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OB > Exam 2- High risk pregnancy > Flashcards

Exam 2- High risk pregnancy Flashcards

1
Q

What is a high risk pregnancy?

A
  • A condition that jeopardizes the health of
    mother, her fetus, or both
  • May result from pregnancy or a condition present
    before pregnancy
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2
Q

High risk pregnancy essential goals

A
  • Early identification is essential to good outcomes
  • Risk assessment begins at the first prenatal visit
    and continues throughout pregnancy
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3
Q

Examples of High-Risk
Pregnancy

A

 Hypertension
 Diabetes
 HIV/AIDS
 Older or younger age
 Substance Abuse
 Preterm
 Multiple gestation
 Obesity
 Hyperemesis gravidarum
 Hemorrhagic complications
 Trauma

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4
Q

Assessment of High-Risk Pregnancy:
Biophysical risk
factors

A

genetic,
nutritional, and medical

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5
Q

Assessment of High-Risk Pregnancy: Psychosocial risks

A

emotional distress,
support,
and relationships

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6
Q

Assessment of High-Risk Pregnancy: Sociodemographic
risks

A

lack of prenatal
care, low income,
and ethnicity

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7
Q

Assessment of High-Risk Pregnancy: Environmental
factors

A

environmental
chemicals, radiation

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8
Q

Antepartum Testing

A

 Fetal movement
 Ultrasound
 Doppler Blood Flow Analysis
 Amniotic Fluid Index (AFI)
 Biophysical Profile (BPP)
 NST

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9
Q

Antepartum Testing: dropper blood flow analysis

A

 Doppler Blood Flow Analysis-provides an indication of
fetal adaptation and reserve (maternal hypertension,
diabetes, IUGR, multiple fetuses)

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10
Q

Antepartum Testing: AFI

A

 Amniotic Fluid Index (AFI)
- making sure the baby has enough amniotic fluid
- safe range: 5-15

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11
Q

Antepartum Testing: BPP

A

 Biophysical Profile (BPP)-AFI, FHR (NST), fetal movement, fetal tone, fetal breathing movements

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12
Q

Antepartum Testing: NST

A

 NST-Two or more fetal heart rate accelerations of 15
beats/min or more with fetal movement in a 20-minute
period is reactive

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13
Q

Bleeding During
Pregnancy

A

 Potentially life-threatening
situation

 Management involves
early recognition,
assessment, and
resuscitation.

 Bleeding is experience in
about 25% of women
during the first trimester **

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14
Q

Antenatal
Hemorrhagic
Disorders: within 1st trimester

A

-Miscarriage
- Ectopic pregnancy
- Molar
- Uterine fibroids

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15
Q

Antenatal
Hemorrhagic
Disorders: within 3rd trimester

A
  • Placenta previa
  • placenta abruption
  • placenta acreta
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16
Q

Antenatal
Hemorrhagic
Disorders: Miscarriage or Spontaneous Abortion (AB)

A

***Pregnancy ending before 20 weeks from natural causes **

 Most common complication of early pregnancy
 < 500 gm, not viable

 80% occur before 12 weeks gestation
 Late miscarriage (second-trimester loss) 12-20 weeks

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17
Q

Antenatal
Hemorrhagic
Disorders: Miscarriage or Spontaneous Abortion (AB) - Risk factors

A

 Risks increase with maternal age.
 At least 50% from chromosomal abnormalities

 Recurrent (generally defined as three or more
consecutive losses)

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18
Q

Types of Spontaneous Abortion

A

 Threatened
 Inevitable
 Incomplete
 Complete
 Missed

1st trimester

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19
Q

Spontaneous Abortion: threatened

A

only spotting + cramping

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20
Q

Spontaneous Abortion: Inevitable

A
  • spotting + cramping
  • SROM
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21
Q

Spontaneous Abortion: Incomplete

A

Mom delivers some of the products of conception

-some of the placenta can be left behind=hemorrhage risk

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22
Q

Spontaneous Abortion: Complete

A

When everything comes out @ once + bleeding stops

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23
Q

Spontaneous Abortion: Missed

A

No heartbeat found

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24
Q

Psychosocial after miscarriage/ spontaneous abortion

A
  • Perinatal loss is complex
  • Grief is unique to each individual person
  • Physical and emotional support
  • Support groups may help
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25
Q

Ectopic Pregnancy

A

1st trimester
 Abnormal pregnancy
 Occurs outside the uterus ***

 Most common site is within one of the fallopian tube

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26
Q

Primary cause of death of pregnancy + cause of maternal morality in first trimester

A

Ectopic pregnancy

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27
Q

Ectopic pregnancy: s/sxs

A

 Bleeding/spotting within 6-8 weeks of missed menstrual period.

 Pain (many are asymptomatic before tubal rupture)

 Positive pregnancy test

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28
Q

Ectopic pregnancy: screening

A

 HCG level
 Transvaginal ultrasound

  • Most result of tubal scarring secondary to pelvic
    inflammatory disease.
29
Q

Ectopic pregnancy: medical therapy (meds)

A

 Methotrexate
- interferes with DNA synthesis, cell multiplication and dissolves the tubal pregnancy

 Best if mass is unruptured and measures less than 4 cm **

 Avoids surgery and is cost-effective

30
Q

Ectopic pregnancy: surgical management

A

 Depends on
- location and extent of tissue involvement
- Future fertility

31
Q

Ectopic pregnancy: follow up care post management / labs

A

 contraceptive for three cycles allow time to heal

 Follow up care is rest and monitor beta-hCG levels

32
Q

Ectopic pregnancy: at risk for?

A

 Increased risk for recurrent ectopic pregnancy

33
Q

Ectopic pregnancy: nursing management

A

 Preparing for treatment
 Education the client
 Emotional and physical support

34
Q

Gestational Trophoblastic Disease Molar Pregnancy (hydatidiform mole)

A

1st trimester
 A rare mass or growth that forms inside the uterus at the beginning of pregnancy

 Results in over productions of the tissue that is supposed to develop into the placenta

 More than 80% are benign (few cases may develop into a choriocarcinoma)

35
Q

Molar Pregnancy: risks d/t dx

A

 Pregnancy too soon –higher risk of having another molar pregnancy

 A few cases may develop into a choriocarcinoma

36
Q

Molar pregnancy: tools for diagnosis

A

 Transvaginal ultrasound and serum hCG levels for
diagnosis

37
Q

Molar pregnancy: nursing mangement

A

 Effective contraception for at least 12 months

 Make sure abnormal tissue does not return

 Suction Curettage

 Measurements of hCG levels for a year.

 Avoid pregnancy for a year.

 Follow up continues for a year.

38
Q

Types of Late Pregnancy Bleeding disorders

A

3rd trimester
 Placenta Previa

 Placenta Abruption (Abruption Placentae)

 Placenta Accreta Spectrum

 DIC -Disseminated Intravascular Coagulopathy

39
Q

Placenta Previa

A

Major complication is hemorrhage and development of
abnormal placental attachment (accrete, increta,
percreta)

3rd trimester

40
Q

Placenta Previa: leads to

A
  • preterm births
  • Birth by cesarean section
41
Q

Placenta Previa: s/sxs

A

 Painless bright red vaginal bleeding

 Uterus with a normal tone (relaxed soft non-tender uterus)

42
Q

Placenta Previa: diagnosis

A
  • Transabdominal ultrasound
43
Q

Placenta Previa: risk factors

A

Evidence suggests on the rise due to increasing c/s rate,
increasing maternal age, & more infertility treatments.

44
Q

Previa Classification

A
  • Low lying:
    placental edge is
    2cm from the
    internal os but
    does not cover it
  • Placental previa:
    placental edge
    covers the
    internal os

**Both require
follow up
ultrasounds

45
Q

Placenta
Previa: mangement

A

Assessment, history, testing, support, education

  • Maintain normal FHTs, no cervical exams*
  • Risk for Hemorrhage
  • Type & Cross
  • IV access
  • CBC
  • RH factor
  • V/s
  • Side lying & pad count if needed
46
Q

Placenta Accreta
Spectrum: patho

A

3rd trimester

Part or entire placenta invades and is inseparable from
the uterine wall.

47
Q

classification of Placenta Accreta
Spectrum

A

 Accreta
 Increta
 Percreta

48
Q

classification of Placenta Accreta
Spectrum: (Accreta)

A

 Accreta- beyond the normal boundary and attaches
too deep in the wall of the uterus but does not
penetrate the uterine muscle

-Most common

49
Q

classification of Placenta Accreta
Spectrum: (Increta)

A

 Increta- Extends into the uterine myometrium.

50
Q

classifications of Placenta Accreta
Spectrum: (Percreta)

A

 Percreta- Extends into the uterine musculature and
can adhere to adjacent tissues and to other pelvic
organs.

-most extensive

51
Q

Placenta Abruption
(Abruption Placentae)

A

3rd trimester

 Premature separation of placenta from lining of the uterus after 20 weeks gestation

 Significant risk for maternal and fetal morbidity and
mortality (can bleed to death)

52
Q

Placenta Abruption
(Abruption Placentae): risk factors

A

 Risk factors: trauma, hypertension, cocaine, smoking,
twin gestation

53
Q

Placenta Abruption
(Abruption Placentae): s/sx

A

 Vaginal bleeding
- Dark red bleeding
- Concealed bleeding (hard abdomen)

 Abdominal pain

 Uterine tenderness
- Extended fundal height

 Contractions
- Fetal distress

54
Q

Placenta Abruption
(Abruption Placentae): classifications

A

 Partial Abruption, concealed hemorrhage
 Partial Abruption apparent hemorrhage
 Complete abruption concealed hemorrhage

 Mild to Severe

55
Q

Placenta Abruption
classifications: how to know if it partial/complete and concealed/apparent

A

 Partial or complete and depending on degree of
separation
 Concealed or apparent by the type of bleeding
 Mild to Severe

56
Q

Previa vs Abruption: onset-type of bleeding

A

Previa
-insidious

vs

Abruption
-sudden

57
Q

Previa vs Abruption: onset- blood description

A

Previa
-always visible

vs

Abruption
-concealed or visible

58
Q

Previa vs Abruption: onset- discomfort

A

Previa
-painless

vs

Abruption
-constant, uterine tenderness

59
Q

Previa vs Abruption: onset: uterine tone

A

Previa
-soft + relaxed

vs

Abruption
-firm to rigid

60
Q

Previa vs Abruption: onset: fetal heart rate

A

Previa
-usually normal

vs

Abruption
-fetal distress

61
Q

DIC -Disseminated Intravascular
Coagulopathy-S/Sx

A
  • Pathologic form of
    clotting ; diffuse and
    consumes large
    amounts of clotting
    factors=causes
    widespread bleeding
  • Most common in
    placental abruption
    and retained dead
    fetus
62
Q

Surgeries During Pregnancy

A
  • Appendicitis
  • Cholelithiasis:
    gallstones in gallbladder
  • Cholecystitis: inflammation of the
    gallbladder
63
Q

Trauma in pregnancies at risk for?

A

due to
-MVA
-Partner violence

 At risk for preterm labor and placental abruption,

64
Q

Trauma in pregnancies Management

A

 Minimum of 4 hours monitoring FHTs and contractions

 Ultrasound
- to check on placenta + baby

 Labs
 Rhogam
- shot given if mom is neg & baby is pos

65
Q

Hyperemesis Gravidarum

A

 a severe form of nausea and vomiting associated with significant cost & psychosocial impact.

  • Uncontrollable nausea and vomiting that begins before 9 weeks

**Usually resolve by 20 weeks.

66
Q

Hyperemesis Gravidarum: s/sx

A
  • dehydration (weight loss, decreased BP, increased pulse rate, + poor skin turgor)
  • nutritional deficiencies
  • ketosis (ketonuria)**
67
Q

Hyperemesis Gravidarum: teaching

A

 Vitamin B6
 Acupressure
 Small frequent amounts -avoid skipping meals
 Eat dry starchy foods on awakening
 Avoid excessive fluids when nauseated
 High protein snack at bedtime
 Ginger
 Sweet & salty
 Breathe fresh air
 Avoid brushing teeth after eating
 Try salty foods during nausea
 Try herbal teas
 Popsicle

68
Q

Hyperemesis Gravidarum: nursing interventions

A

in hospital settings

 Obtain weight and vital signs, UA,
electrolytes
 Comfort & Nutrition
 Support & Education

69
Q

Hyperemesis Gravidarum: hospital tx

A

 Treatment: IV therapy, vitamin B6,
Zofran, Progress diet as tolerated

OB (8 decks)

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