Complications Of Preggers Flashcards
Qualitative vs Quantitative Test
Which are routine
Give examples
Qualitative: Routine
Hcg ( + or - ) Detected within 3 days of implantation
Quantitative: Non Routine
Numeric value
<5 Not preggers
>5 Preggers
Quantitative Hcg Test: Non Routine
Numeric value
<5 Not preggers
>5 Preggers
Give normal Values of Hcg value increase
And Peak….
Monitored with preggers complications…..
Doubles every 48 hrs
Peaks 75th day
Threatened abortion
Ectopic preggers
Molar Preggers
Hyperemesis gravidarum
Ectopic vs Molar Preggers
______ occurs outside the uterus, often in a fallopian tube, and can cause dangerous bleeding. A ________ happens within the uterus due to abnormal tissue growth, leading to high hCG levels and possible bleeding. Ectopic pregnancies may need surgery
ectopic pregnancy
Molar Preggers
High Hcg levels from having twins which symptom will get increasing worse with the rise of Hcg
Nausea
Hemorrhagic conditions
Bleeding / Spotting initial months
Name 3 conditions
Abortion
Ectopic
Gestational trophoblastic disease
(Aka Molar/ hydatiform mole)
Spontaneous abortion (miscarriage)
SAB
Induced
MIP, VIP,VTP
Abortion = loss of pregnancy Before Viability
Medical / State MI definition
Medical: <20 weeks or <500 g
State MI: <400 g
Abortion: Loss of pregnancy Before
Medical: <20 weeks or <500 g
State MI: <400 g
What is it called it baby dies after these guidelines
Interuterine demise
SAB (spontaneous abortion)
19 - 31% of all pregnancies
50- 70% happen in which trimester….
Most common causes…. (3)
Care Priorities (4)
Which age group is most likely….
50- 70% happen in which trimester
1st trimester
Most common causes
Chromosomal 50 - 60%
Congenital anomalies
Often incompatibility with life
Care Priorities:
Hemorrhage risk
Infection risk
Pain treatment
Psychological support
Which age group is most likely
> 45 yrs old - >50%
Vaginal bleeding, cramping, backache & pelvix pressure occurs in a Threatened Abortion
Is the fetus still viable…..
Interventions
Yes still viable
Interventions
Notify provider
Vag US
Serum beta-Hcg amd progesterone levels/ Normal for GA
Limit sex when bleeding
Monitor for SS of infection
Psychological support
Up to inevitable Abortion cannot be stopped (Membranes rupture, cervix dilates, contractions/bleeding)
Interventions (5)
IV acceds and T&S (hemorrhage risk)
Natural evacuation of POC
Vacuum Curettage: Clears out uterus with Vacuum (Early GA)
Dilation and Curettage (D & C) Scraping of uterine wall to rid POC <14 WEEKS
IOL: Oxytocin & prostaglandin administration >14 Weeks
POC ….
Products of conception
Baby, membranes, placenta
Incomplete abortion
Fetus delivers but some POC are left.
Bleeding/ cramping
Risks…..
Interventions (5)
Hemorrhage & infection
Interventions
T&S
IV & Fluids
D &C
IV oxytocin
Hemorrhage meds
Misoprostol: Stops hemorrhage
Methylergonovine (Methergine)
Prevent or control postpartum hemorrhage. Raises BP Contradicted in Preeclampsia/ HTN
Carboprost (Hemabate)
Prostaglandin analogue used to control severe postpartum bleeding when other treatments are ineffective.
It induces strong uterine contractions, helping to reduce hemorrhage by constricting blood vessels in the uterine lining.
Side effects like fever, diarrhea, nausea, and vomiting.
Contraindicated in patients with asthma due to the risk of bronchospasm.
Interventions for a Complete Abortion
All POC are expelled (4)
Verify all POC are expelled
No additional interventions needed unless Bleeding & Infection occur
Monitor for Bleeding, pain, fever
Psychological support
Missed abortion
Fetus is dead but retained during which part of preggers….
Uterus decrease in size (Amniotic fluid absorbed) urinary frequency stops, red/brown bleeding may occur, Maceration of fetus in uterus.
Interventions
1st half
Interventions
US to confirm lack of FHR
hCG test
Delivery options:
Watch & Wait: Body will naturally miscarry pregnancy.
RISK: Hemorrhage, infection, prolonged emotional pain
Intervene: Dilation & Evacuation, Dilation & Curettage or IOL depends on GA
Usually between 13-24 weeks of pregnancy.
Dilating the cervix to allow suction and specialized tools are used to evacuate the contents.
D&E is commonly used in cases of missed or incomplete miscarriage, second-trimester abortion, or when the pregnancy poses health risks to the mother.
Dilation & Evacuation
Recurrent Spontaneous abortion
2 or more SAB
Mostly happen from…
Other causes: Abnormalities of reproductive tract
Bicornuate uterus
Uterine septum
Adhesions
Incomplete cervix
Fibroids
Diseases….
Interventions….
Chromosomal abnormalities 60%
Bicornuate uterus: Heart shapped fetus
Uterine septum: Septum forms in uterus
Adhesions
Incomplete cervix
Fibroids
Diseases….
Antiphospholipid Syndrome
Diabetes
PCOS: Polycystic Ovarian Syndrome
Lupus
Endocrine
STD
Interventions
Rho-gam
Examine reproductive system
Genetic screening
Managing disease process:
DM : Normal BS
Endocrine: Correct hormones
Incomplete cervix: Cerclage
Ectopic pregnancies
97% = fallopian tube
Risk factors;
S&S
Ruptured tube is this level of medical emergency
Risk
Previous Ectopic
Endometriosis
Pelvic infection
PID
Surgery
Failed tubal ligation: Procedure to permanently prevent pregnancy by blocking or cutting the fallopian tubes.
IUD
ART
Multiple VTP
S&S
Missed period
+hCG test
Unilateral ab pain
Vaginal spotting
Ruptured tube = Deadly
Give SS of a Ruptured Tube associated with Ectopic pregnancies
Deadly
Sudden/Severe pain in Ab, radiating scapula pain, hemorrhage & Hypovolemic shock
________ is a chronic condition where tissue similar to the lining of the uterus (the endometrium) grows outside the uterus, often on the ovaries, fallopian tubes, and other pelvic organs.
This misplaced tissue responds to hormonal changes during the menstrual cycle, leading to inflammation, pain, and sometimes scar tissue or adhesions.
Symptoms can include severe menstrual cramps, pain during intercourse, heavy periods, and, in some cases, infertility.
The exact cause of endometriosis is not fully understood, but treatment options may include pain management, hormonal therapies, and, in some cases, surgery to remove the excess tissue.
Endometriosis
Endometriosis is a chronic condition where…..
Leading to inflammation, pain, and sometimes scar tissue or adhesions.
Symptoms can include…..
The exact cause of endometriosis is not fully understood, but treatment options may include pain management, hormonal therapies, and, in some cases, surgery to remove the excess tissue.
tissue similar to the lining of the uterus (the endometrium) grows outside the uterus, often on the ovaries, fallopian tubes, and other pelvic organs.
severe menstrual cramps, pain during intercourse, heavy periods, and, in some cases, infertility.
ART
Artificial reproductive technology
Ectopic pregnancies
Why the increased amount…
AMA
And already have endometriosis
How to diagnose a Ectopic pregnancy
Interventions….
Medication…
Transvaginal US & Low beta HCG
Methotrexate (Chemo drug that stops cell growth)
Linear salpingostomy
Salpingectomy
Rhogam
f/u hCG
Methotrexate does what during a salpingostomy…
Type of drug…
SE
Teaching:
Avoid….
Use these precautions as a nurse
Stops cell growth - during salpingostomy
Chemotherapy agnet/ Folic acid Antagonist
SE: N/V & pain r/t egg expulsión
Avoid: folic acid or alcohol Decreases effectiveness
Use chemo precautions for medication & urine handling
Gestational Trophoblastic disease
Aka…..
Describe…..
Big risk…
Hydatidform Mole or Molar Preggers
Trophoblasts from fertilized ovum proliferate abnormally creating Placental-like tissue that fill the uterus
Big risk: May become cancerous - metastize To lungs, vag, liver, brain
Molar Preggers aka Gestational Trophoblastic disease
Interventions
Terminate pregnancy
D & C
Risk factors for Hydatidiform Mole…
SS….
Dx….
Tx / Follow up….
Asian
Young / Old maternal age
Hx of Molar Preggers
SS: Elevated HCG, Large uterus for GA, Hyperemisis r/t increase hCG, & PIH
Dx: High hCG, US shows vesicles, absence of fetal sac & no FHR, Preggers Induced Hypertension / Hyperemisis
Tx: Vacuum extraction & Curettage
Follow up: Serial hCG 1 for 1 year
Chest X-ray, CT Scan, MRI to R/O metastatic disease
LATE HEMORRHAGIC CONDITIONS
(4)
Placenta previa
Abruptio Placentae
Accreta/ Increata/ Percreta
Vasa Previa
Placenta previa
Abruptio Placentae
Accreta/ Increata/ Percreta
Vasa Previa
Have in common
LATE HEMORRHAGIC CONDITIONS
When the placenta grows over cervix blocking new borns birth route.
Complete, partial, marginal (Which are always C sections)
Can placenta move / migrate during pregnancy
Placenta previa
Complete & partial are always C Sections
Yes they can move
Placenta previa during labor (Describe the blood)
Placenta abruption (Describe what it is and blood during labor)
Placenta previa (Placenta blocks cervix) during labor = Bright red blood Not painful
Placenta Abruption (Placenta separates from uterine lining) Painful, board like stomach, may or may not be blood (Dark blood)
The placenta should grow on the uterine wall with a easily separated plane between the placenta and uterine lining.
Describe condition where the placenta grows too deep.
Accreta Grows too deep into uterine wall
Increta: Grows even deeper into uterine wall
Percreta: Grows through uterine wall and into surrounding organs
Vasa previa is a rare complication in which….
fetal blood vessels run near or across the opening of the cervix, unsupported by the umbilical cord or placenta.
These exposed vessels are at risk of tearing if labor begins or the membranes rupture, which can lead to rapid and life-threatening blood loss for the baby.
Vasa previa is typically diagnosed through ultrasound during pregnancy.
C/S 34 -37 Weeks
Total, partial, marginal Placenta Previa
Placenta too close to or covers the cervical OS. Baby can’t exit uterus
Risk factors…
S&S…..
Risk factors: PREVIOUS C/S or other uterine surgery, pervious Placenta Previa, AMA, Multiparas
S&S; Sudden Painless uterine bleeding, Scant or Perfuse.
Bleeding may not occur until labor starts.
Bloody show
Blood-tinged mucus from the cervix, often signaling that labor may begin soon. This occurs when the cervix begins to dilate & efface and the mucus plug—a thick barrier at the cervix—to dislodge.
The mucus may appear pink, red, or brown.
bloody show is a common sign that labor could start within hours or days
Describe the difference in appearance with Bloody Show and blood from Placenta Previa….
Placenta previa is more watery and bright red & PAINLESS
With placenta previa the main diagnosis is from a SVE
T or F
F
No vag exams. May separate the placenta
Placenta previa
Repeat US often due to Placental migration
Which posistions could have a vag delivery route…
Low-lying
Total / Complete Always C/S
Placenta previa may monitor from home
What are things cant a woman with placenta previa do?
No strenuous activity/ No sex
Why would bleeding during placenta previa be a Urgent C/S
Bleeding = Lowered perfusion to baby
Increases risk for PPH: Higher risk of placenta accrete among placenta previa patients
T or F
T
Placenta accrete: Placenta grows too deep on uterus and may attach to other organs
Separation of Placenta before fetus is born….
Abruptio Placenta
Abruptio Placenta
Maternal risk:
Infant risk:
Risk factors:
Maternal risk: Hemorrhage, shock, DIC
Infant risk: Asphyxia & Premature
Risk factors: COCAINE & TRAUMA
cigs, HTN, PROM, Multigravida, short cord & Hx of abruption
Abruptio Placenta: Separation of Placenta before fetus is born
Tx
Marginal: Medications
Total Abruption
Marginal Spotting may resolve (Bedrest, tocolytics, EFM, Steroids, home monitoring when stabel)
Total abruption: Emergency STAT C/S (No Blood flow to baby) - Treat for hypovolemia & shock
Bleeding vaginal or concealed (trapped in hemotoma)
Uterine tenderness or Ab
HARD BOARD-LIKE ABDOMEN
From Abruptio Placenta
Describe
Fundal height
HR
Restlessness
BP
Urine output
FHR
Name serious fetal consequences…..
ABRUPTION PATTERN: DESCRIBE UTERINE ACTIVITY & TONE
Fundal height UP
HR UP
Restlessness UP
BP DOWN
Urine output DOWN
FHR DOWN
Name serious fetal consequences: Hypovolemic Shock, Fetal Distress, Fetal death
ABRUPTION PATTERN: DESCRIBE UTERINE ACTIVITY & TONE
BOTH INCREASE
Placenta Acreta/ Increta/ Percreta
Risk factors….
Dx….
Risks….
Tx….
Small accrete pieces sometimes remain causing these risks…
Risk factors; Previous C/S or uterine surgery, Placenta Previa, AMA, Multiparas
Dx: US sometimes only during hemorrhage evaluation
Risks: MASSIVE POSTPARTUM HEMORRHAGE. Injury to surrounding organs (percreta), infection, infertility - due to scar tissue, sterility due to hysterectomy
Tx: Scheduled C/S, Additional PPH resources, Blood products, hysterectomy,
Infection & Subinvolution
Why placental anomalies when previous C/S
Scar tissue
Placenta doesn’t like to grow on scar tissue
Placental Acreta usually ends up with a hysterectomy.
Why?
It’s very hard to remove all the attached pieces of the Placenta from the Uterus
Umbilical Cord implants in membranes & and I front of cervical OS
WHICH DISEASE
Vasa Previa
Vasa Previa
DX US
S&S Sudden painless bleeding
Risk….
Goal…
Tx….
Risk: SROM cause membranes to rip through the cord & massive Fetal Hemorrhage
Goal: Prevention SROM
Tx: Continuous hospitalization 30+ weeks, steroids, planned delivery at 35 weeks, immediate delivery with labor, tocolytics, bedrest and No Intercourse
Risk of FETAL HEMORRHAGE
Goal; PREVENT SROM
This condition
Vasa Previa
Cord implants in membranes & infront of the cervical OS
What is the treatment for Vasa Previa
Continous hospitalization 30+ weeks
Steroids, planned delivery 35 weeks, immediate delivery with labor, tocolytics, bedrest, No intercourse
Late Hemorrhage Risk. all
hemorrhages happen to the mothers blood supply expect…
Vasa Previa
Disseminated Intravascular Coagulation (DIC) aka Consumptive Coagulopathy
Life threatening Macrobleeding & Microclotting
OB risk factors
Missed abortion/ Retained dead fetus
Abruption
Severe PIH
HELLP
Anaphylactoid syndrome (Amniotic fluid embolism)
Sepsis
Disseminated Intravascular Coagulation (DIC) aka Consumptive Coagulopathy
Life threatening Macrobleeding & Microclotting
Lab changes:
Fibrigen
pT
PTT
Fibrin split product
Platelets
Lowered: Fibrogen & Platelets
Increased: PT & aPTT / Fibrin degraded products or Fibrin Split Products (FSP)
DIC
CONSUMPTION OF PLASMA FACTORS resulting in a deficit and therefore BLOOD IS UNABLE TO CLOT.
While anticoagulation is occurring, inappropriate coagulation occurs in tiny blood vessels blocking blood flow to the organs causing _____
Ischemia
DIC
S&S
Interventions
S&S: EXCESS BLEEDING (IV sites, incisions, gums, nose & placental attachment site)
Interventions
CORRECT THE UNDERLYING CAUSE
blood replacement, whole blood, Packed RBC. Cryoprecipitate
Monitor for bleeding/bruising
Epidural maybe Contradicted
Define Readings
Hypertension: Systolic / Diastolic
Severe Hypertension: Systolic/ Diastolic
Hypertensive Emergency: Systolic/ Diastolic
Hypertension:
Systolic: >140 OR
Diastolic: >90
Severe Hypertension:
Systolic: >160 OR
Diastolic: >110
Hypertensive Emergency:
(Persistent, severe Hypertension)
2 severe BP values (>160/110) taken
15 - 60 min apart
Severe values do not need to be consecutive
If severe BP elevations persist for 15 min or more, begin treatment STAT
Severe HTN First line meds….
Prevention of seizures in PreE….
IV labetalol
IV hydralazine
PO Nifedipine
Magnesium Sulfate (Prevents seizures in PreE)
PO Nifedipine works as quickly as IV Labetalol/ hydralazine
T or F
T
Antihypertensive/ beta blockers
Produces drop in BP without decreasing maternal HR or Cardiac output
Dosage initial 20 mg over 2 minutes. May increase IVP dosage to 80mg
200 mg PO labetalol Starting Dose
SE: Hypotension, dizziness, NV,Dysrhthmias
Nursing interventions……. (Assess How Often)
Labetalol
Intervention
After IVP Bolus, assess BP q5min for 30 min, then 30 min for 2 hrs, then hourly for 6
Which do you give first in a HTN crisis
Labetalol or hydralazine
Labetalol
_______
Antihypertensive, Vasodilator
Relaxes arterial smooth muscle
Doseage: IVP ……..
MAX Dose ……..
Excretion Liver
Precautions: CHD, Maternal pulse <60, Avoid with active asthma, heart disease, CHF. May cause Neonatal bradycardia
Adverse effects: Headache, dizzy, hypotension (Placenta impact), epigastric pain (Confused with worsening PreE)
Hydralazine (Apresoline)
IVP: 5 - 10 mg over 2 min. Every 20 min. PRN
MAX: Don’t exceed 25 mg / 24 hrs
Antidote for Magnesium Sulfate
Calcium Gluconate
_____
Anticonvulsants
Decreases the CNS to act as Anticonvulsants. Also, decreases frequency & strength of UC
Prevention / control of seizures in PreE. Neuro protection for preterm labor
Doseage…..
Therapeutic level…..
Contraindications: Myocardial damage, heart block, myasthenia gravis, impaired renal function.
Doseage: IV loading dose: 4 - 6 g over 20 - 30 min
Therapeutic level: 4 - 8 mg/dl
(>8 may result in respiratory depression/ cardiac arrest)
________
Anticonvulsant
Decrease CNS to act as Anticonvulsant
Prevent/ control seizure activity in preE & neuro protection for preterm
Dose/ Route….
Therapeutic level….
Contractions Myocardial damage, Heart Block, myasthenia gravis, impaired renal function.
Dose/ Route IV loading dose 4 - 6 g over 20 - 30 mins.
IVBP continous infusing 2 g / hr.
Therapeutic level 4 - 8 (>8 may result in respiration depression/ cardiac arrest)
During bolus dose of Magnesium Sulfate. Which is most important nursing interventions
Stay at bedside with patient for full 30 minutes
When does GHTN start
> 20 weeks
CHTN W/ Superimposed PreE
When HTN onset…
Systemic issues…
Before 20 weeks preggers
Systemic SS Yes
Chronic HTN
BP?
HTN Onset?
Systemic?
> 140 or >90
<20 weeks
Systemic NO
GHTN
BP?
HTN Onset?
Systemic?
> 140 or >90
HTN >20 weeks
Systemic NO
PreE & E
BP?
ONSET HTN?
Systemic?
BP Usually >140 or >90 but if no HTN but still systemic issues they Can be diagnosed with PreE
Onset Usually after 20 weeks Typically late preggers or postpartum
Systemic YES
Chronic hypertension
HTN <20 WKS GA
TREATMENT…..
If systemic SS of PreE develop WHAT WILL BE DIAGNOSES
Control BP with antihypertensive meds
Ensure baby getting perfusion
Monitor for onset symptoms of PreE
Considered IOL @ 37 weeks
If systemic SS of PreE develop: Chronic hypertension with Superimposed PreE
GHTN
Peripheral vascular resistance = Circulation to body’s organs decreased
HTN BP >140/90 (2 Readings 6 hrs apart)
More accurate Dx…..
Tx: increases monitoring, antihypertensive, low dose aspirin.
Cure: Deliver baby. Consider IOL @ 37 weeks
Systolic Increase 30 or Dystolic increase 15
Eclampsia…..
Preeclampsia with Seizures
PreE has multiple systems involved
NS, CV, RESP, RENAL, LIVER ,EYES
Describe what bad things happen with the placenta….
Lowered Perfusion, nutrients/ oxygen, IUGR hypoxia, fetal death
Usually >20 wks
Most near term or postterm
Primiparity
Chronic HTN / Chronic renal disease
History of thrombophilia
Multifetal pregnancy
In vitro fertilization
Type 1 or 2 DM
Obese
Lupus
AMA
Risk factors for…
Preeclampsia
Also
Previous preEclampsia / Family history of
Greater than or equal to 140 / 90
2 occasions atleast 4 hrs apart
After 20 wks
Normal BP before
&
Proteinuria (greater than 300mg per 24 hr urine collection. Or this amount extrapolated from a timed collection
Or…..
In the absence of proteinuria new onset HTN with any of the following
Thrombocytopenia
Renal insufficiency
Impaired liver function
Pulmonary edema
Cerebral / visual
Protein/ creatinine ratio >or equal to 0.3
Dipstixk reading of +1
PreE diagnostic criteria
Greater than or equal to 140 / 90
2 occasions atleast 4 hrs apart
After 20 wks
Normal BP before
&
Proteinuria (greater than 300mg per 24 hr urine collection. Or this amount extrapolated from a timed collection
Or
Protein /creatinine ratio >or equal to 0.3
Dipstick reading +1
Or…..
In the absence of proteinuria new onset HTN with any of the following
Thrombocytopenia
Renal insufficiency
Impaired liver function
Pulmonary edema
Cerebral / visual
Severe features of preE
Renal insufficiency….
Thrombocytopenia….
Impaired liver function…
Pulmonary edema
Cerebral or Visual
Renal insufficiency: Serum Creatinine concentration greater than 1.1mg/dl or doubling of serum Creatinine in absence of other renal disease
Thrombocytopenia: platelet <100,000 / microliter
Impaired liver function Elevated blood concentration of liver transamimase to twice normal
Pain in which area for preE
URQ
Other Symptom of preE
Proteinuria > ____ in a 24 hr
Caused by damage to glomeruli
Urine output….
Uric acid….
Swelling of face and hands
NV 2nd half of pregnancy
Sudden weight gain
Clones & hyperactive relfexes
0.3 g
Urine decrease
Uric acid increase
PreE / E precautions
When to do these precautions
Private room
Pad side nails / bed low
02 and suction equipment bedside
Airway, reflex hammer, ambulation bag, magnesium Sulfate/ calcium gluconate
Dim lights
Group nursing interventions
Restrict visitors
When?
When preggers arrives with HTN. No order needed
Too much mag will cause this with the reflexes
Give scale
Too slow
0 Reflex Absent
+1 hypoactive
+2 Normal
+3 brisk
+4 hyperactive
Clones assessment ….
Findings….
Supine
Support stretched leg and dorsiflex foot sharply and hold stretch.
Normal: No movement
Clones present
Mild 2 movements
Mod 3 - 5
Severe >6
When to worry about edema
When it’s on face & hands
Weight gain 5 lbs more in 1 week
Occurs after 20 wk GA
Mag Sulfate assessments
Have ready….
Hourly
VS
Neurological
RR <12 Mag too high
DTF
Urine output <30mL /hr concern
LOC
Ready:
Suction equipment
Magnesium Sulfate
Calcium Gluconate
Signs of Mag Toxicity
RR…
SPo²…
BP…
Serum Mag Level..
DTR…
Skin…
LOC…
RR <12
SPo² <95
BP <100 /60
Serum Mag Level >8
DTR: Absence
Skin: Sweaty / Flushed
LOC: Confused / lethargy
How to adminster Calcium Gluconate for Mag overdose
1g IVP over 3 min
When having Mag Toxicity SE is the first answers mostly turn the mag off?
No. Keep mag on and provide interventions for their SE
Mag keeps from having seizures
Eclampsia (PreE w/ seizures)
Hypoxia may occur in…
Risk for aspiration
Other risks; CVA, Cerebral edema, anoxia, coma, Maternal death (0.4 - 14%)
Eclampsia should be preventable
Hypoxia in mother & fetus
Posistion for seizures patient
Lateral
Mag given 2 gms over 5 minutes
Total of how much…
6 gms
HELLP SYNDROME
Occurs with PreE
Define…
Hemolysis
Elevated Liver enzymes
Low Platelets
DIC VS HELLP
Platelets 150,000 - 400,000
Fibrinogen 300 - 500
PT 11-13
PTT 25 - 45
FSP <10
Platelets DIC Down / HELLP <100,000
Fibrinogen DIC DOWN / HELLP Normal
PT 11-13 DIC Prolonged/ HELLP Normal
PTT 25 - 45 DIC Prolonged/ HELLP Nor
FSP <10 DIC > 40 U / HELLP Normal
HELLP management
Avoid palpation of liver. Which quadrant
Transport carefully
Meds…
Fluid replacement?
Delivery?
RUQ
Meds: Magnesium Sulfate & Antihypertensive
Fluid replacement to replace intravascular volume
Yes if able
Why does hyperglycemia occur with DM
Why does polydipsia happen with DM
Dehydration?
Lack of insulin to transport glucose from bloodstream to inside cells.
Body tries to dilute BS
Fluid goes from inside cells to blood stream to dilute BS
GD
Is insulin required?
Does Glucose regulation return to nom after birth?
At risk for TYPE II After birth
Insulin maybe required
Glucose regulation returns normal after birth
Yes risk type II after
Risk factors for GD
Fasting serum glucose….
Random serum glucose….
Fasting >90
Random >190
GD risk factors
Obese
Previous birth large infant (How large)
Chronic HTN
Maternal age ….
Family history DM
Previous GD
> 4000g
Maternal age >25
Increased SA
PID
UTI
Polyhydramnios - Excessive Amniotic fluid in sac
Ketoacidosis
Macrosomia - Large fetal weight
Describes which condition
Gestational diabetes
GD
Congenital anomalies- Neurotube defects/ cardiac
Macrosomia
IUGR
Preterm & PROM
Respiratory distress syndrome
Hypoglycemia
Perinatal death
Fetal affects for which illness
GDM
Why Macrosomia in GDM
Maternal hyperglycemia = fetal hyperglycemia
Excessive BS stimulates excessive insulin (a growth hormone):in fetus
Why low BS in newborns
High maternal blood glucose = High fetus blood glucose.
When birthed the glucose stops coming from the mom but baby still produces Insulin
Hypoglycemia
Normal BS for first 4 hrs of life
Normal bs for a baby
4 hours = Low as 25
Baby >40
SHE SAID 40 IN CLASS
Why Hyperbilirubinemia?
Fetus with recurrent hypoxia compensate by producing more RBC (to carry oxygen)
Bilirubin is a product of broken down RBCs
Why respiratory distress in babies whose mother’s have GDM
Delayed production of surfactant
LECITHIN / SPHINGOMYELIN (L/S) RATIO AND PRESENCE OF PHOSPHATIDYLGLYCEROL (PG) WILL BE DONE BEFORE C/S TO EVALUATE LUNG MATURITY
LECITHIN / SPHINGOMYELIN (L/S) RATIO AND PRESENCE OF PHOSPHATIDYLGLYCEROL (PG) WILL BE DONE BEFORE C/S TO EVALUATE
LUNG MATURITY
L/S LECITHIN/ SPHINGOMYELIN Ratio
Used to evaluate lung maturity
LECITHIN in amniotic fluid is less than the amount of SPHINGOMYELIN until ____
At _____ weeks the 2 lipids will be equal value
At _____ weeks LECITHIN levels will raise sharply.
NORMAL VALUE _____
requires 3 cm of amniotic fluid
What is the ratio of fetuses of insulin dependent moms _____
LECITHIN in amniotic fluid is less than the amount of SPHINGOMYELIN until 26 weeks
At 30 - 32 weeks the 2 lipids will be equal value
At 35 weeks LECITHIN levels will raise sharply.
NORMAL VALUE 2:1 LECITHIN to SPHINGOMYELIN or greater
requires 3 cm of amniotic fluid
What is the ratio of fetuses of insulin dependent moms 3.5 - 1
Nursing Management
BS monitoring
GOAL FASTING/ POSTPRANDIAL
Fasting: <95 (No food 4 hours)
Postprandial: < 120 (2 hrs after meal)
Insulin needs are increased during 2nd and 3rd trimester.
3 times & types of insulin daily ….
Is an insulin drip ever used during labor….
- Regular (short acting) & NPH @ Brkfst
- Regular before dinner
- NPH at HS
Yes
Insulin Orange Needle
Route?
Angle?
Aspiration needed?
SubQ
90° Fat / 45° Skinny
No aspiration needes
Glucose Challenge Test
24 - 28 wk
How long to fast?
Pass =
If fail…
No fasting required
Pass <140 mg/dl
If fail 3 HR. GTT
Fast after midnight day of test
Fasting blood level drawn AM
Ingest 100g of oral glucose
Blood drawn at 1,2,3 hrs
Dx is positive if ….
Positive if Fasting is abnormal or 2 or more draws are elevated
Fasting is >95
1hr >180
2hr>155
3hr>140
Hypoglycemia looks like….
Treatment…
Drunk
15 grams of carbs
Hyperglycemia looks like…
Most common cause….
Adminster….
Hot & Dry
Infection
Insulin
Rh positive carries ___ on RBC
Rh neg doesn’t
When Rh positive blood enters Rh negative, What happens?
Antigen
Rh negative builds antibodies to attack antigen.
Erythroblastosis fetalis is the destruction of babies RBCs by their Rh- mothers antibodies crossing into the placenta.
What diseases can happen from this
hydrops fetalis (severe edema)
Heart failure
Jaundice
Anemia
What does an Indirect Coombs test do?
Test Rh- mother to see if she has been previously sensitized. 1st prenatal visit
If indirect Coombs Neg. Repeat at 28 weeks.
28 weeks Rho-gam is given to unsensitized, Prophylactic
1st prenatal visit (Blood type / Rh)
Rh negative women
Draw indirect Coombs test - determines if previously sensitized.
If indirect Coombs (Pos / Neg)
Repeat at 28 weeks
What happens at 28 weeks
Neg
Rhogam is given to unsensitized, ( Prophylactic to prevent sensitization)
Prenatal management
Indirect Coombs positive (what does this mean)
Management….
Positive = Sensitized Rh - mom has Rh + antibodies to attack infants blood.
Repeat Coombs test throughout preggers to ensure no raising tigers.
Amniocentesis: Determine babies Rh status
US: Edema, ascites, enlargement of heart
Postpartum
How to perform direct Coombs
Umbilical cord
Doseage of Rho-gam
Route
When
300 mcg
IM Deltoid
28 weeks preggers & within 72 hr birth
ABO Incompatibility
Describe Severity….
Type of Antibodies….
Describe Effects on Fetus….
Less severe than Rh
IgM - Don’t cross thr placenta
Born with Jaundice NOT ANEMIA
Type A blood has A antigens and anti-B antibodies.
Type B blood has B antigens and anti-A antibodies.
Type AB blood has both A and B antigens but no antibodies, making it a universal plasma reciever
Type O blood has no antigens but both anti-A and anti-B antibodies, making it a universal blood donor.
People with AB blood type are known as “universal recipients” for plasma transfusions because they have both A and B antigens on their red blood cells and do not have anti-A or anti-B antibodies in their plasma. This means they can safely receive red blood cells from any blood type:
O (no A or B antigens)
A (A antigens)
B (B antigens)
AB (both A and B antigens)
However, when it comes to donating blood, AB blood can only be given to other AB recipients due to the presence of both antigens.
Probably not in test
UTI 3 major categories
Asymptomatic
Causative bacteriuria …….
No symptoms
Treatment……
Cystitis
Causative agent….
Symptoms: dysuria, frequency, urgency, suprapubic tenderness, may progress to pyelonephritis.
Treatment……
Acute Pyelonephritis
Causative agent……
Symptoms…….
Treatment…….
Asymptomatic
Causative bacteriuria: E. Coli, Klebsiella, Proteus
No symptoms
Treatment: Sulfonamides, ampicillin, nitrofurantoin
Cystitis
Causative agent Same as above
Symptoms: dysuria, frequency, urgency, suprapubic tenderness, may progress to pyelonephritis.
Treatment Same as above
Acute Pyelonephritis
Causative agent: same as above
Symptoms: Same as above Plus: fever, chills, flank pain, CVA, tenderness NV
Treatment: IV antibiotics & hospitalization
Asymptomatic bacteriuria can move to the ____ and be called Cystitis.
Infection during preggers can cause early Term delivery
Bladder
Eating raw eat or contact with cat feces can cause this problem from a protozoan….
Asymptomatic ___%
New born effects….
Treatment….
Toxoplasmosis
Asymptomatic 90%
Miscarriage (if in early preggers)
Neurological, hydrocephalus, microcephaly.
Pyrimethamine - antiprotozoal
folinic acid -protect healthy cells from folate depletion and to minimize side effects.
sulfadiazine- antibiotic
Pyrimethamine, Folinic Acid , sulfadiazine
Treat…..
Toxoplasmosis
Transmission
Body fluids
Type of virus: Herpes
Widespread- eventually infects most humans
Maternal effects: Most Asymptomatic
2% live births affected:
Severe effects: deaf, retarded, seizures, blind, dental
Cytomegalovirus
Cytomegalovirus; Herpes virus - common
Management:
Mother….
Neonate….
Mom: treat symptoms, mild analgesia, rest
Neonate: no therapy/ CONTACT ISOLATION required
_______
Transmission: Droplet, direct contact with nasopharyngeal secretions, transplacental.
Care precautions DROPLET & STANDARD
Viral Transmission
Maternal Effects: Fever, malaise, rash (begins on face and spreads. Last 3 days)
Rubella
Woman had MMR vaccine when young. Will she ever need another one?
Maybe, read the titers
Rubella risk level….
Greatest risk Trimester….
Health concerns to baby
Serious
1st trimester
Deaf, cataracts, IUGR, Cardiac, retarded
Rubella titer that indicates immunity….
Women with Rubella, no special therapy.
Neonates…..
How long after Rubella vaccine does a woman have to wait to become pregnant….
1:8 or >
Neonates = isolation
Wait 4 weeks
Varicella- Zoster Virus
Precaution….
Air born , contact, standard
Maternal Effect
Pruritic rash
Preterm labor
Encephalitis
Varicella pneumonia
Death rate 50: 100,000
Precautions: Airborne, Contact, Standard
Name disease
Varicella-ZOSTER Virus
When is Varicella contactable according to the rash associated with it…
3 days prior
Does Varicella have isolation precautions…
Yes, and it’s Airborne too
Varicella vaccine safe for preggers
No, avoid getting preggers for 1 month After vaccine
If mom gets Varicella 5 - 7 days before labor give…
Zoster immune globulin (VZIG)
Herpes 1 & 2
Care Precautions…..
Only way to distinguish between types is serum blood test
Type Of herpes infection most dangerous during preggers…
Virus is shed until lesions are ……
Herpes Virus 1 & 2
1st time virus outbreak
Completely healed
Herpes + mother is always a C/S delivery…
False
Only if there are lesions/ outbreak is C/S needed
Herpes
Primary infection during 1st 20 weeks may results in….
Complications are ____ from recurrent infections
Spontaneous abortion, IUGR, Preterm labor
Rare
Neonatal effects
Herpes
Death rate…
What increases death rate…
50%
Mothers primary infection of herpes
No cure for herpes
Use Acyclovir, this type of medication…
After delivery should infant be isolated from mom?
Is breastfeeding OK if there are lesions?
Antivirals
No
No
Hyperemisis gravidarum (HEG)
Persistent vomiting
Begins when…
Risk factors…
<20 wks
Unmarried
White
1st preggers
Multifetal / Molar preggers
PPROM
Preterm Premature Rupture of Membranes
<37 wks
To R/O or Confirm ROM use these 2 test. Which is more accurate
Nitrazine
Ferning (more accurate)
PROM Treatment
If term, labor induction if not spontaneous, if fails ….
If preterm….
If infected…
CS
Hospitalization. Body may form a seal to keep fluid in.
Labor induction, antibiotics, CS
Vag birth or CS in women with heart disease
Vag
SS fatigue, headache, Pica
Fetal effects: profound anemia & reduction of oxygen supply.
Take ferrous 320 mg.
Take with citrus
Iron deficiency
Folic acid is essential for ….
Maternal effects…
Infants…..
What should take folic acid?
Cell duplication & fetal / Placental growth.
Mom: Increased risk of SROM
BABY: neural tube defects
All woman of child bearing age - 400 mcg
This level will be measured in the following complications
Threatened abortion
Missed abortion
Ectopic pregnancy
Molar pregnancy
Hyperemisis gravidarum
hCG secreted from trophoblast in early pregnancy
Gestational Trophoblastic disease is aka…
Molar pregnancy/ Hydatidiform mole
Most common trimester to lose a pregnancy
1st 50 - 70%
Interventions for…
TS
IV Fluids
DC
IV Oxytocin
Hemorrhage medication (3)
Misoprostol (Cytotec), Methylergonovine (Methergine)
Carboprost (Hemabate)
Incomplete abortion
IV
TS
Natural Evacuation of POC
Vacuum Curettage
DC
IOL
Interventions for…
Inevitable Abortion
Misoprostol (Cytotec)
Methylergonovine (Methergine)
Carboprost (Hemabate)
Are this type of medication….
Hemorrhage meds PRN
Missed abortion (Dead fetus is retained in uterus during the 1st half of pregnancy)
SS Include…
Infection
Hemorrhage
DIC
Is Rho-gam given with recurrent SAB to prevent future sensitization?
Yes
Ectopic pregnancies are Dx how…
Transvaginal US and low beta hCG
Methotrexate
Class….
SE….
PT Education
Cautions…
Chemotherapy agent / Folic Acid Antagonist
NV & increased pain rt egg expulsión
Edu: Don’t Take folic acid or Alcohol
Caution: Chemotherapy precautions for medication & urine
Hydatidform Mole Continue
SS increased hCG, Large uterus for GA, Hyperemisis, PIH
Dx increased hCG, US Shows vesicles, absence of fetal sacno FHR
Tx…
Removal Vacuum extraction and curettage.
Follow up serial hCG for 1 year
Chest X-ray, CT , MRI RO metastic disease
Why multiple US for placenta previa
Because the uterus may move to a favorable posistion to give vag birth
Which problem has a Hard Board-like abdomen
Abruptio Placenta
Which problem has the risk of Massive Postpartum Hemorrhage…
Accreta, Increata, Percreta
This may cause subinvolution of the uterus or infection…
Accreta, Increta, Percreta
Umbilical cord Implants in Membranes & infront of the cervical OS
Vasa Previa
Does the bleeding hurt from Vasa Previa
Sudden Painless Bleeding
Explain how DIC is caused…
Consumption of plasma factors, resulting in a deficiency, and blood is unable to clot
ASK TEACHER
Fasting serum glucose >
Random serum glucose >
Fasting serum glucose > 140
Random serum glucose > 200
Fetal affects
Congenital anomalies / Neurotube defects & Cardiac defects
Macrosomia
IUGR
Preterm birth and PROM
Respiratory distress syndrome
Hypoglycemia
Perinatal death
DM or GDM
Cool & Clammy give him candy
Hot & Dry sugar high
OK
Nifedipine is given via this route
Oral
Avoid use of this medication with Asthma, heart disease, congestive heart failure
Nifedipine
Contradictions to this medication include Myocardial damage, heart block, myasthenia gravis, impaired renal function
Magnesium Sulfate
Dose: IV loading 4 - 6 g over 20 - 30 minutes.
IVBP: Continuous 2g/hr via pump
Treatment for Chronic HTN (4)
Control BP with antihypertensive
Ensure baby is getting perfusion
Monitor for new onset symptoms of preE
Consider IOL at 37 wks
Symptom of preE
PROTEINURIA > ____ IN 24 HRS
0.3
PreE & Eclampsia Assessments
VS
Neurological (Reflexes, HA, Visual disturbances, Clonus)
Respiratory Assessment q4h PE evaluation
Fetal surveillance EFM US BPP Growth US
Edema, Weight gain
I&O
RUQ Pain
Safety
When checking DTR in brachial tendon do this…
Support their limp arm
Place thumb over tendon and strike with small end of hammer
Edema assessment
Describe categories…
1+ slightly indentation 2mm
2+ 4mm
3+ Deep pit 6mm
4+ 8mm
Brawny edema: No pitting: Skin surface shiny, warm, moist
Can fluid be restricted for Mag overdose…
Yes to 60 - 100 mL per hour
Due to PE
Rh sensitization can occur from…
All types abortion
Amniocentesis
CVS
Rapid production of erythroblasts (immature RBC) Cannot carry oxygen.
Edema results
Called…
Can progress to…
Hydrops fetalis
Congestive heart failure
Toxoplasmosis
Care Precaution…
Standard
Cytomegalovirus
Transmission…
Care Precautions …
Isolation for newborn…
Transmission; Body Fluid
Care Precautions; Standard
Contact Isolation
Herpes 1 & 2
Care Precautions…
Contact precautions until lesions are dry and crusted.
Then, Standard
Herpes 1 & 2
Primary infection during 1st 20 weeks is most serious.
Describe harm to fetus…
Spontaneous abortion
IUGR
Preterm Labor
Malpresentation
Poor nutrition, incompetent cervix
Hydramnios
Multiples
Cervical infections
Possible causes of…
PROM
Lack of _____
Increased risk of spontaneous abortion, Abruptio Placenta
Folic acid
Antiphospholipid Syndrome
Diabetes
PCOS: Polycystic Ovarian Syndrome
Lupus
Endocrine
Diseases associated with…
Recurrent Spontaneous abortion
