Exam 4 Preeclampsia Flashcards
The onset of HTN without proteinuria after week 20 of pregnancy
Gestational HTN
HTN is defined as a systolic BP greater than what?
140/90
Gestational HTN does not last longer than what?
Week 12 postpartum
When does gestational HTN usually resolve?
1st postpartum week
Pregnancy-specific condition in which HTN and proteinuria develop after 20 weeks of gestation in a woman who previously had neither
Preeclampsia
A vasospastic, systemic disorder that is easily characterized as mild or severe
Preeclampsia
When does preeclampsia resolve?
After the birth the fetus and expulsion of the placenta
Risk factors for preeclampsia
- Primigravida younger than 19 or older than 40
- Severe preeclampsia in previous pregnancy
- Family history of mother or sister with preeclampsia
- Paternal history of fathering a preeclamptic pregnancy in another woman
- African descent
- Multifetal gestation
- Maternal infection/inflammation
What preexisting medical or genetic conditions are risk factors for preeclampsia?
- Chronic HTN
- Renal dz
- Pregestational DM
- Connective tissue dz (lupus, RA)
- Thrombophilia
- Obesity
What is the best preeclampsia prevention method?
Early prenatal care and early detection
Mild preeclampsia BP
Greater than or equal to 140/90
Proteinuria for mild preeclampsia
Greater than or equal to 1+ on a dipstick
Urine output for mild preeclampsia
Greater than 25-30 mL/hr
Fetal effects of mild preeclampsia
Placental perfusion is reduced and intrauterine growth restriction
Severe preeclampsia BP
Greater than or equal to 160/110
Proteinuria for severe preeclampsia
Greater than or equal to 3+ on a dipstick
Urine output for severe preeclampsia
Less than 500 mL in a 24 hr period
HA with mild/sever preeclampsia
Mild: absent/transient
Severe: persistent/severe
Visual problems with severe preeclampsia
Blurred, photophobia
Pulmonary edema with mild/severe preeclampsia
Mild: absent
Severe: may be present
Irritability or changes in affect with mild/severe preeclampsia
Mild: transient
Severe: severe
What might be present with severe preeclampsia but not mild?
Epigastric pain, N/V, thrombocytopenia, impaired liver function
Fetal effects from severe preeclampsia
Decreased perfusion expressing as IUGR, abnormal fetal status on antepartum tests
The onset of seizure activity or coma in a woman with preeclampsia who has no history of preexisting patho
Eclampsia
Usually preceded by premonitory s/s, including persistent HA, blurred vision, severe epigastric or RUQ abdominal pain, and altered mental status
Eclampsia
What follows an eclampsia seizure?
Hypotension, muscular twitching, disorientation, amnesia
What do you monitor with eclamptic pts?
Urine output, lung sounds, DTRs, may have mag sulfate toxicity. You expect BP to be low, but really watch the respirations
A lab diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction
HELLP Syndrome
HELLP Syndrome is characterized by what?
- Hemolysis (H)
- Elevated liver enzymes (EL)
- Low platelets
HELLP Syndrome usually develops when?
Antepartum period, progresses rapidly
Mag sulfate is continued after birth for how long?
12-24 hours
Preeclamptic women should be hospitalized where?
Tertiary care facility that is able to provide both maternal and neonatal intensive care
What meds are ordered to enhance fetal lung maturation?
Corticosteroids
Betamethasone, Celestone
When is immediate birth indicated?
If eclampsia, pulmonary edema, placental abruption, DIC, or renal dysfunction develops
What meds are given for preeclampsia?
- Mag sulfate
- Hydralazine
- Labetalol
- Procardia
- Celestone
Excessive N/V that doesn’t subside throughout pregnancy. Causes weight loss, electrolyte imbalance, nutritional deficiency, and ketonuria
Hyperemesis Gravidarum
Complications of hyperemesis gravidarum
- IUGR
- Low birth weight
- Prematurity
- 5 min agars less than 7
Maternal risks from a hemorrhagic disorder
Hypovolemia, anemia, infection, preterm labor
Fetal risks from a hemorrhagic disorder
Blood loss, anemia, hypoxemia, hypoxia, anoxia, and preterm birth
What has the highest incidence of maternal mortality?
Ruptured ectopic pregnancy and abruptio placentae
Types of early pregnancy bleeding
Miscarriage, reduced cervical competence/incompetent cervix (premature dilation of cervix), ectopic pregnancy, hydatidiform mole (molar pregnancy)
A pregnancy that ends without medical surgical methods before 20 weeks or gestation or fetal weight of less than 500 grams
Miscarriage
Threatened miscarriage (A)
You don’t really know if it’s gonna happen or not
Inevitable miscarriage (B)
You know for sure they’re going to deliver
Incomplete miscarriage (C)
Not all the products of conception are delivered. Sometimes the placental is retained. D&C cleans out the uterus
Complete miscarriage (D)
Everything comes out
Missed miscarriage (E)
Fetus has died in utero but has not delivered yet
Septic miscarriage
There’s an infection in the uterus and the baby is going to miscarry
Recurrent (habitual) miscarriage
A woman just keeps miscarrying
What meds do you do for miscarriage?
Maybe IV fluids or pain meds, really you just watch and wait
Cytotec
Drug that causes uterine contractions to help expel the products of conception
RhoGAM with miscarriages
They go ahead and give the mom a dose cause they won’t know what the baby was
Passive and painless dilation of the cervix during the second trimester
Reduced cervical competence/Incompetent cervix. May cause recurrent miscarriages
Causes of Incompetent Cervix
- Previous cervical trauma
- Lacerations during childbirth
- Excessive cervical dilation for curettage or biopsy
- Exposure to DES (diethylstilbestrol)
Most common way to treat incompetent cervix
Cerclage
A suture is placed around the cervix beneath the mucosa to constrict the internal cervix
Cerclage
How is a cerclage placed?
Prophylactically (11-15 weeks) or as a rescue procedure once the cervix has been found to be effaced or dilated
Risks with cerclages
- Premature ROM
- PTL
- Chorioamnionitis
Follow up care with cerclages
- Bedrest
- Avoid sex
- Stress importance of initial activity restriction and close observation
Patient education with cerclages
Signs of PTL:
- Infection
- Contraction
- ROM
- Severe perineal pressure
- Urge to push
The frequency of ectopic pregnancies is consistent across what?
Maternal age ranges and ethnic origins
Causes of ectopic pregnancies
- Previous ectopic pregnancy
- History of STDs
- Fallopian tube scars form PID
- Endometriosis
- Previous pelivc surgery
- Infertility treatment
- Uterine fibroids
- Previous intrauterine contraception
Clinical manifestations before rupture of ectopic pregnancy
- Dull LQ abdominal pain on one side
- Delayed menses
- Spotting occurring 6-8 weeks after last normal menstrual period
- Mild to moderate dark red or brown intermittent vaginal bleeding
Clinical manifestations after rupture of ectopic pregnancy
- Referred shouolder pain: diaphragmatic irritation caused by blood in the peritoneal cavity
- Generalized, one sided or deep LQ acute abdominal pain
- Faintness, dizziness r/t amount of bleeding in abdominal cavity
- Cullen sign
Ecchymotic blueness around umbilicus
Cullen sign
Medical treatment for ectopic pregnancy if the pt desires a future pregnancy
Methotrexate IM
3.5 cm or less, no fetal cardiac activity, enraptured, condition stable
Surgical removal of fallopian tube
Salpingectomy
Incision made for removal of products of conception (for ectopic pregnancies)
Salpingostomy
Benign proliferative growth of the placental trophoblast in which the chorionic villi develop into edematous, cystic, avascular transparent vesicles that hand in a grapeike cluster
Hydatidiform Mole (molar pregnancy)
A group of pregnancy related trophoblastic proliferative disorders without a viable fetus that are caused by abnormal fertilization
Gestational trophoblastic dz
GTD includes what?
Molar pregnancies, invasive mole and choriocarcinoma
Cause of molar pregnancies
Unknown but may be r/t an ovular defect or a nutritional deficiency
Who is at an increased risk for molar pregnancies?
Women who have had a previous molar pregnancy, early teens or older than 40 years of age
Types of molar pregnancies
Complete and partial
Clinical manifestations of molar pregnancies
- Dark brown (looks like prune juice) or bright red vaginal bleeding, either scant or profuse
- Excessive N/V
- Abdominal cramps
- Signs of preeclampsia before 24 weeks of gestation
- Excessively enlarged uterus
What labs do you frequently check with molar pregnancies?
Serum hCG levels
A rising titer of serum hCG levels and enlarged uterus may indicate what?
Choriocarcinoma
Types of late pregnancy bleeding
Placenta previa and Abruptio placentae (placental abruption)
