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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
Ectopic Pregnancy
**1st trimester**  Abnormal pregnancy  Occurs outside the uterus ***  Most common site is within one of the fallopian tube
26
Primary cause of death of pregnancy + cause of maternal morality in first trimester
Ectopic pregnancy
27
Ectopic pregnancy: s/sxs
 Bleeding/spotting within 6-8 weeks of missed menstrual period.  Pain (many are asymptomatic before tubal rupture)  Positive pregnancy test
28
Ectopic pregnancy: screening
 HCG level  Transvaginal ultrasound * Most result of tubal scarring secondary to pelvic inflammatory disease.
29
Ectopic pregnancy: medical therapy (meds)
 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
Ectopic pregnancy: surgical management
 Depends on - location and extent of tissue involvement - Future fertility
31
Ectopic pregnancy: follow up care post management / labs
 contraceptive for three cycles allow time to heal  Follow up care is rest and monitor beta-hCG levels
32
Ectopic pregnancy: at risk for?
 Increased risk for recurrent ectopic pregnancy
33
Ectopic pregnancy: nursing management
 Preparing for treatment  Education the client  Emotional and physical support
34
Gestational Trophoblastic Disease Molar Pregnancy (hydatidiform mole)
**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
Molar Pregnancy: risks d/t dx
 Pregnancy too soon –higher risk of having another molar pregnancy  A few cases may develop into a choriocarcinoma
36
Molar pregnancy: tools for diagnosis
 Transvaginal ultrasound and serum hCG levels for diagnosis
37
Molar pregnancy: nursing mangement
 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
Types of Late Pregnancy Bleeding disorders
**3rd trimester**  Placenta Previa  Placenta Abruption (Abruption Placentae)  Placenta Accreta Spectrum  DIC -Disseminated Intravascular Coagulopathy
39
Placenta Previa
Major complication is hemorrhage and development of abnormal placental attachment (accrete, increta, percreta) *3rd trimester*
40
Placenta Previa: leads to
- preterm births - Birth by cesarean section
41
Placenta Previa: s/sxs
 Painless bright red vaginal bleeding  Uterus with a normal tone (relaxed soft non-tender uterus)
42
Placenta Previa: diagnosis
- Transabdominal ultrasound
43
Placenta Previa: risk factors
Evidence suggests on the rise due to increasing c/s rate, increasing maternal age, & more infertility treatments.
44
Previa Classification
- 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
Placenta Previa: mangement
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
Placenta Accreta Spectrum: patho
*3rd trimester* Part or entire placenta invades and is inseparable from the uterine wall.
47
classification of Placenta Accreta Spectrum
 Accreta  Increta  Percreta
48
classification of Placenta Accreta Spectrum: (Accreta)
 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
classification of Placenta Accreta Spectrum: (Increta)
 Increta- Extends into the uterine myometrium.
50
classifications of Placenta Accreta Spectrum: (Percreta)
 Percreta- Extends into the uterine musculature and can adhere to adjacent tissues and to other pelvic organs. -most extensive
51
Placenta Abruption (Abruption Placentae)
*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
Placenta Abruption (Abruption Placentae): risk factors
 Risk factors: trauma, hypertension, cocaine, smoking, twin gestation
53
Placenta Abruption (Abruption Placentae): s/sx
 Vaginal bleeding - Dark red bleeding - Concealed bleeding (hard abdomen)  Abdominal pain  Uterine tenderness - Extended fundal height  Contractions - Fetal distress
54
Placenta Abruption (Abruption Placentae): classifications
 Partial Abruption, concealed hemorrhage  Partial Abruption apparent hemorrhage  Complete abruption concealed hemorrhage  Mild to Severe
55
Placenta Abruption classifications: how to know if it partial/complete and concealed/apparent
 Partial or complete and depending on degree of separation  Concealed or apparent by the type of bleeding  Mild to Severe
56
Previa vs Abruption: onset-type of bleeding
Previa -insidious vs Abruption -sudden
57
Previa vs Abruption: onset- blood description
Previa -always visible vs Abruption -concealed or visible
58
Previa vs Abruption: onset- discomfort
Previa -painless vs Abruption -constant, uterine tenderness
59
Previa vs Abruption: onset: uterine tone
Previa -soft + relaxed vs Abruption -firm to rigid
60
Previa vs Abruption: onset: fetal heart rate
Previa -usually normal vs Abruption -fetal distress
61
DIC -Disseminated Intravascular Coagulopathy-S/Sx
- 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
Surgeries During Pregnancy
- Appendicitis - Cholelithiasis: gallstones in gallbladder - Cholecystitis: inflammation of the gallbladder
63
Trauma in pregnancies at risk for?
due to -MVA -Partner violence  At risk for preterm labor and placental abruption,
64
Trauma in pregnancies Management
 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
Hyperemesis Gravidarum
 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
Hyperemesis Gravidarum: s/sx
- dehydration (weight loss, decreased BP, increased pulse rate, + poor skin turgor) - nutritional deficiencies - ketosis (ketonuria)**
67
Hyperemesis Gravidarum: teaching
 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
Hyperemesis Gravidarum: nursing interventions
in hospital settings  Obtain weight and vital signs, UA, electrolytes  Comfort & Nutrition  Support & Education
69
Hyperemesis Gravidarum: hospital tx
 Treatment: IV therapy, vitamin B6, Zofran, Progress diet as tolerated

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