Conditions during Pregnancy (part of pregnancy ppt) Flashcards
Exam 1
What would result in dizygotic or fraternal twins?
When two eggs are fertilized, the result is dizygotic or fraternal twins.
What would increase the risk of dizygotic twinning rates?
Risks for dizygotic twinning rates include:
the use of fertility drugs,
certain ethnicity,
or a family history of twinning.
What are monozygotic twins and how would they occur?
Monozygotic twins are identical and occur after the fertilization of one ovum.
What is monozygotic twinning considered?
Monozygotic twinning is considered a random, spontaneous event.
Mutli fetal risk increases maternal and fetal risk: Examples?
Risks include gestational diabetes, hypertensive disorders of pregnancy including preeclampsia, pulmonary embolism, fetal growth restriction, fetal anomalies, early pregnancy loss, stillbirth, and placenta previa.
Hyperemesis gravidarum (HG)
Hyperemesis gravidarum (HG) is characterized by unusually acute nausea and vomiting.
Hyperemesis gravidarum (HG) may lead to what?
HG may lead to weight loss, malnutrition, dehydration, ketonuria, and electrolyte imbalances.
What would nurses have to evaluate for with HG?
Nurses must evaluate for signs of dehydration, malnutrition, and laboratory tests.
What is the treatment for Hyperemesis gravidarum (HG)
Treatment may include antiemetics (although some have known teratogenic effects), intravenous (IV) rehydration, and the administration of parenteral electrolytes.
What are some risk factors for Hyperemesis gravidarum (HG)?
History of Hyperemesis gravidarum (HG)
Gestational trophoblastic disease
Multiple pregnancy
Hyperthyroidism (overactive thyroid)
GI disease prior to pregnancy
Depression and anxiety
Female fetus
Bleeding in EARLY Pregnancy (<20 weeks GA) can mean?
Abortion
Cervical Insufficiency
Ectopic Pregnancy
Gestational Trophoblastic Disease
Bleeding in LATE Pregnancy (>20 weeks GA) can mean?
Placenta Previa
Abruptio Placenta
What percent of women report vaginal bleeding in early pregnancy
Up to 20% of women report vaginal bleeding in early pregnancy.
Bleeding in Early Pregnancy (<20 weeks GA): Miscarriage/Abortion: For a subset of women, vaginal bleeding may be indicative of what?
For a subset of women, vaginal bleeding may indicate a miscarriage, ectopic pregnancy, or gestational trophoblastic disease.
What are other names for miscarriage? When does miscarriage occur?
A miscarriage, also known as a spontaneous abortion or spontaneous pregnancy loss, occurs before 20 weeks gestation.
When do the majority of miscarriages occur? Why?
Majority of miscarriages occur between weeks 5 and 8 - result of chromosomal abnormalities.
Bleeding in Early Pregnancy (<20 weeks GA): Miscarriage/Abortion:
If pregnancy loss is suspected, the woman should be evaluated for symptoms of:
What is used to evaluate?
bleeding,
cramping, and
the passage of tissue.
An ultrasound may be ordered to evaluate the pregnancy as well as beta hCG levels.
What percent of miscarriages are associated with chromosomal abnormalities?
Approximately 70% of miscarriages are associated with chromosomal abnormalities.
Bleeding in Pregnancy: Ectopic Pregnancy
A pregnancy that occurs outside the uterus, often occurs in the fallopian tube.
Bleeding in Pregnancy: Ectopic Pregnancy
What are they considered? What should be done?
Ectopic pregnancies are considered life-threatening for the mother and must not be continued.
Bleeding in Pregnancy: Ectopic Pregnancy
Signs of ectopic pregnancy include:
pelvic pain that may be unilateral and
bleeding.
How would treatment of ectopic pregnancy occur?
Treatment may be managed medically or surgically, depending on time of discovery.
Bleeding in Pregnancy: Gestational Trophoblastic Disease
Gestational trophoblastic disease (GDP), also known as a molar pregnancy, is a nonviable mass of trophoblastic tissue.
Bleeding in Pregnancy: Gestational Trophoblastic Disease
How is molar pregnancy?
A molar pregnancy grows at an abnormally high rate, produces abnormally high levels of beta hCG, and may spread beyond the uterus (gestational trophoblastic invasive mole or gestational choriocarcinoma).
Bleeding in Pregnancy: Gestational Trophoblastic Disease
How is it diagnosed?
Diagnosed on ultrasound.
Bleeding in Pregnancy: Gestational Trophoblastic Disease
How is it treated?
Treatment includes hysterectomy or dilation and curettage, possible prophylactic chemotherapy, serial serum hCG levels for 6 months to 1 year, and avoiding subsequent pregnancy for 1 year.
Hypertensive Disorders of Pregnancy: Gestational Hypertension
How is it diagnosed?
Gestational hypertension is diagnosed by systolic blood pressure greater than 140 mm Hg or higher and/or a diastolic blood pressure of 90 mm Hg or higher without protein in the urine or signs of end-organ dysfunction diagnosed at 20 weeks of pregnancy.
As many as half of the patients diagnosed with gestational hypertension go on to develop what?
As many as half of the patients diagnosed with gestational hypertension go on to develop preeclampsia.
Complications of gestational hypertension include?
Complications of gestational hypertension include preterm birth, small for gestational age (SGA) infants, and placental abruption.
Preeclampsia can occur in what percent of pregnancies?
Preeclampsia occurs in 3% to 5% of pregnancies.
Preeclampsia can cause what to the fetus specifically:
oligohydramnios
placental abruption
intrauterine growth restriction for the fetus
Preeclampsia can cause what to the mother specifically?
Can impact maternal organ systems causing renal damage, pulmonary edema, impaired liver function, cerebral edema, and thrombocytopenia.
How is preeclampsia diagonosed?
Diagnosis: when a patient has BP ≥ 140/90 mm Hg on two occasions at least 4 hours apart and has proteinuria.
Preeclampsia with Severe Features:
BP levels
Hypertension (>160/110 mmHg) with or without proteinuria and
Preeclampsia with Severe Features:
Platelet count?
Platelet count <100,000
Preeclampsia with Severe Features:
Serum creatinine liver
Serum creatine liver >1.1 mg/dL
Preeclampsia with Severe Features:
other features
Elevated liver enzymes, pulmonary edema, or
New-onset visual or cerebral symptoms.
Eclampsia
Eclampsia is preeclampsia with tonic-clonic seizure activity.
Risk Factors for Preeclampsia:
Maternal risk factors
Age ≥20 or ≤35
African descent
Low socioeconomic status
Family history of preeclampsia
First pregnancy or pregnant with a new partner
Type 1 or gestational diabetes
Obesity
Chronic hypertension
Kidney disease
Thrombophilia (an increased tendency to clot)
Risk Factors for Preeclampsia: Pregnancy risk factors
Chromosomal abnormalities of fetus (such as trisomies 18 and 21)
Hydatiform mole (molar pregnancy)
Hydrops fetalis
Multifetal pregnancy
Donated eggs or sperm
Structural congenital abnormalities of the fetus
Nursing Assessment & Care: Preeclampsia and Eclampsia
During Pregnancy assess: (first 7)
Blood pressure
Headache
Blurred vision
Restlessness
Epigastric and right upper quadrant pain
Shortness of breath
Nursing Assessment & Care: Preeclampsia and Eclampsia
During Pregnancy assess: (last 6)
Fetal movement
Urine output
Unusual vaginal bleeding or discharge
Reflexes (DTR)
Clonus
Laboratory tests –
Nursing Assessment & Care: Preeclampsia and Eclampsia
During Pregnancy assess: What lab tests?
Laboratory tests –
Comprehensive metabolic panel
Liver function tests
Complete blood count with platelets
Nursing Assessment & Care: Preeclampsia and Eclampsia
During Labor and Delivery
Head-to-toe assessment every 4 hours
Precautions
Lab tests
Nursing Assessment & Care: Preeclampsia and Eclampsia
During Labor and Delivery, Head-to-toe assessment every 4 hours includes:
Headache
Vision changes (floaters or spots)
Shortness of breath/breath sounds
Epigastric pain
Urine output
Edema
Deep tendon reflexes (patellar)
Clonus
Vital signs every 15 minutes
Continuous pulse oximetry
Fetal monitoring
Nursing Assessment & Care: Preeclampsia and Eclampsia
During Labor and Delivery, precautions that should be taken:
Minimal stimuli (to reduce the risk of seizure)
Nursing Assessment & Care: Preeclampsia and Eclampsia
During Labor and Delivery, lab tests include?
Comprehensive metabolic panel
Liver function tests
Complete blood count with platelets
Treatment: Preeclampsia and Eclampsia
To reduce the risk of preeclampsia, women at high risk may be advised to what?
To reduce the risk of preeclampsia, women at high risk may be advised to start taking an aspirin and calcium supplement to decrease risk.
How should women with mild preeclampsia and gestational hypertension be monitored?
Women with mild preeclampsia and gestational hypertension may be monitored on an outpatient basis and do not require medication.
Women suspected of having progressed to severe preeclampsia may need what?
Women suspected of having progressed to severe preeclampsia may need to be induced and deliver early.
In preeclampsia, how may hypertension be controlled?
Hypertension may be controlled by IV antihypertensives to protect from complications such as stroke, renal damage, and heart disease.
What is NOT reccommended in pregnancy for the treatment of preeclampsia?
Routine bed rest is not advised in pregnancy for the treatment of preeclampsia
What is given to prevent seizures in preeclampsia?
Magnesium sulfate is often given by IV to prevent seizures.
What does treatment with mg sulfate do for preeclampsia?
Magnesium sulfate reduces central nervous system irritability caused by cerebral edema and brings down the seizure activity by an estimated 50%.
Signs of Mg sulfate toxicity include:
Respiratory depression (under 12 breaths/min)
Oliguria
Absent reflexes
Lethargy
Slurred speech
Muscle weakness
Loss of consciousness
Signs of Mg sulfate toxicity are serum levels of what?
Signs of magnesium sulfate toxicity ( serum levels > 8 mEq/L):
Interventions to address Mg sulfate toxicity include:
Stop the infusion immediately.
Administer antidote Calcium gluconate as ordered (typically 1 g by slow IV push over 3 minutes).
Gastric diabetes occurs in what percent of pregnancies? What is it associated with?
Gestational diabetes occurs in about 6% of pregnancies and is associated with insulin resistance and results in high blood glucose levels.
Risks Associated with Gestational Diabetes
Preeclampsia
Fetal macrosomia
Polyhydramnios
Fetal organomegaly
Operative delivery (c-section or surgical vaginal delivery)
Birth trauma to pt and fetus
Neonatal respiratory problems
Neonatal metabolic probs
Perinatal mortality
Slides 84-86
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Infections in Pregnancy may be caused by:
Infection may be caused by sexually transmitted infections (STIs), vaginitis, TORCH infections, and urinary tract infections.
Chlamydia and gonorrhea during pregnancy may cause what? How are the STIs treated?
Chlamydia and gonorrhea may cause preterm labor, preterm rupture of membranes, low birth weight, or postpartum endometritis. Treated with antibiotics followed by retesting 3 to 4 months later.
Herpes while pregnant how is that handled?
Herpes can be transmitted to the fetus. Patients with herpes are typically prescribed an antiviral medication the month before pregnancy due date and are delivered by cesarean if lesions are present.
HIV and pregnancy, how is that handled?
Pregnancy is not contraindicated for patients who are HIV positive. Patients with HIV are often delivered by cesarean to reduce risk of transmission to fetus.
Hepatitis B patients and pregnancy
Infants born to hepatitis B-positive patients should be given the hepatitis B vaccine and the hepatitis B immune globulin within 12 hours of birth.
TORCH infections
TORCH infections are a group of infections that may cause fetal anomalies and are often asymptomatic for the mother.
TORCH infections include
Toxoplasmosis
Other Infections
Rubella
Cytomegalovirus (CMV)
Herpes (HSV-1 and HSV-2).
How are UTIs during pregnancy? How are they treated?
Urinary tract infections are often asymptomatic and should be treated with antibiotics during pregnancy.
Cervical Insufficiency
Painless, premature dilation of the cervix in the second trimester of pregnancy.
Cervical Insufficiency makes a high risk for?
High risk for miscarriage or premature birth.
Cervical Insufficiency is diagnosed how?
Diagnosed with history of second-trimester pregnancy losses and/or measurement of cervical length by ultrasound.
Cervical Insufficiency treatment includes?
Treatment options include maternal progesterone supplementation and cervical cerclage.
Trauma in pregnancy may be related to?
Trauma in pregnancy may be related to motor vehicle collisions, falls, or intimate partner violence.
Care considerations for trauma treatment include: how to reduce supine hypotension
Placing a wedge under the patient’s right hip to minimize supine hypotension
Care considerations for trauma treatment include: What to understand about chest compressions
Understanding chest compressions may be more challenging and ineffective later in pregnancy
Oxygen consumption is increased and patients should be monitored closely for hypoxia.
Care considerations for trauma treatment include: oxygen consumption
Oxygen consumption is increased and patients should be monitored closely for hypoxia.
Care considerations for trauma treatment include: Abdominal trauma
Abdominal trauma may result in placental abruption.
Trauma may be an indication for the administration of Rho (D) immune globulin to an Rh-negative patient.
The nurse should carefully assess the patient and the fetus for complications related to trauma.
Intrauterine Growth Restriction (IUGR) in what percent of pregnancies is it diagnosed in?
IUGR is diagnosed in 10% of pregnancies.
Infants with IUGR are at high risk for:
Infants with IUGR are at high risk for hypoglycemia, problems with thermoregulation, and respiratory distress after birth.
IUGR =
there is a pathological process in place that is causing the fetus not to meet its growth potential
SGA and IUGR should not be used interchangeably.
Condition that indicates there has been a complication of pregnancy.
The root cause of IUGR may be
The root cause of IUGR may be maternal, placental, or fetal in origin and should be evaluated.
Small for Gestational Age
a fetus measuring under the 10th percentile for weight
Amniotic Fluid Volume Disorders
POLYHYDRAMNIOS:
OLIGOHYDRAMNIOS:
POLYHYDRAMNIOS:
Polyhydramnios is excessive amniotic fluid.
Causes of Polyhydramnios
Cause may be unknown or related to diabetes (8 to 10%) or twin-to-twin transfusion.
What is Polyhydramnios associated with?
Associated with poor outcome for fetus and patient including preterm labor, birth defects, postpartum hemorrhage, and placental abruption.
How is Polyhydramnios diagnosed?
Polyhydramnios is diagnosed by ultrasound assessment of the four largest pockets of amniotic fluid. The amount of fluid in the four pockets are added together to obtain an amniotic fluid index (AFI). Values equal to or greater than 24 cm are abnormal.
Treatment for Polyhydramnios includes?
Treatment includes amnioreduction, administration of indomethacin (prior to 31 weeks) to stabilize amniotic fluid, and induction of labor.
OLIGOHYDRAMNIOS:
Is decreased amniotic fluid that may be caused by fetal anomalies or premature rupture of membranes
What is Oligohydramnios associated with
Oligohydramnios is associated with poor prognosis.
How is Oligohydramnios diagnosed?
Diagnosed with ultrasound findings of AFI equal to or less than 5 cm and the largest vertical pocket equal to or less than 2 cm fluid.
Treatment for oligohydraminos may include
Treatment may include amnioinfusion of ringer lactate into the amniotic sac
Dermatoses (skin disorders) of Late Pregnancy
Intrahepatic cholestasis:
Pruritic urticarial papules and plaques of pregnancy:
Slide 92 - must review
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