Complications of Maternity Flashcards
What are the major complications related to maternity
- Miscarriage
- hydatidiform mole
- Ectopic pregnancy
- placenta previa
- Abruptio Placenta
- Incompetent Cervix
- Hyperemesis Gravidarum
- Preeclampsia
- Eclampsia
- Premature Labor
- Prolapsed Cord
- Shoulder dystocia
- Group B Streptococcus (GBS)
When someone has spotting and cramping what are these s/s indicative of
Miscarriage
What are the treatments for miscarriage
- Bedrest and pelvic rest
- if miscarriage imminent–>IV, Blood, D&C
- Worry when levels of hcG start to drop
What is hydatidiform mole (molar pregnancy)
-It is when you have a benign neoplasm which could turn malignant.
-Grape like clusters of vessicles
-No fetus involvement
If uterus enlarges too fast, this is how the pregnancy start
When there is no fht and some bleeding with vesicles what can this be a s/s of
hydatiform mole (molar pregnancy)
What confirms a molar pregnancy
U/S
How do we treat a molar pregnancy
- With a D and C cutting and emptying uterus
- Do not get pregnant during f/u time
- check hcg levels weekly until normal, recheck q2-4weeks, then 1-2 months for 6months to a year
What is it called if a molar pregnancy becomes malignant
Choriocarcinoma, cxr to see if it has mestastasized
What occurs in an ectopic pregnancy
It is when the gestation occurs outside uterus, in the fallopian tube
What confirms an ectopic pregnancy
U/S
When someone is going through pain, spotting, bleeding into peritoneum what is this a s/s of
Ectopic pregnancy
What is the Tx for ectopic pregnancy
1) Methotrexate- to stop growth of embryo and save tube
2) otherwise a laproscopic incision will be made into tube and embryo will be removed
3) Laprotomy if tube has ruptured or if ectopic pregnancy is advanced.
What do we worry if a tube has ruptured in an ectopic pregnancy
Hemorrhage
What is placenta previa
It is when the placenta has implanted wrong
it is when the placenta prematurely begins to separate during dilation and the fetus doesn’t get enough oxygen
What is the most common cause of bleeding in the later months
Placenta previa
What test should be done to confirm placental location
U/S
Normally where should the placenta be attached
Up high in the uterus
When you have painless bleeding in the 2nd half of pregnancy (spotting or profuse bleeding) what is this a s/s of
Placenta previa
What are the treatment options for someone with placenta previa
1) hospitalization to prevent blood loss and fetal hypoxia
2) bed rest
3) Rule out other sources of bleeding like abruption
4) Pad count
5) monitor blood count and body close
6) monitor for contractions call MD (wont be vaginal delivery)
7) C-section
8) Do not perform vaginal exam
What are some fetal complications related to placenta previa
1) Preterm delivery
2) Intrauterine growth retardation
3) Fetal Distress
4) Anemia
What are some maternal complications
1) Hemorrhage
2) Potential DIC risk
is placenta position on -side of the uterus (low lying placenta) -halfway covering cervix(partial previa) -completely covering cervix (complete previa) okay?
is not a good sign
In abruptio placenta is the placenta implanted normally
yes
What an occur in a abruptio placenta
The placenta could be partial or completely abrupted
what happens when the placenta abrupts
the placenta separates prematurely and bleeding occurs, it could be external or concealed
What is concealed bleeding
it’s bleeding into the uterus
what confirms the diagnosis of abruptio placenta
ultra sound and the severity is based on the scale 1-3 3 is the worse
What can a MVC, domestic violence, previous cesarean, rapid decompression of uterus, cocaine use, PIH and smoking be a cause of
Abruptio placenta
When someone has a rigid board like abdomen with or without vaginal bleeding.
Abdominal pain and increased uterine tone, and have a difficult time palpating fetus what do you think is happening
Abruptio placenta
What is the treatment for a abruptio placenta
C-section delivery and do not try to do any vaginal examinations
What are the 2 priorities with abruptio placenta
manage fetal status and maternal shock
What occurs with an incompetent cervix
It is when the cervix dilates prematurely
and can result in repeated, painless, second trimester miscarriages
When does an incompetent cervix occur
4th month of pregnancy
Why does a miscarriage occur in the 2nd trimester
weight of baby causes pressure on the cervix to prematurely dilate
What is the treatment for incompetent cervix
-purse-string suture (cerclage) at 14-18 weeks to reinforce cervix
-may have a c-section to preserve suture
and 80-90 percent chance of carrying baby to term with the cerclage
What is a cerclage
It is used for incompetent cervix, suture to help reinforce cervix
What is hyperemesis gravidarum
It is when you have more than the typical morning sickness, excessive vomitting, dehydration, starvation and death could occur
What are the causes of hyperemesis gravidarum
high levels of estrogen and hcG
When someone’s BP, UO, K, weight drops, and h/h go up and the patient has ketones in their urine what could this be related to
hyperemesis gravidarum
What are the treatments for hyperemesis gravidarum
- NPO for 24 hours
- quiet environment
- oral hygeine
- IVF 3000ml for 24 hours
- Antiemetics
- Vitamins
- Don’t mention food, keep emesis basin out of sight
- 6-8 small meals followed by clear fluid
- foods should be either icy cold/hot
- well ventilated room
If a person has increased bp, proteinuria edema after 20 weeks what is this considered to be
Preeclampsia
What is mild preeclampsia
130/90 or 30/15 of their baseline
s/s of proteinuria include
-sudden weight gain
-swollen hands and face
-headache, blurred vision, seeing spots,
-hyper-reflexia (increased DTR)
-clonus- seizures
VASOSPASMS
What do we know about a clinical s/s of PIH
if a patient increases weight by 2 or more pounds per week
How do we treat mild pre-eclampsia
- bed rest
- increase protein
What would your BP be with severe PIH
160/110
What are the tx for severe preeclampsia
sedations to delay seizures
magnesium sulfate
Apresoline is given with magnesium sulfate if diastolic is greater than 100
Delivery is the only cure
What are the functions of magnesium sulfate
It acts as a vasodilator
it is a simple salt solution, attracts fluid back into vascular space from tissue
What should you be monitoring with magnesium sulfate
Magnesium toxicity, check BP, Resps, DTR’s, LOC every 1-2 hours
Urine output hourly and serum mg periodically
What is used for preterm labor
magnesium
What is a client at risk for with magnesium sulfate
Pulmonary Edema
What should a client’s care be for someone with preeclampsia
Quiet single room, dim lights and no tv
Why is betamethasone used for preeclampsia
stimulates sufactant production in the alvelor space and causes less tension when the infant breathes
When should steroid therapy be given
between 24 and 34 weeks gestation
What is expectant management
Balance risk between mom and baby
What occurs from preeclampsia to eclampsia
Seizure occurs
What should you be monitoring with eclampsia
Watch for fetal heart tones
Watch for labor
Watch for heart failure, stroke, heart attack, renal failure, DIC, HELLP syndrome, neurological damage, multisystem organ failure
When you have proteinuria and it’s after 20 weeks what are you thinking
PIH
When you have no proteinuria and it’s after 20 weeks what are you thinking
Gestational Hypertension
When the client was hypertensive before pregnancy what is this called
Chronic Hypertension
When the client was hypertensive prior to pregnancy but hypertension is getting worse with developing proteinuria after 20 weeks what is this called
Chronic hypertension with superimposed PIH
When labor occurs 20-37 weeks what is this called
Premature labor
What are the treatments for stopping labor
1) Tocolytics: Terbutaline (Brethine): Side effects increased pulse and hyperactivity
2) Magnesiumm sulfate: relaxes uterus
3) Bethamethazone (Celestone): given to moms to stimulate maturation of baby’s lung in case preterm occurs
It can also be stopped by hydrating mum and treating vaginal and urinary tract infections
What happens when you get a prolapsed cord
The umbilical cord falls down the cervix, most likely because the presenting part is not engaged and the membranes ruptured
What is important to check when membranes rupture either spontaneously or artificially
FETAL HEART TONE
What is the next step to do if you have a compressed cord and you see variable deccelration in FHT
C-section
What indicates death
When cord is not pulsating
What treatment options are for Prolapse cord
- Lift head off cord until physician arrives mannually
- Trendelenburg or knee chest position
- Oxygenation
- Monitor fetal heart tones
Do we push back the cord
No
What is a shoulder dystocia
it is when the fetal head is delivered and shoulder gets impacted with pelvis
Risks to shoulder dystocia
- Hypoxia- leads to cerebral palsy and asphyxia
- Brachial Plexus injury-leading to Erb’s palsy
- Broken clavicle
- Bell’s pallsy
What is Bells’ Palsy and what is it caused from
It is when you have paralysis of the face with drooping to one side of the face
Forcep use
What are some potential maternal risks related to shoulder dystocia
- Traumatic delivery leading to permanent damage
- Bruised bladder
- Extention of episiotomy
- Rectal Tear
- Torn cervix and or uterus
-What do LGA or macrosomic infants greater than 4000 grams
-Gestational diabetes
-Previous history of shoulder dystocia
-Post date delivery ,large fetus
All have in common
Risk for having a shoulder dystocia
What are some nursing care regarding shoulder dystocia
McRoberts Maneuvers
Mazzanti techniques suprapubic pressure (never apply fundal presure)
GBS what can you do to reduce risk
Routinely assess for GBS, risk factors during pregnancy (cultured around 35-37 weeks) and on admission L & D
Prophylactic antibiotic therapy; penicillin
How is GBS transmitted
Through birthing canal
When is there a risk to the fetus with GBS
When the rupture of the membrane occurs
Is GBS a sexually transmitted disease
No
Who is at risk for GBS
- Preterm births less than 37 weeks
- positive prenatal cultures in pregnancy
- premature rupture of membrane
- positive history for early-onset neonatal GBS
- intrapartum maternal fever higher than 100.4
- previous infant with GBS
