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Maternity > Exam 2 - Ch. 20 > Flashcards

Exam 2 - Ch. 20 Flashcards

1
Q

**Parameters of a Non-stress test

A

Monitor FHR for 20 minutes
Results:
Reactive = normal FHR, 2 accelerations of 15 bpm lasting 15 seconds
Non-reactive = absence of 2 accelerations of 15 bpm lasting 15 seconds in 20 minutes (more testing indicated)
***

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2
Q

Parameters of contraction stress test

A

Monitor FHR reaction to contractions (at least 3 in 10 min)
Positive (ABNORMAL) = FHR shows late decelerations w/ 50% or more of contractions
Negative = no late or significant variable decelerations
Equivocal-suspicious: intermittent late decels or significant variable decels

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3
Q

T/F: a contraction stress test is interpreted by presence/absence of late decelerations

A

True

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4
Q

**What are the components of a biophysical profile?

A

Non-stress Test (NST)
By ultrasound:
Fetal breathing
Fetal activity
Fetal muscle tone
Amniotic fluid volume (AFI)

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5
Q

**When is a BPP (biophysical profile) performed?

A

With a non-reactive non-stress test or with a high risk pregnancy.

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6
Q

What is the thin, tough sac of membrane that covers the embryo?

A

Amnion

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7
Q

What is the protective, filled with amniotic fluid, inner membrane that encircles the embryo?

A

Amnion

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8
Q

What is the outer membrane that surrounds the amnion?

A

The chorion

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9
Q

What serves as the support platform for fetus and amnion?

A

The chorion

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10
Q

What provides nutrient exchange from mother to fetus and is the foundation for embryonic development?

A

The chorion

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11
Q

What has the chorionic villi – barrier between maternal & fetal blood?

A

Chorion

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12
Q

The chorion is the barrier between the maternal and fetal what?

A

Blood

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13
Q

In multiple pregnancies, what type of presentation has less risk of cord entanglement?

A

If each fetus has own amniotic sac.

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14
Q

If each fetus in a multiple pregnancy does not have its own amniotic sac, what can happen that puts the fetuses at risk?

A

Cord entanglement

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15
Q

What is it called in a multiple birth when one fetus steals nutrition from the other when there is one placenta?

A

Twin-to-twin transfusion

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16
Q

There is one placenta in twin-to-twin transfusion and each fetus has it’s own what?

A

Amniotic sac

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17
Q

What chorion/amnion condition puts multiple fetuses at risk for twin-to-twin entanglement?

A

Monochorionic/monoamnionic

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18
Q

**What is a Multizygotic pregnancy?

A

2 or more eggs are fertilized at the same time

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19
Q

**What is a dizygotic pregnancy?

A

2 separate eggs fertilized = fraternal twins (2 genetically unique children)
70% of multiple pregnancies

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20
Q

**What is a zygote?

A

Fertilized ovum

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21
Q

**Risk factors for having a multizygotic pregnancy…

A
  • Artificial reproductive technology (ART)
  • Ethnicity (particularly African descent)
  • Family history
  • Advanced maternal age (↑FSH can cause release of >1 egg as menopause approaches)
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22
Q

Why does the chance of twins increase with maternal age?

A

↑FSH can cause release of >1 egg as menopause approaches

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23
Q

**All fetuses came from the same ovum in what type of multiple births?

A

Monozygotic

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24
Q

**Identical twins are from what type of multiple pregnancy?

A

Monozygotic

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25
Q

What determines # of amnions, chorions, placentas in a multiple pregnancy?

A

Time of ovum split

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26
Q

**T/F: A monozygotic split is a random / spontaneous event.

A

True

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27
Q

**What type of multiple pregnancy is not associated with a genetically inherited trait or ethnic group?

A

Monozygotic split

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28
Q

Typical discomforts of pregnancy are reduced or amplified in multiple pregnancies?

A

Amplified

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29
Q

Risks in multiple pregnancies:

A

gestational diabetes
hypertensive d/o, including preeclampsia
pulmonary embolism
preterm birth (50%)
perinatal mortality (3x more for twins, 4x more for triplets)
placenta previa
fetal anomalies
cord entanglement
twin-to-twin transfusion syndrome (50% higher mortality rate)

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30
Q

Hyperemesis gravidarum (HG) is characterized by what?

A

Unusually acute nausea and vomiting.

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31
Q

Unusually acute nausea and vomiting is called what?

A

Hyperemesis gravidarum (HG)

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32
Q

In what weeks of pregnancy is hyperemesis gravidarum usually present?

A

From weeks 11-20

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33
Q

In what condition are the following risks associated?

Weight loss
Malnutrition
Dehydration
Ketonuria
Electrolyte imbalances

A

Hyperemesis gravidarum

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34
Q

Treatments for hyperemesis gravidarum…

A

Rest
Possible anti-emetics (*see O’Meara Pharmacy table 20.1)
IV fluids
Parenteral nutrition

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35
Q

What is promethazine (Zofran) used for in pregnancy?

A

Relieving nausea/vomiting in hyperemesis gravidarum

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36
Q

What is Metroproclamide (Reglan) used for?

A

Relieving nausea/vomiting in hyperemesis gravidarum

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37
Q

What is ondansetron (Zofran) used for?

A

Relieving nausea/vomiting in hyperemesis gravidarum

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38
Q

What type of medication is the drug of last resort with hyperemesis gravidarum?

A

Corticosteroids

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39
Q

Risk factors for hyperemesis gravidarum.

A

History of HG
Gestational trophoblastic disease
Multiple pregnancies
Hyperthyroidism
GI disease prior to pregnancy
Depression/anxiety
Female fetus

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40
Q

What condition are the following symptoms indicative of?

History of the condition
Gestational trophoblastic disease
Multiple pregnancies
Hyperthyroidism
GI disease prior to pregnancy
Depression/anxiety
Female fetus

A

Hyperemesis gravidarum

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41
Q

A patient who is 13 weeks pregnant has experienced excessive vomiting for two weeks. Which of the following indicate dehydration?

Decreased heart rate
Decreased BP
Pedal edema
Poor skin turgor

A

Poor skin turgor

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42
Q

A miscarriage (AKA spontaneous abortion) occurs before what stage of gestation?

A

Before 20 weeks gestation

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43
Q

**A miscarriage, ectopic pregnancy, or gestational trophoblastic disease may present how?

A

Vaginal bleeding

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44
Q

When does implantation bleeding usually occur?

A

Usually around 6-11 days after fertilization, bright red or dark brown, lasting ~1 day

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45
Q

What type of gestational bleeding should be carefully evaluated?

A

All bleeding should be carefully evaluated.

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46
Q

At what point in gestation does miscarriage usually occur?

A

About 5-8 weeks

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47
Q

What is the likely cause of miscarriage?

A

Chromosomal abnormalities

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48
Q

What condition are the following risk factors for?

Advanced parental age
Drug/alcohol use
Poor maternal nutrition
Use of teratogenic meds
Certain maternal health conditions

A

Miscarriage

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49
Q

Nursing assessments for miscarriage

A

When was last period?
Vaginal bleeding assess color, clotting, contents, tissue?
Cramping?
HCG doesn’t double every 2-3 days (72 hours) for 8-11 weeks.

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50
Q

Nursing interventions for miscarriage

A

Emotional support
Risk of infection

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51
Q

Report all episodes of the following in miscarriage to indicate what?
Heavy bleeding
Fever
Foul-smelling discharge
Abdominal tenderness

A

Infection

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52
Q

**What is it called when a pregnancy develops outside the uterus, often in a fallopian tube?

A

Ectopic Pregnancy

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53
Q

**T/F: Ectopic pregnancies are considered non-life-threatening and a “watch and see” position is indicated.

A

False. Ectopic pregnancies are life-threatening and must be ended urgently

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54
Q

**What condition are the following indicative of?

Severe pelvic pain that may be unilateral (may refer to one shoulder)
Bleeding
Slow rise of Beta hCG levels

A

Ectopic pregnancy

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55
Q

**Can ectopic pregnancies be asymptomatic?

A

Yes.

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56
Q

At what point in pregnancy should the heart beat be seen on ultrasound?

A

6 weeks

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57
Q

**Do IUD’s contribute to ectopic pregnancies?

A

Yes.

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58
Q

**Ectopic pregnancy locations are:

A

Ovary
Fallopian tube
Intestine
Cervix

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59
Q

**An ectopic pregnancy in the cervix is likely caused by what?

A

Multiple pregnancies

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60
Q

**What are the risk factors for an ectopic pregnancy?

A

History of the condition
Pelvic infection
Pelvic surgery
Advanced maternal age (AMA)
Cigarette smoking
IUD (intrauterine device)
STI – gonorrhea and/or chlamydia

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61
Q

**What condition are the following indicative of?
History of the condition
Pelvic infection
Pelvic surgery
Advanced maternal age (AMA)
Cigarette smoking
IUD (intrauterine device)
STI – gonorrhea and/or chlamydia

A

Ectopic pregnancy

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62
Q

What drug ends pregnancy by inhibiting cell reproduction and DNA synthesis?

A

Methotrexate

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63
Q

**What is the drug of choice for an ectopic pregnancy?

A

Methotrexate

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64
Q

**Is surgery an option for removal of the ovum in an ectopic pregnancy?

A

Yes.

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65
Q

**How can the STI’s gonorrhea and chlamydia cause ectopic pregnancies?

A

Scarring

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66
Q

**What is the name of the procedure for removal of a fallopian tube?

A

Salpingectomy

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67
Q

**Is Rhogam administered to a woman with an ectopic pregnancy?

A

Yes, if she is RH-

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68
Q

**What to watch for in an ectopic pregnancy.

A

Heavy bleeding
Dizziness
Tachycardia

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69
Q

**What is the condition called when a nonviable mass is reproducing in the uterus?

A

Gestational trophoblastic disease (GTD)

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70
Q

**What’s another name for gestational trophoblastic disease?

A

Molar pregnancy

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71
Q

Failure of a fertilized egg to develop properly can be due to what 2 factors?

A

Fertilization of egg with no genetic material
2 sperm simultaneously fertilize 1 egg with normal genetic material

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72
Q

**Can trophoblastic tissue grow beyond the uterus?

A

Yes

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73
Q

**If trophoblastic tissue growing beyond the uterus is cancerous, what condition must be met before getting pregnant again?

A

All the cancer must be gone.

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74
Q

**How should cancerous trophoblastic tissue that is growing outside the womb be monitored after removal?

A

By HCG levels. In pregnancy, should double every 2-3 days (72 hours) for 8-11 weeks. If tissue is removed, should return to normal.

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75
Q

**What condition are the following assessments indicative of?

Abnormally rapid growth
Abnormally ↑ beta hCG
Ultrasound – “snowstorm” (no expected fetal structures)
Often experience vaginal bleeding

A

Molar pregnancy (gestational trophoblastic disease.

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76
Q

**What is the treatment for GTD?

A

D&C (dilation and curettage) to remove products of conception if not passed spontaneously.

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77
Q

**For how many months after a D&C to remove a GTD, should a woman avoid getting pregnant?

A

6-12 months

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78
Q

**What condition are the following signs indicative of?

Brownish vaginal bleeding
Uterine size large for gestational age
Nausea

A

GTD/Molar pregnancy

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79
Q

**Treatments for GTD/Molar pregnancy

A

D&C
Rhogam for Rh- woman
Emotional support

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80
Q

**Why should a woman who has had a D&C to remove a GTD watch for the following signs?

Heavy bleeding
Foul-smelling vaginal discharge
Abdominal pain and tenderness
Fever

A

Infection

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81
Q

**Conditions during the 1st trimester

A

Gestational trophoblastic disease (molar pregnancy)
Ectopic pregnancy
Miscarriage
Hyperemesis Gravidarum

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82
Q

Conditions of 2nd trimester in pregnancy:
Gestational Hypertension
Preeclampsia
Eclampsia
Gestational Diabetes Mellitus
TORCH infections
UTI
Cervical insufficiency
IUGR
Polyhydramnios
Oligohydramnios

A
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83
Q

**How is gestational hypertension diagnosed?

A

Systolic blood pressure ≥140 mm Hg &/or diastolic blood pressure ≥90 mm Hg without protein in the urine or signs of end-organ dysfunction after 20 weeks of pregnancy

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84
Q

**Up to half of the women diagnosed with gestational hypertension go on to develop what condition?

A

Preeclampsia

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85
Q

**What are the complications of gestational hypertension?

A

preterm birth
small for gestational age (SGA) infants
placental abruption

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86
Q

**How is preeclampsia diagnosed?

A

Patient with hypertension (≥ 140/90 mm Hg) on two occasions at least 4 hours apart AND has proteinuria
A BP of ≥ 160 systolic &/or ≥ 110 diastolic does not require a 4-hr wait between readings
OR
Patient has hypertension with or without proteinuria AND:
a platelet count <100,000
serum creatine >1.1 mg/dL
elevated liver enzymes
pulmonary edema –or-
new-onset visual or cerebral symptoms

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87
Q

**What is the following an indication of?

Patient with hypertension (≥ 140/90 mm Hg) on two occasions at least 4 hours apart AND has proteinuria***

A

Preeclampsia

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88
Q

**What condition are the following indicative of?

Patient has hypertension with or without proteinuria AND:
a platelet count <100,000 (thrombocytopenia)
serum creatine level >1.1 mg/dL (progressive renal insufficiency)
elevated liver enzymes (doubled)
pulmonary edema –or-
new-onset visual or cerebral symptoms

A

Preeclampsia

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89
Q

**What is the proteinuria level on a preeclampsia woman?

A

Proteinuria of at least +1

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90
Q

**At what time in gestation does a pregnant woman develop preeclampsia?

A

After 20 weeks

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91
Q

**Preeclampsia with tonic-clonic seizures is called what?

A

Eclampsia

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92
Q

**What causes preeclampsia?

A

Not well understood but may be:
- abnormal attachment of placenta
- abnormal pregestational maternal inflammation or epithelial cell functioning

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93
Q

**Risks from poor circulation (vasoconstriction) caused by preeclampsia are:

A

Oligohydramnios
Placental abruption
IUGR

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94
Q

**What is the treatment for patients at high risk of preeclampsia?

A

Aspirin and calcium supplements

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95
Q

**What is the treatment for mild preeclampsia and gestational hypertension?

A

Maybe be monitored on an outpatient basis

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96
Q

**What is the treatment for severe preeclampsia?

A

May have to be induced

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97
Q

**What medication is often given to patients with severe preeclampsia?

A

Magnesium sulfate is often given by IV to prevent seizures (reduces CNS irritability; can lower seizure threshold by ~50%) *AND given for neuroprotection for the fetal brain (decreased cerebral palsy)

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98
Q

**What type of protection does Mg Sulfate offer to the fetus?

A

Neuroprotection for the fetal brain (decreased cerebral palsy)

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99
Q

**How is Mg Sulfate administered?

A

IV

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100
Q

**What does Mg Sulfate do?

A

Prevents seizures

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101
Q

**How does Mg Sulfate prevent seizures in woman with preeclampsia?

A

Reduces CNS irritability; can lower seizure threshold by ~50%

102
Q

**What are the home management recommendations for preeclampsia?

A

Bedrest - lying on side
Blood pressure monitoring
Monitoring weight gain
Edema from plasma leakage into maternal tissues
Monitor symptoms
Monitor fetal activity
Late decelerations may indicate a deterioration of fetal reserve
Normal diet – no restrictions, increase protein intake

103
Q

**Why are tocolytics possibly administered during preeclampsia?

A

Act as a contraction buster.

104
Q

**What is the antidote for Mg Sulfate?

A

Calcium gluconate

105
Q

**Assessment for preeclampsia

A

BP
Deep Tendon Reflexes
Epigastric pain (RUQ)
Headache
Visual disturbances
Oliguria (↓ urine output)
Peripheral edema

106
Q

**What lab tests are drawn to check for preeclampsia?

A

24-hour urine test
CBC w/ platelets
liver enzymes
serum creatinine

107
Q

**Fetal assessment on patient with suspected preeclampsia

A
  • Non-stress test
  • BPP
  • Ultrasound to monitor placental degradation
  • Doppler flow studies to measure umbilical blood flow
  • Determination of fetal lung maturity for delivery
108
Q

**How will the DTR reflexes present in a woman with preeclampsia?

A

CNS is heightened so hyperreflexia is closer to seizing.
Hyporeflexia means too much Mg Sulfate.

109
Q

**How can the persistent headache in preeclampsia be treated?

110
Q

**How will the edema in preeclampsia be different than the normal edema in pregnancy?

A

The woman’s face with be swollen

111
Q

**What causes the epigastric pain in preeclampsia?

A

Hepatic portal hypertension

112
Q

**What causes the oliguria in preeclampsia?

A

Renal damage

113
Q

**What causes the decreased platelets in preeclampsia?

A

Thrombocytopenia

114
Q

**How is the urine tested in preeclampsia?

A
  • Urine stick test for protein
  • 24-hour urine collection for how much protein
115
Q

**In hospital management of preeclampsia…

A

Magnesium Sulfate
Antihypertensive meds in severe preeclampsia (labetalol, hydralazine, methyldopa, nifedipine)
Blood pressure monitoring
Minimize stimulation
Low lights, noise, activity to decrease probability of seizures
NST & BPP
Laboratory monitoring
Prevention of injury from seizures
Corticosteroids (Betamethasone) IM for fetal lung maturity (23-34 wks GA)
Delivery

116
Q

**What is the treatment used for preeclampsia in the hospital?

A

IV Mg sulfate

117
Q

**Antihypertensive meds used in severe preeclampsia

A

Labetalol, hydralazine, methyldopa, nifedipine

118
Q

**How is the probablity of seizures reduced in preeclampsia patients?

A

Minimize stimulation
Low lights, noise, activity

119
Q

**How is the fetus treated/monitored in preeclampsia?

A

NST, BPP
Corticosteroids IM for fetal lung maturity (23-34 wks GA)
Prepare for delivery

120
Q

**What labs are monitored in preeclampsia?

A

24-hour urine test
CBC w/ platelets
liver enzymes
serum creatinine

121
Q

**What is the corticosteroid administered to a pregnant mother to develop the lungs of the fetus?

A

Betamethasone given 2 x 12 hours apart

122
Q

**Which of the following assessment findings indicate a worsening in a 33-week pregnant client with preeclampsia?

Pedal edema
+1 reflexes
Spots before eyes
Right arm pain

A

Spots before eyes

123
Q

How are reflexes graded?

A

4 = Very brisk, with clonus
3 = Brisker than average; possibly but not necessarily indicative of disease (hyperactive)
2 = Average; normal
1 = Somewhat diminished, or requires reinforcement (hypoactive)
0 = Reflex absent

124
Q

**T/F: Mg Sulfate is administered IV as secondary infusion.

125
Q

**What dose of Mg Sulfate is administered?

A

Magnesium sulfate slow IV push in 4-6 g bolus + maintenance dose to maintain a serum Mg level of 4 to 7 mEq/L

126
Q

**What is the level of Mg Sulfate that should be monitored in the blood?

127
Q

**Signs of magnesium toxicity include:

A

Respiratory depression
Maternal bradycardia
Oliguria
Absent deep tendon reflexes
Lethargy
Slurred speech
Loss of consciousness
Muscle weakness

128
Q

**Interventions to address Mg Sulfate toxicity include:

A

Stop the infusion immediately.
Administer calcium gluconate as ordered (typically slow IV push over 3 minutes).

129
Q

**Treatments for Eclampsia

A

Magnesium sulfate slow IV push in 4-6 g bolus + maintenance dose
Oxygen Therapy
Maintain a safe environment
Hypertensive medications

130
Q

**The following are treatments for what condition?

Magnesium sulfate slow IV push in 4-6 g bolus + maintenance dose
Oxygen Therapy
Maintain a safe environment
Hypertensive medications

131
Q

Antihypertensives are either given or typically not given to women with gestational hypertension or mild preeclampsia?

A

Typically not given.

132
Q

Treatment of hypertension in pregnancy is provided for what level of high bp?

A

Severely hypertensive patients (BP 160/110 or greater)

133
Q

What meds are used to control hypertension when indicated in pregnancy?

A

IV hydralazine or Labetolol

134
Q

Correct blood pressure only to what level with anti-hypertensives with women with chronic hypertension throughout pregnancy?

135
Q

Gestational diabetes mellitus is associated with what condition and results in what?

A

Associated with insulin resistance and results in high blood glucose levels.

136
Q

Gestational diabetes is similar to what non-pregnancy condition?

A

Similar to Type 2 DM

137
Q

What risks are associated with gestational diabetes?

A

Preeclampsia
Fetal macrosomia
Polyhydramnios
Fetal organomegaly
Operative delivery (c-section or surgical vaginal delivery)
Maternal birth trauma
Neonatal respiratory problems
Neonatal metabolic problems (hypoglycemia, hypocalcemia, jaundice)
Mortality

138
Q

The following list are risk factors for what condition?

Preeclampsia
Fetal macrosomia
Polyhydramnios
Fetal organomegaly
Operative delivery (c-section or surgical vaginal delivery)
Maternal birth trauma
Neonatal respiratory problems
Neonatal metabolic problems (hypoglycemia, hypocalcemia, jaundice)
Mortality

A

Gestational Diabetes

139
Q

Routine screening for gestational diabetes is completed for all patients at what point in pregnancy?

A

24 to 28 weeks
Women at high risk may be screened at their first prenatal visit for preexisting diabetes

140
Q

**How does a non-fasting oral glucose test work?

A

Patient not fasting
Drinks 50 g glucose
Wait 1 hour
Do glucose test
If >130, complete fasting glucose test.

141
Q

**What is the non-fasting blood glucose level that indicates further testing in a pregnant woman?

142
Q

How is a fasting glucose test performed on a pregnant woman?

A

Overnight fast
Drinks solution with 100g glucose
Glucose checked at 1, 2 and 3 hour intervals

143
Q

What are the levels of a fasting glucose test to diagnose gestational diabetes?

A

If two or more are elevated:
Fasting ≥ 95
1 hour ≥ 180
2 hours ≥ 155
3 hours ≥ 140

144
Q

**Risks to mother from gestational diabetes?

A

Oligohydramnios (too little amniotic fluid)
Infection
Ketoacidosis
Spontaneous Abortion
Preeclampsia

145
Q

**Risks to the fetus during gestational diabetes

A
  • Stillbirth
  • Congenital Anomalies
  • Macrosomia
  • Intrauterine Growth - Restriction (IUGR)
  • Respiratory Distress Syndrome (RDS)
  • Fetal Hyperinsulinism
146
Q

Put these in order of priorities for treating gestational diabetes:

Insulin
Diet/Exercise
Oral meds

A

Least invasive first:
Diet/Exercise
Oral meds
Insulin

147
Q

Oral meds used to treat gestational diabetes

A

Glyburide
Metformin

148
Q

How does glyburide treat gestational diabetes?

A

Stimulates pancreas to release more insulin

149
Q

What are the contraindications to glyburide use?

A
  • Patients w/ sulfa allergy or kidney failure
  • Can cause hypoglycemia
  • Teach pt about s/s
  • Encourage them to carry a source of fast sugar
150
Q

Patient education when using glyburide

A
  • Can cause hypoglycemia
  • Teach pt about s/s
  • Encourage them to carry a source of fast sugar
151
Q

How does Metformin treat gestational diabetes?

A

Increases sensitivity of cells to insulin & decreases release of glucose from liver

152
Q

What is a consequence of using Metformin?

A

Often require supplemental insulin

153
Q

What risks are posed to the baby of a mother on Metformin?

A

Lower birth weight

154
Q

T/F: There is currently no consensus regarding fetal monitoring for women with well-controlled gestational diabetes

155
Q

What must a provider do with woman who require medications (metformin, glyburide, or insulin)?

A

Monitored more closely.

156
Q

How often should a pregnant woman with gestational diabetes check her blood sugar daily?

A

4-6 times/day

157
Q

What does postprandial mean?

A

After meals

158
Q

What should glucose levels be in a pregnant woman with controlled gestational diabetes?

A

Fasting blood glucose should remain <95 mg/dL.
1-hour postprandial levels should be <140 mg/dL.
2-hour postprandial levels should be <120 mg/dL.

159
Q

With a pregnant woman with gestational diabetes, what is the preferred delivery method?

A

Spontaneous vaginal birth is the preferred method of delivery; c-section may be necessary

160
Q

Does GDM normally resolve after delivery of the placenta?

161
Q

A woman who experienced GDM is at greater risk for developing what in the future?

A
  • GDM w/ future pregnancies
  • Type 2 DM later in life
162
Q

**Patient teaching for woman with gestational diabetes

A
  • Follow weight gain recommendations according to BMI
  • Carefully monitor carbohydrate intake – 30-40% of diet from complex carbs
  • Eliminate simple sugars
  • Avoid spikes & dips in blood glucose levels:
  • Eat 3 meals & 2-3 snacks each day
  • Eat a snack with carbohydrates before bedtime
  • Don’t go more than 10 hours without eating
  • Keep a food log that includes finger stick glucose test results
  • Exercise regularly (at least 3x/wk)
163
Q

What infections may cause preterm labor, preterm rupture of membranes (PROM), or postpartum endometritis?

A

Chlamydia and Gonorrhea

164
Q

What infection may also cause IUGR, postpartum sepsis & chorioamnionitis (infection of membranes surrounding fetus)

165
Q

With what infection might infants be born with conjunctivitis, arthritis, pharyngitis?

166
Q

How are Chlamydia and Gonorrhea treated during pregnancy?

A

Treated with antibiotics followed by retesting 3 months later
Partner must also be tested.

167
Q

**T/F: Pregnancy is contraindicated for HIV+ women

A

False. Woman with HIV+ may get pregnant.

168
Q

**Chance of transmission of HIV to fetus during pregnancy is high or low?

169
Q

**What type of delivery do woman who are HIV+ have and why?

A

Women with HIV are often delivered by cesarean to reduce risk of transmission to fetus

170
Q

**Is a newborn who is born to an HIV+ mother treated after birth and with what?

A

With antiretroviral meds for 4-6 wks

171
Q

**T/F: Breastfeeding from an HIV+ mother is contraindicated in US.

A

True. It increases risk of transmission.

172
Q

**90% of newborns who contract Hep B from mother will develop what?

A

Chronic liver disease

173
Q

**Newborns of Hep B + women should be given what vaccines and when?

A

Hepatitis B vaccine and the Hepatitis B immune globulin within 12 hours of birth.

174
Q

What are TORCH infections?

A

Group of infections commonly implicated in congenital anomalies

175
Q

**What are the TORCH infections?

A

T = Toxoplasmosis
O = Other (syphilis, varicella, mumps, etc.)
R = Rubella
C = Cytomegalovirus (CMV)
H = Herpes (genital: HSV-1 & HSV-2)

176
Q

**Toxoplasmosis is transmitted how?

A

Transmitted through exposure to litter of infected cat, gardening w/out gloves, eating raw/rare meat

177
Q

***When is the greatest risk to the fetus from toxoplasmosis?

A

Greatest risk to fetus during 1st trimester

178
Q

**What birth defects occur in a fetus exposed to toxoplasmosis?

A

Damage to CNS, skin, ears; hydrocephalus, IUGR

179
Q

**Rubella vaccination contraindicated or recommended in pregnancy?

A

Contraindicated

180
Q

**Maternal symptoms of what disease include: rash, fever, flu-like symptoms
Fetal anomalies: CNS, cardiac, ocular, endocrine problems.

181
Q

**What virus is the most common cause of congenital, nonhereditary hearing loss and can also cause vision impairment & cerebral palsy?

A

Cytomegalovirus

182
Q

**How prevalent is CMV?

A

60% of women infected w/ CMV by age 44 –

183
Q

**How is cytomegalovirus transmitted?

A

Transmitted through blood, saliva, urine, semen, breastmilk.

184
Q

**T/F: Herpes Simplex Virus (HSV) can be transmitted to the fetus?

185
Q

**What affect can Herpes have on the fetus?

A

Can cause severe infection and death

186
Q

**What type of birth is indicated with a woman with herpes?

A

Vaginal birth contraindicated if active lesions present

187
Q

**Women with herpes are typically prescribed what and when?

A

Antiviral medication (acyclovir) the month before pregnancy due date and are delivered by cesarean if lesions are present.

188
Q

**When will a fetus be delivered cesarian to a woman with herpes?

A

If lesions are present at delivery

189
Q

**Are UTIs treated during pregnancy?

A

Urinary tract infections are often asymptomatic and should be treated with antibiotics during pregnancy

190
Q

The following are S/S of what condition?

Frequent urination, sensation of incomplete emptying, pain w/ urination, lower abdominal or pelvic pain

191
Q

What is pyelonephritis?

A

Kidney infection & inflammation

192
Q

Pyelonephritis presents like what other condition?

193
Q

How do cystitis and pyelonephritis present?

A

Fever, chills, N&V, lower back pain

194
Q

Why are cystitis and pyelonephritis a threat to the fetus?

A

Associated w/ preterm birth

195
Q

What conditions can manifest from pyelonephritis?

A

Sepsis, kidney failure, respiratory failure.

196
Q

**What is the treatment for UTIs in pregnant women?

A

Antibiotics – oral or IV depending on infection & severity

197
Q

**What is cervical insufficiency?

A

Painless, premature dilation of the cervix in the second trimester of pregnancy

198
Q

**What can be caused by congenital or acquired cervical/uterine defects ?

A

Cervical insufficiency

199
Q

**What is the risk of cervical insufficiency?

A

Miscarriage or premature birth

200
Q

**How is cervical insufficiency diagnosed?

A

History of second-trimester pregnancy losses and/or measurement of cervical length by ultrasound

201
Q

**What hormone is used to treat cervical insufficiency?

A

Progesterone IM or vaginally from ~16-20 weeks through 36 wks

202
Q

**What is cerclage?

A

Cervix stitched closed – reinforces cervix, helps prevent premature dilation, help protect fetal membranes

203
Q

**What are the two types of cerclage?

A

Transvaginal (removed at 36 wks) or transabdominal placement (indication for c-section)

204
Q

Conditions in 3rd trimester

A

Trauma
Oligohydramnios
Polyhydramnios

205
Q

Care considerations for trauma:

A
  • Place a wedge under the woman’s hip to minimize supine hypotension
  • Chest compressions may be more challenging and ineffective in a pregnant woman
  • Oxygen consumption is increased - women should be monitored closely for hypoxia
    Abdominal trauma may result in placental abruption
    Trauma may be an indication for the administration of Rho (D) immune globulin to an Rh-negative woman
    The nurse should carefully assess the woman (ABCs, VB, ctx, abd pain) and the fetus (FHR, u/s) for complications related to trauma.
    In event of unsuccessful CPR of pregnant woman, goal is to have delivery by cesarean within 5 minutes
206
Q

With a pregnant woman who has had trauma, why put a pillow under a hip?

A

Place a wedge under the woman’s hip to minimize supine hypotension

207
Q

What is the challenge for resuscitating a pregnant woman with trauma?

A

Chest compressions may be more challenging and ineffective in a pregnant woman

208
Q

What Rh considerations should be addressed with a pregnant woman who has had trauma?

A

Trauma may be an indication for the administration of Rho (D) immune globulin to an Rh-negative woman.

209
Q

What respiratory considerations should be addressed with a pregnant woman with trauma?

A

Oxygen consumption is increased - women should be monitored closely for hypoxia/

210
Q

What changes to the placenta might be seen in a pregnant woman with truma?

A

Abdominal trauma may result in placental abruption.

211
Q

In event of unsuccessful CPR of pregnant woman, goal is to have delivery by when?

A

By cesarean within 5 minutes

212
Q

While no IUGR is desired, which type is desired?

A

Asymmetric

213
Q

What is asymmetric IUGR?

A
  • 70% of cases
  • Growth restriction happens mostly or entirely in 3rd trimester
  • Normal growth of fetal head, slower growth of fetal body
214
Q

Root cause of IUGR

A

The root cause of IUGR may be maternal, placental, or fetal in origin and should be evaluated.

215
Q

Is IUGR a cause of stillbirths?

A

Yes, IUGR is diagnosed in 20% of stillbirths.

216
Q

What is symmetric IUGR?

A

Both head and body grow at slower rate
AKA global growth restriction

217
Q

What problems are associated with symmetric IUGR?

A

Associated with significant neurologic problems in neonate

218
Q

When are most symmetric IUGR seen?

A

Often seen in 2nd trimester.

219
Q

Causes of asymmetric intrauterine growth restriction

A

Uteroplacental insufficiency
Maternal hypertensive disorder
Severe maternal malnutrition
Maternal genetic disorder
Abnormal placentation
Multiple gestation

220
Q

Causes of symmetric IUGR

A

Torch infection
Maternal substance abuse
Maternal anemia
Chromosomal abnormality of fetus
Smoking
Teratogenic meds

221
Q

**Short term risks for infants born with IUGR

A

Respiratory distress after birth
Hypoglycemia
Problems with thermoregulation
Necrotizing enterocolitis (NEC)
Retinopathy of prematurity
Polycythemia → incr. risk for elevated bilirubin → jaundice

222
Q

The following are risks to the newborn from what condition?

Respiratory distress after birth
Hypoglycemia
Problems with thermoregulation
Necrotizing enterocolitis (NEC)
Retinopathy of prematurity
Polycythemia → incr. risk for elevated bilirubin → jaundice

223
Q

Long term (chronic) risks for infants born with IUGR

A

HTN
Type 2 DM
High cholesterol
Cardiovascular disease
PCOS
Motor &/or cognitive delays

224
Q

Amniotic Fluid Volume Disorders

A

Polyhydramnios
Oligohydramnios

225
Q

Polyhydramnios is what?

A

Excessive amniotic fluid

226
Q

Amniotic fluid starts forming when?

A

Amniotic fluid starts to form at ~12 days post-conception

227
Q

What purpose does amniotic fluid serve?

A

Serves as a protective buffer for the fetus and allows for fetal movement.

228
Q

What causes polyhydramnios?

A

Mismatch between production & absorption of amniotic fluid, generally between fetal swallowing & elimination

229
Q

40% of polyhydramnios cases are caused by what?

A

Are idiopathic

230
Q

Most common causes of polyhydramnios

A

Congenital anomalies of fetal gut, heart, neural tube
Diabetes

231
Q

With twins, what is a cause of polyhydramnios?

A

Suspected cause: twin-to-twin transfusion

232
Q

Polyhydramnios is associated with what maternal outcomes?

A

Preterm birth, cord prolapse, postpartum hemorrhage, placental abruption, perinatal death

233
Q

Fetal risks from polyhydramnios

A

Birth defects, meconium-stained fluid, poor labor tolerance, low Apgar scores, increased NICU admissions

234
Q

How is polyhydramnios diagnosed?

A

Polyhydramnios is diagnosed by ultrasound assessment of the four largest pockets of amniotic fluid to obtain an amniotic fluid index (AFI).

235
Q

What is a normal level of amniotic fluid?

A

An AFI of 20 to 25 cm is abnormal

236
Q

How is polyhydramnios monitored?

A

BPPs and NSTs weekly or biweekly

237
Q

Polyhydramnios treatment

A

Amnioreduction
Administration of indomethacin (prior to 34 weeks) to stabilize amniotic fluid
Corticosteroids & fetal lung maturity assessment
Induction of labor, ideally after 34 wks

238
Q

What does indomethacin do and what condition is it used to treat?

A

NSAID, used to stabilize amniotic fluid in polyhydramnios

239
Q

What is Oligohydramnios?

A

decreased amniotic fluid

240
Q

Oligohydramnios is associated with poor prognosis including…

A

Usually preterm birth, early induction or c/section related to concerns about fetal wellbeing

241
Q

How it oligohydramnios diagnosed?

A

Diagnosed with ultrasound findings of decreased AFI of ≤ 5 cm

242
Q

What level of amniotic fluid is considered to be oligohydramnios?

A

AFI of ≤ 5 cm

243
Q

What is the treatment for oligohydramnios?

A

Treatment may include amnioinfusion of Ringer’s lactate into the amniotic sac.

244
Q

What is Intrahepatic cholestasis?

A

Caused by impaired bile flow from liver

245
Q

Symptoms of intrahepatic cholestasis include…

A

Pruritis, clay-colored stools, dark urine, and fatigue

246
Q

Treatment for intrahepatic cholestasis include…

A

Minimizing itching (topical meds), reducing concentration of bile acid (PO ursodeoxycholic acid), and induced delivery at 36 to 37 weeks

247
Q

What is the outcome of intrahepatic cholesasis?

A

Resolves with the end of pregnancy

248
Q

What are pruritic urticarial papules and plaques of pregnancy (PUPPP)?

A

Highly pruritic papules that may be associated with an inflammatory process caused by stretching of the skin

249
Q

Treatment for pruritic urticarial papules and plaques of pregnancy?

A

Treatments include oral topical corticosteroids and an antihistamine

250
Q

What are the outcomes of pruritic urticarial papules and plaques of pregnancy?

A

Resolves within a few weeks of delivery

Maternity (8 decks)

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