Complications of Maternity Flashcards
S/S Miscarriage
When do we worry?
What to do when it happens?
What if it’s REALLY bad?
Spotting + cramping
Worry when hCG levels are down Pelvic rest (no sex), and bed rest
IV, blood, dilation & curettage (remove remains, may be sedate)
What is a Hydatidiform mole?
NCLEX - is the fetus involved?
Benign neoplasm that can turn malignant
Grape-like clusters of vesicles
NCLEX - no
Hydatiform Mole
How does the pregnancy start?
S/S
Dx?
Uterus enlarges too fast
S/S - Absence of FHT, vesicles may cause bleeding
Dx: Confirmed with US
Hydatiform Mole–
Treatment
Make sure to avoid what? Why?
What if it becomes malignant? How do we know if it metastasis?
How often is hCG measured?
Dilation and Curretettage
Avoid getting pregnant during follow-up time because we won’t be able to tell if the hCG levels mean pregnancy or not
Malignant = Choriocarcinoma
Metastasis confirmed with CXR
hCG measured weekly until normal, then every 2-4 weeks, then every 1-2 months for up to a year
Ectopic Pregnancy confirmed with what?
First sign? Other signs?
Where are they going to bleed?
Risk factor
US
PAIN, usually same signs as a normal pregnancy
Maybe bleed into peritoneum
If fallopian tube ruptures, vaginal bleeding may occur
Having 1 risks another
How to treat Ectopic pregnancy–
Goal is to what?
Meds?
What if meds don’t work?
What if the tube has ruptured?
SAVE THE TUBE
Methotrexate to stop embryo growth
If not working, an incision is made to remove the embryo, or perhaps the whole tube
Laparotomy - WORRY ABOUT HEMORRHAGE, may need blood transfusion
What is placenta Previa?
What does it commonly cause?
Confirmed with what?
What is a risk factor?
The placenta implants in a bad spot
Most common cause of bleeding in the later months (usually 7th)
Confirmed with US
RF: C-section
How does Placenta Previa happen?
Where should the placenta normally be?
What it is called when it’s in other places?
Why do we worry about this?
Placenta separates early with the start of dilation, causing decreased oxygen to baby
Should normally be attached high up
Low lying placenta: side of uterus
Partial previa: Halfway over cervix
Complete Previa: Over cervix
Placenta comes out first!
S/S Placenta previa
Painless bleeding in the 2nd half of pregnancy (spotting or perfuse)
Placenta Previa Treatment –
Complete Previa
Not much bleeding?
what do we need to rule out?
Complete: Hospital as early as 32 weeks to prevent blood loss and fetal hypoxia if labor happens
Bedrest if not much bleeding
Rule out other sources of bleeding such as an abruption (placenta detaches)
Placenta previa
What to we need to monitor?
What if contractions start?
What kind if delivery?
WHAT DO WE NOT PREFORM ON THESE PATIENTS
Pad counts
Blood count
Fetus closely*
Contractions: CALL DR
C-section
DO NOT PREFORM A VAGINAL EXAM
Complications of placenta previa
Fetus
Mom
Fetus Preterm delivery Immature growth retardation Fetal distress Anemia
Mom
Hemorrhage
DIC risk
Abruption previa (Abruption)
Where is the placenta? Partial or complete? When does the placenta separate? bleed where?? When is it seen? Dx How is it treated?
NORMAL PLACEMENT! May be either Separated prematurely (bleeds ext or within uterus) Seen in the last half of pregnancy Dx US Severity 1-3 (worst is 3)
Causes of an abruption
Trauma
Previous C section
ROM rapidly (RAPID DECOMPRESSION OF THE UTERUS)
Cocaine, PIH, smoking
S/S abruption
Abdomen?
Bleeding?
Pain?
Fetus?
Rigid, hard abdomen w or w/o vaginal bleeding (NO EXAM IF BLEEDING)
Abdominal pain w increased uterine tone
Hard to palpate the fetus
NCLEX: UNEXPLAINED VAGINAL BLEEDING
DO NOT DO A VAGINAL EXAM
Abruption
Delivery?
2 priorities
C section
Watch for Fetal status and maternal shock
What happens with an incompetent cervix?
When does it occur?
What is a common history?
Premature dilation of the cervix
4th month of pregnancy
Hx of repeated, painless, 2nd trimester miscarriages
When are miscarriages usually?
1st trimester
Causes of incompetent cervix
Baby weight causes pressure on cervix causing it to prematurely dilate
How to treat an incompetent cervix
Procedure?
Delivery?
Purse-String suture / Cerclage at 14-18 weeks to reinforce the cervix (80-90% term)
MAY have c-section to preserve the suture or may clip it if a vaginal birth is wanted
Hyperemesis Gravidarum
How does it start? Then what?
Cause?
Starts like regular morning sickness
THEN excessive vomiting, dehydration, starvation, then death
R/t high levels of hCG and estrogen
S/S hyperemesis gravidarum
BP H&H UO K Weight Urine
BP - decreased H&H - decreased UO - decreased K - DECREASED - lots of K in vomit Weight - decreased Urine - ketones d/t fat breakdown
Treatment of Hyperemesis Gravadarum
Diet for how long? Fluid Meds Environment Hygiene
talk about food?
give puke bucket?
what kind of meals?
any food/liquid should be what?
room
NPO 48 hours IVF 3000mL first 24 hours Anti-Emetic IV, vitamins Quiet env, far from nurse station Oral hygiene
VERY nauseous - no food talk
No basin - out of site, out of mind
Meals: 6-8 small, dry feedings followed by clear liquids
Food/liquid should be icy cold or hot
Well-ventilated room - fresh
Preeclampsia
3 main S/S that occur when?
What mx could be a sign?
HTN (130/90 is high if baseline not known)
Proteinuria
Edema
S/S Preeclampsia
Weight Swollen Neuro things Reflexes Serious stuff
Sudden weight gain Swollen face/hands - losing protein and albumin HA, blurred vision, seeing spots Increased DTRs (hyperreflexia) Clonus (muscle spasm) --> SEIZURE
When do we especially worry about PIH?
Weight gain of 2 or more pounds in a week
BP in mild vs severe preeclampsia
Documentation?
Only cure for both?
Mild: up 30/15 from baseline
Severe: 160/110
Both documented 6 hours apart
Pregnancy is the only cure!
MILD preeclampsia treatment
Bedrest
Increased protein in diet
SEVERE preeclampsia treatment
Drug of choice?
Sedate to delay seizures
Mg Sulfate (VD, increase renal perfusion and placenta perfusion)
What is Mg Sulfate?
Risk for what with impaired kidney function?
What happens to labor?
What is this good for?
Hypertonic solution - bring fluid into vascular space
Risk for pulmonary edema
Labor stopped unless used with oxytocin
Use for preterm labor
What do we monitor for a patient on Mg sulfate?
Toxicity every 1-2 hours
BP, RR, DTR, LOC
UO, serum mag
What do we give for a diastolic greater that 110?
SE?
Give Apresoline (Hydrazine) in combination with MG sulfate
SE: ^HR
What do we watch for after preeclampsia delivery?
Environment?
Seizure risk for 48 hours!!!!
Single room
Quiet
Dim lights, no stimuli
^Promote a seizure!
What else might we give to help prevent immature lungs in the preeclampsia baby?
Steroids to stimulate surfactant production and cause less tension when the infant breathes
Eclampsia - what has changed
Monitor what?
Mom HAS A SEIZURE!
Monitor FHT
Watch for labor
Watch for HF
DIFFERENCES
PIH
Gestational HTN
Chronic HTN
Chronic HTN w superimposed PIH
PIH - after 20 weeks, proteinuria
Gestational HTN - after 20 weeks
Chronic HTN - HTN before
Chronic HTN w superimposed PIH - HTN got worse after 20 weeks
Premature delivery
Occurs when?
Medication to stop the labor?
What else may stop it?
20-37 weeks
Terbutaline - may cause ^HR
Mg Sulfate
Bethamethasone - mature lungs, IM
Hydrating mom and fixing UTI
Prolapsed cord
Check what?
How do you know compression is occurring? - Need what?
Cord through cervix
Check FHT when ROM
Compression: Decreased FHR, variable decel - Need IMMEDIATE C SECTION
What if a cord isn’t pulsing?
Fetal death
Prolapsed cord Nursing action
Do what? Mom position? Give what? Monitor what? WHAT NOT TO DO
Lift head manually
Mom: Trenhdeleberg or Knee chest
Give O2
Monitor FHT
DO NOT PUSH IT BACK IN
Shoulder Dystocia
Shoulders big and baby can’t get out caution anterior should impaction
Shoulder Dystocia Risk to baby
Causes?
Can it resolve?
Hypoxia –> CP, asphyxia
Brachial plexus injury –> Erb’s Palsy
Broken clavicle
Bell’s palsy
Cause: forceps
May resolve, but can lead to permanent damage
Shoulder Dystocia risk to mom
Permanent damage to birth canal
Bruised bladder
Rip episiotomy
Torn cervix or uterus
What fuckin fat babies are gonna cause Shoulder Dystocia
LGA >4000g
Gestational DM
Previous Hx of it
Post-delivery
Shoulder Dystocia Nursing care
NEVER DO WHAT
McRoberts Maneuver - pull legs up and open
Mazzanti technique: suprapubic pressure to assist in easing the shoulder out
NEVER APPLY FUNDAL PRESSURE - doctor has to do this
Group B Strep
Leading cause of what? Culture when? Transmitted how? Risk for fetus when? Patient teaching
Risk factors
Treatment
Neonatal mortality Culture 35-37 wk, admission From mom to baby through birth canal Risk after ROM Teach it's NOT an STD
RF: Preterm, + cultures, premature ROM (>18hr), fever, previous GBS
Treatment: Prophylactic antibiotics; Penicillin
When do we never do a vaginal exam?
BLEEDING from vag
Placenta previa, abruption
WHEN DO THEY BLEED
Ectopic Pregnancy
Placenta previa
Abruption
HAPPENS WHEN
Incompetent cervix when and common hx
Ectopic Pregnancy
Placenta previa - 2nd half pregnancy, around month 7
Abruption - last months
Incompetent cervix - month 4, 2ndT miscarriage
