Complications in Pregnancy - Maternal Care Challenges Flashcards
Gestational Conditions
- Disorders that did not exist before pregnancy
- Occurrence puts woman and fetus at risk
Hypertension in in pregnancy (chronic hypertension, preeclampsia, HELLP syndrome, eclampsia) - Gestational diabetes mellitus
- Hyperemesis gravidarum
- Hemorrhagic complications (PPH)
- Surgery during pregnancy
- trauma
- infections during pregnancy
Hypertension in Pregnancy: Significance and Incidence
- hypertensive disorders of pregnancy are increasingly common, involving 5-10% of pregnancies
- not the most common issue, but the more common ones dont have the same negative consequences
- women over 40 years of age are a highest risk
- hypertension is the leading cause of maternal and perinatal morbidity and mortality worldwide
- SOGC has recommendations regarding prevention of pre-eclampsia and its associated complications
Hypertensive Disorders of Pregnancy: Definition
Systolic BP > 140 mm Hg and diastolic BP > 90 mm Hg
Severe Hypertension: systolic BP > 160 and diastolic BP > 110
Chronic hypertension
hypertension present before pregnancy
Superimposed preeclampsia
chronic hypertension in association with pre-eclampsia (after 20 wks gestation)
Gestational hypertension
Hypertension develops at or after 20 weeks of gestation in previously normotensive woman without proteinuria
Preeclampsia
Hypertension develops at or after 20 weeks of gestation in previously normotensive woman with proteinuria. determined through ketones on a pee stick
Severe preeclampsia S&S
- hypertension
- proteinuria
- cerebral disturbances
- epigastric pain
Eclampsia
seizure activity or coma in woman diagnosed with preeclampsia (no other reason)
Preeclampsia Pathophysiology
- differs from chronic hypertension (because NOT pregnant)
- the main pathogenic factor is not an increase in BP but poor perfusion resulting from vasospasm
- believed to be an interaction between cardiovascular and uteroplacental responses to pregnancy
- caused by disruption in placental perfusion and endothelial cell dysfunction
- arteriolar vasospasm diminishes the diameter of blood vessels, which impedes blood flow to all organs and increases BP
- women who are pregnant have increased BV and more cardiac requirements, more effort. risk for vasospasm is higher
Maternal Risk Factors
- age
- parity
- obesity
- diabetes
- hypertension
- autoimmune diseases
- sickle cells anemia
Signs and Symptoms of Preeclampsia (9)
- swelling of face and hands
- fluid retention (decreased urine output)
- sudden weight gain (>2 lbs/weeks/6lbs/mos)
- persistent headache
- seeing spots or changes in eyesight
- pain in the upper abdomen or shoulder
- Nausea and vomiting (in the second half of pregnancy)
- Difficulty breathing (dyspnea)
- Tachycardia
It is easy to write off all these symptoms as normal pregnancy symptoms.
Nursing Care Management Preeclampsia: Assessment
First Sign - Elevated BP
2nd Sign - Proteinuria
3 Questions: do you have a headache? Visual disturbance? RUQ epigastric pain?
Fetal health surveillance (nonstress test, contraception stress test, laboratory stress)
women get their BP check eery prenatal appointment. checked and cataloged, pee on the stick every visit is no longer used. it wasnt indicating it and most women produce ketones to some level in pregnancy. proteinuria has to be accompanied by other symptoms
Plan of care Preeclampsia - ensure maternal safety & healthy baby. Mild preeclampsia
home care
- fetal health surveillance
- activity restriction
- diet
Plan of care Preeclampsia: severe preeclampsia and HELLP Syndrome
- hospital care (O2 for perfusion) -
- magnesium sulphate (1-1 care)
- control of BP (<160/100)
- no NSAIDS (elevate liver enzymes)
HELLP Syndrome
hemolysis, elevated liver enzymes, and low platelets - factors very specific to HTN in pregnancy. If not treated immediately maternal death.
Nursing Care management: Eclampsia
- immediate care
- postpartum nursing care
- future health care
Magnesium Sulphate Side Effects
- facial flushing
- hypotension
- metallic taste
- N&V
- palpitations
- sweating