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NURS 4500 > Complications of Pregnancy > Flashcards

Complications of Pregnancy Flashcards

1
Q

Pregnancy complications can occur _______ throughout the pregnancy

A

at any time

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2
Q

Decisions about management generally involve _____ between gains in fetal maturity and maternal/ fetal consequences of continuing with the pregnancy

A

a balance

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3
Q

Pathway from triage to labour and birth unit can lead to:

A

Induction
Labour and birth
Operating Room
Monitoring

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4
Q

Worldwide major causes of maternal death

A

Infection
Hemorrhage
Hypertensive disorders
Complications from the birth
Unsafe abortion

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5
Q

In Canada, the main causes of maternal mortality include

A

Hypertensive disorders
Pulmonary and amniotic embolism
Hemorrhage
And other causes (such as mental illness)

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6
Q

Factors strongly related to maternal death

A

Age (<20, >35 years)
Lack of prenatal care
Low education level

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7
Q

_____ are leading causes of newborn morbidity and mortality

A

Preterm and multiple birth rates

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8
Q

Other causes of newborn death

A
  • Low birth weight
  • Respiratory distress syndrome
  • Sudden infant death
  • Effects of maternal complications
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9
Q

Infant death rate is higher if ______

A

mother is of a lower socioeconomic status

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10
Q

Newborn morbidity and mortality is strongly connected to ______

A

fetal well being

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11
Q

Hypertensive disorders in pregnancy incidence

A

Hypertensive disorders or pregnancy are increasingly common, involving approximately 7% of pregnancies

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12
Q

Hypertensive disorders in pregnancy morbidity

A

Acute renal failure, pulmonary oedema, HELLP syndrome syndrome (hemolysis, elevated liver enzymes, and low platelets), and cerebral edema with seizures

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13
Q

Hypertensive disorders in pregnancy mortality

A

Mortality is primarily from hepatic rupture, placental abruption, and eclampsia

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14
Q

The fetus of the pre-eclamptic is at increased risk ________

A

Placental abruption, preterm birth, intrauterine growth restriction (IUGR), and acute hypoxia

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15
Q

Hypertension in pregnancy non-severe

A
  • Systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg
  • At least 2 measurements
  • Taken at least 15 minutes apart, AFTER 5 minutes of rest
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16
Q

Severe hypertension

A

Severe hypertension is a systolic blood pressure of ≥ 160 mmHg or a diastolic blood pressure ≥ 1110 mmHg

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17
Q

Three categories of hypertensive disorders of pregnancy

A
  1. Chronic hypertension
  2. Gestational hypertension
  3. Pre-eclampsia
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18
Q

Chronic hypertension

A
  • Hypertension pre-pregnancy or evident before 20 weeks gestation
  • Pregnancy is usually uncomplicated
  • Increased risk of: poor fetal growth; fetal stillbirth
  • May develop superimposed pre-eclampsia/ eclampsia (~25%)
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19
Q

Chronic hypertension with superimposed pre-eclampsia - one or more of the following at ≥ 20 weeks gestation:

A
  • resistant hypertension
  • new onset proteinuria
  • one or more adverse condition
  • one or more severe complications
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20
Q

Chronic hypertension with superimposed pre-eclampsia

A

Development of 1 or more characteristics of preeclampsia (i.e., new-onset proteinuria or 1 or more adverse conditions) superimposed on chronic hypertension

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21
Q

Gestational hypertension

A

Detected at or after 20 weeks gestation
Hypertension without evidence of pre-eclampsia
Not usually associated with fetal growth restriction or pregnancy complications
May go on to develop pre-eclampsia (~25%)

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22
Q

What is pre-eclampsia?

A

It is a hypertensive disorder accompanied by new-onset proteinuria and, potentially, other end-organ dysfunction

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23
Q

What can pre-eclampsia occur?

A

After 20 weeks gestation

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24
Q

What occurs in pre-eclampsia?

A

It is a multi system, vasospastic disease process - main pathogenic factor is poor perfusion as a result of vasospasm, not an increase in BP
Results in reduced tissue perfusion to the major organs
Increases blood pressure

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25
Q

Pre-eclampsia symptoms

A

Gestational hypertension with new-onset proteinuria or one/ more adverse conditions

26
Q

How is proteinuria sampled?

A

A concentration of 0.03g/L or more in at least two random urine specimens collected at least 6 hours apart where there is no evidence UTI

27
Q

Proteinuria is defined as…

A

30 mg/mmol urinary PCR in a spot (random) urine sample, or ACR 8 mg/mmol, or 0.3g/day in a complete 24-hour urine collection

28
Q

Proteinuria testing does not need to be repeated…

A

Once proteinuria criteria for preeclampsia have been met

29
Q

Pre-eclampsia in the central nervous system: adverse conditions that require close ongoing monitoring to determine the need for delivery

A

Headache
Visual disturbance

30
Q

Pre-eclampsia in the central nervous system: adverse conditions that require delivery (birth) regardless of gestational age

A

Eclampsia
Posterior reversible encephalopathy syndrome (PRES)
Cortical blindness or retinal detachment
Stroke or TIA
GCS <13

31
Q

What is eclampsia?

A

Seizures in a woman diagnosed with preeclampsia, with no other history that would explain the seizures

32
Q

Eclampsia seizures may happen suddenly or can be preceded by specific signs and symptoms:

A

Headache
Severe epigastric pain
Hyperreflexia

33
Q

Eclampsia: During the convulsion, both the pregnant person and the fetus…

A

Are not receiving oxygen

34
Q

Pre-eclampsia in cardiorespiratory system: Adverse conditions that require close ongoing monitoring to determine the need for delivery

A

Chest pain/ dyspnea
Oxygen saturation <97%

35
Q

Pre-eclampsia in cardiorespiratory system: Adverse conditions that require delivery (birth) regardless of gestational age

A

Uncontrolled severe hypertension >12 hours, despite use of three antihypertensive agents
Oxygen saturation <90%, need for 50% oxygen for >1 hr, intubation (other than for cesarean section), pulmonary edema
Positive inotropic support
Myocardial ischemia or infarction

36
Q

Pre-eclampsia in hematological system: adverse conditions that require close ongoing monitoring to determine need for delivery

A

Low platelet count

37
Q

Pre-eclampsia in hematological system: adverse conditions that require delivery (birth) regardless of gestational age

A

Platelet count < 50x10^9/L
Transfusion of any blood product

38
Q

Pre-eclampsia in renal system: adverse conditions that require close ongoing monitoring to determine need for delivery

A

Elevated serum creatinine

39
Q

Pre-eclampsia in renal system: adverse conditions that require delivery (birth) regardless of gestational age

A

Acute kidney injury
New indication for dialysis

40
Q

Pre-eclampsia in hepatic system: adverse conditions that require close ongoing monitoring to determine need for delivery

A

Nausea or vomiting
RUQ or epigastric pain
Elevated serum AST, ALT

41
Q

Pre-eclampsia in hepatic system: adverse conditions that require delivery (birth) regardless of gestational age

A

Hepatic dysfunction
Hepatic hematoma or rupture

42
Q

Pre-eclampsia in uteroplacental dysfunction: adverse conditions that require close ongoing monitoring to determine need for delivery

A

Abnormal or atypical Fetal Heart Rate (FHR) - NST
Fetal growth restriction
Oligohydramnios
Absent or reversed end diastolic flow by umbilical artery Doppler velocimetry
Angiogenic imbalance

43
Q

Pre-eclampsia in utter-placental dysfunction: adverse conditions that require delivery (birth) regardless of gestational age

A

Abruption with evidence of maternal or fetal compromise
Absent or reversed ductus venous A wave by doppler velocimetry
Intrauterine fetal death

44
Q

HELLP Syndrome

A

Usually considered a variant or complication of pre-eclampsia
Can occur during later stages of pregnancy or after childbirth
Mortality rate of HELLP can be as high as 25%
Hemolysis - destruction of red blood cells
Elevated Liver Enzymes
Low Platelets

45
Q

Diagnosis of HELLP syndrome

A

Platelet count less than 100 x 10^9/L with elevated liver enzymes (AST and ALT)

46
Q

Management of hypertensive disorders of pregnancy

A

Anti-hypertensive therapy for management of BP
Activities for the prevention of pre-eclampsia and prevention of fetal and maternal adverse outcomes
Monitoring for pre-eclampsia
Planning for timing of delivery

It is a balance of gains in fetal maturity vs. risks of fetal and maternal compromise

47
Q

How do you monitor for pre-eclampsia in hypertensive disorders of pregnancy?

A

Proteinurea, adverse conditions (maternal and fetal)
Formalize the risk of adverse maternal outcomes among hypertensive pregnant people by using predictive models

48
Q

In gestational hypertension/ chronic hypertension, monitor for:

A

Visual disturbances: blurred vision, spots, stars
Headaches
Epigastric / RUQ pain
Chest pain / dyspnea
Vaginal bleeding with abdominal pain
Blood pressure, O2 saturation (in clinic or if self monitoring at home)
Proteinuria (in clinic, may also be self monitoring at home with urine dipstick)
Deep Tendon Reflexes – Basso, 2022
Pre-eclampsia, monitor for (twice weekly) - Maternal testing should include, in addition to gestational age and the above (except proteinuria):
-oxygen saturation
-platelet count
-serum creatinine
-AST or ALT

49
Q

Fetal health surveillance

A

Daily fetal movement
Electronic fetal monitoring/ non-stress test
Ultrasound for assessment of fetal growth and deepest amniotic fluid pocket (amniotic fluid volume), and umbilical artery doppler

50
Q

Pharmacological control of hypertension in pregnancy

A

Labetolol - B-Blocking agent
Hydralazine
Nifedipine
Methyldopa (Aldomet)

51
Q

Recommended target for pharmacological control of hypertension in pregnancy

A

For pregnant people with chronic or gestational hypertension or preeclampsia is a diastolic pressure of 85 mm Hg

52
Q

Important key things to manage pregnancy hypertension in hospital

A

Assist with arterial line placement as needed (could receive arterial line placement for ongoing BP assessment and lab work)
Stabilization and likely planned delivery (by induction of labour)
Administer Magnesium Sulphate as ordered for seizure prevention
Continuous electronic fetal monitoring
Calm, quiet environment

53
Q

What things determine the timing of induction?

A

Chronic hypertension
Gestational hypertension
Preeclampsia

54
Q

Eclampsia prevention and treatment

A

Magnesium sulfate IV for seizure prevention and treatment as ordered
Usual dose:
- 4g IV loading dose - piggyback infusion
- Load dose is usually followed by 1g/hr IV maintenance dose

Requires close monitoring

55
Q

Signs of magnesium toxicity

A

Decreased or absent reflexes
Low BP
Lower heart rate or cardiac arrhythmia
<12 breaths/minute for 15 minutes
O2 saturation <94% for 15 minutes
<30 mL/hr for 4 hours
Excessive drowsiness, slurred speech

56
Q

Antidote for magnesium toxicity

A

Calcium gluconate

57
Q

Assessment timings for magnesium sulphate

A

Reflexes upon completion of loading dose, and every hour while on therapy
BP, HR, RR, and O2 sat every 30 minutes
Urine output every hour
CNS and neuromuscular symptoms when noticed

58
Q

Signs of tonic-clonic seizure

A

Stage of invasion
Stage of contraction
Stage of seizure

59
Q

Management of eclampsia pre convulsion or seizure

A

Call bell easily accessible
Oxygen is working and mask available
Suction available and working
Side rails raised
IV site patent
Room is organized
Quiet environment
Emergency med tray

60
Q

Management of eclampsia during convulsion/ seizure

A

Maintain patent airway
Call for help - do not leave bedside
Protect from injury if possible
Observe and record activity/ timing

61
Q

Management of eclampsia post convulsion or eizure

A

O2 by face mask @10L/min
Electronic fetal monitoring (FHR and uterine activity)
Prepare for birth as needed (ROM, dilation, delivery is most definitive cure)
Risk for placental abruption - monitor

62
Q

Ongoing care considerations for preeclampsia patients

A

Delivery is most definitive cure
Postpartum - higher risk for postpartum hemorrhage if magnesium sulphate was administered
Ongoing monitoring throughout postpartum period, anti-hypertensive meds may continue

NURS 4500 (4 decks)

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