Complications Of Preganancy Flashcards
What is Gestational diabetes
Occurs when mothers can’t metabolize carbohydrates
Occurs in 4% of all pregnancies
Excess glucose goes to the fetus and the fetus stores it as fat
What is the treatment for gestational diabetes?
-Glucose monitoring
-diet
Exercise
Insulin
How is diabetes affected in pregnancy?
May manifest as hyperglycemic or hypoglycemic episodes
Insulin dependent diabetics may need to adjust their dosages during pregnancy.
What is preeclampsia
Unknown cause
Often healthy, normotensive Primigravida
-usually occurs after the twentieth week, often near term
-Underlying mechanism involves abnormal formation of blood vessels in placenta
Signs and symptoms of preeclampsia
-abnormal swelling of hands and face
-severe/persistent headaches
-changes in vision
N/V
How to diagnose preeclampsia
Hypertension (blood pressure greater than 140/90mmhg)
Acute rise of 20mmhg in systolic pressure or 10mmhg rise in diastolic pressure
-proteinuria
Excessive weight gain with edema
Treatment for preeclampsia
Treat hypertension and prevent seizures
What can preeclampsia lead to?
-impaired liver function
-SOB caused by fluid in the lungs
Decreased urine output
RBC damage and breakdown
Eclampsia
Risk factors for preeclampsia
-Nulliparity
-Advanced maternal age
-chronic hypertension
-diabetes
Chronic renal disease
Multiple gestation
What is eclampsia
Same signs and symptoms of preeclampsia plus seizures or coma. Often begins as oral twitching, often apnic during seizure, can initiate labour
How to manage ecclampsia
-left lateral recumbent
-minimize stimulation
-oxygenation and ventilation assistance
-IV
What to give if a pt with ecclampsia begins seizing
Magsulfate 4 grams IV at 1 gram/min
Diazepam 5 mg IV or Midazolam 5mg IV/IN/IM
Monitor vitals
Maternal asthma complications
-premature labour
-preeclampsia
-respiratory failure
-vaginal hemorrhage
Eclampsia
Fetal asthma complications
Premature birth
Low birth rate
Poor growth
Death
What changes occur in the kidneys and what can this cause?
Kidneys increase in length, this can cause urinary stasis and urinary tract infections
What is Rh sensitization?
Occurs when the mother is Rh negative and the father is Rh positive, the fetus could inherit the factor from the father. The fetal blood can enter the woman’s circulation and produce a maternal antibody to the factor. In subsequent pregnancies the antibodies will attack the fetal RBCs
What effects does Rh sensitivity have on the fetus
Can result in death or hemolytic disease
What is the treatment for Rh sensitization
Blood transfusion before or slightly after birth
Rh immunoglobulin (Rhlg)
How does epilepsy effect pregnancy?
Most have a normal pregnancy
Medication may be effected by altered hemodynamics
Onset of labour can trigger seizures which can cause fetal distress
Increased risk of vaginal bleeding both during and after pregnancy
What are some causes of vaginal bleeding
Abortion
Ectopic pregnancy
Abruption placentae
Placenta previa
Uterine rupture
Postpartum hemorrhage
What is Abortion
Expulsion of the fetus before the 20th week
Most occur during the first trimester before the placenta is fully mature
What is a spontaneous abortion (miscarriage)
-occurs naturally
-affects about 1 out of every 5 pregnancies
What causes a spontaneous abortion
-acute or chronic illness in pregnant woman
-Maternal exposure to toxic substances
Abnormalities in the fetus
Abnormal attachment of the placenta
What is an induced abortion
Brought about intentionally
Complications such as vaginal bleeding or sepsis from having parts of the fetus in utero
Can be self induced
What are the stages of abortion
threatened
Inevitable
Incomplete
Missed
Septic
What is threatened abortion
Attempting to take place
vaginal bleeding during first half of pregnancy
Can progress or subside
Continue with normal activity
What is an inevitable abortion
Spontaneous abortion that cannot be reversed
Severe abdominal pain caused by strong uterine contractions
Vaginal bleeding and cervical dilation
What is an incomplete abortion
Some of the products of the conception remain in the uterus
Cervix dilated to expel the fetus
Be alert for signs of shock
If products of conception are protruding from the vagina, consult OLMC
Fundal massage
What is a missed abortion
Fetus dies during the first 20 weeks but remains in utero
Transport and emotional support
Cessation of vaginal bleeding followed by a gradual dismissing of the signs or pregnancy
Brownish vaginal discharge
Generally precedes a spontaneous abortion
What is a septic abortion
Uterus become infected
What are some causes of vaginal bleeding in the third trimester
Abruptio placentae
Placenta previa
Uterine rupture
What is the greatest danger in third trimester bleeding
Hemorrhage
becomes more acute as the woman approaches term
Large volume of blood presents within the pregnant woman’s body
Compensatory mechanisms functioning as a result of pregnancy
What is abruptio placentae
Premature separation of a normally implanted placenta
Most common during the last trimester of pregnancy
Maternal hypertension is the most common cause
What are the risk factors for abruptio placentae
-Trauma
-Maternal hypertension
-Preeclampsia
-Multiparity
-Previous abruption
Symptoms of abruptio plancentae
Sudden onset of severe abdominal pain
Signs of shock
Severe hemorrhaging
Possible contraction / premature labour
What is placenta previa
Placenta is implanted low in the uterus and partially or fully obscures the cervical canal
Leading cause or vaginal bleeding in the second and third trimesters of pregnancy
C/C is painless vaginal bleeding
What causes a uterine rupture
Prolonged labour
trauma
Women who have had previous C-sections
Symptoms of a uterine rupture
Signs of shock
Bleeding may be hidden
Described as tearing
Rare but accounts for 5-15% of maternal deaths
What is hyperemesis gravidarum
Morning sickness
Condition or persistent nausea and vomiting during pregnancy
Prolonged vomiting leads to dehydration and malnutrition
Exact cause is unknown
Vomiting is projectile and consists of bile and possibly blood
Prehospital treatment for morning sickness
100% O2
Start and IV
Gravol
BGL
Orthostatic vital signs
Transport
What is a molar pregnancy
Genetic error during fertilization resulting in abnormal placenta
Can be complete or partial
Symptoms of a molar pregnancy
Preeclampsia
Vaginal bleeding
Severe N/V
Pelvic pain / pressure
Treatment for molar pregnancy
Prenatal screenings tend to find most instances of molar pregnancies
Pregnancy terminates itself or a DNC is preformed
What is a partial mole?
Two sperm on one egg join to form and embryo with 69 chromosomes
What is a complete mole
One sperm enters an egg which has lost its chromosomes. The sperm duplicates its own chromosomes therefore the pregnancy has only paternal chromosomes
What is an ectopic pregnancy?
Severe disorder with potentially life-threatening consequences
Fertilized ovum becomes implanted somewhere other than the uterus
Normal signs of pregnancy are present
Severe pain with hypovolemic shock
Requires rapid transport for surgery
Manage for hemorrhagic shock
What are the causes of maternal trauma
Vehicular crashes
Falls
Penetrating objects
