotein could mean chromosomal anomaly or neural tube defect
- Can also test fetal lung maturity
- Fetal hemolytic disease
Maternal Alpha Fetoprotein
blood test
Maternal Alpha Fetoprotein weeks
16-18
Maternal Alpha Fetoprotein interpretation of findings
High levels- neural tube defect or open abd defect
Low levels- down syndrome
Screening tool- further test needed if positive
nonstress test
Non invasive fetal monitoring with external doppler transducer (for FHT) and tocotransducer (for contractions)
nonstress test reactive NST
- Fetal heart rate normal at 110- 160/min
- Moderate variability (fluctuation in HR by 6-25 beats)
- Fetal heart rate accelerates at least 15/min for at least 15 seconds
(>32 weeks), 10/min for at least 10 seconds for <32 weekers - Two accelerations in a 20 minute period
- No decelerations
nonstress test nonreactive NST
Anything above is not met in 40 min
BPP needed
Biophysical Profile (BPP)
Ultrasound to visualize physical and physiological characteristics of the fetus and observe for responses to stimuli
Biophysical Profile (BPP) test for
FHR (fetal heart rate)
Reactive nonstress test (NST
Fetal breathing movements
At least 1 episode of greater than 30 seconds duration in 30 min
Gross body movements
At least 3 body or limb extensions with return to flexion in 30 min
Fetal Tone
At least 1 episode of extension with return to flexion
Qualitative amniotic fluid volume
At least 1 pocket of fluid that measures at last 2 cm in 2 perpendicular planes=
