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Gestational Condition Flashcards

1
Q

Hypertension in Pregnancy: Significance & Incidence

A
  • Preeclampsia complicates approx. 5-10% of all pregnancies
  • HTN disorders of preg are the most common medical complication reported during preg
    > hemorrhagic/SI are 2nd & 3rd
  • Significant contributor to maternal & perinatal morbidity & mortality
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2
Q

Gestational Hypertension

A
  • Develops after 20th wk of preg w/out proteinuria
  • Need more than 1 HTN reading
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3
Q

Chronic Hypertension

& risk for, & fetal effects

A
  • HTN before pregnancy or diagnosed before 20 wks
  • Risk for
    > placental abruption
    > superimposed preeclampsia: development of preeclamp from HTN
    > incrd perinatal mortality
  • Fetal Effects
    > growth restriction
    > preterm birth
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4
Q

Preeclampsia

A
  • HTN & proteinuria develops after 20wks
    or
  • HTN w/ end organ damage
    > renal/liver
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5
Q

Eclampsia

A
  • Seizure activity or coma in women diagnosed w/ preeclampsia
  • No previous hx
    > or pre-existing patho of seizure disorder
  • Eclamptic seizures can occur before, during, or after birth
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6
Q

Chronic HTN w/ Superimposed Preeclampsia

A
  • A sudden incr in blood pressure tht was previously well-controlled
  • New-onset proteinuria or a sudden & sustained incr in proteinuria in a women known to have proteinuria before conception or early in pregnancy
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7
Q

Preeclampsia - Pathophysiology

A
  • Disruptions in placental perfusion & endothelial cell dysfunctions
  • Placental itching (spasm)
    > = small baby
  • Generalized vasospasm
    > incrd risk of clots
  • Spiral arteries don’t remodel to allow for incrd blood flow
  • Reduced kidney perfusion
    > protein in urine
    > generalized edema
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8
Q

Preeclampsia - Etiology

A

S/S only develop during pregnancy and disappear after birth

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9
Q

Preeclampsia - Risk Factors

A
  • Fam hx
  • Multifetal pregnancy
  • African-American race
  • Obesity
  • 19-40yrs
  • Any pre-existing medical or genetic conditions
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10
Q

Preeclampsia: HELLP Syndrome

A
  • Lab diagnostic variant of severe preeclamp involves hepatic dysfunction, characterized by:
    > Hemolysis (H)
    > Elevated liver enzymes (EL)
    > Low platelets (LP)
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11
Q

Preeclampsia: HELLP Syndrome - Associated w/ Incrd Risk For

A
  • Pulm edema
  • Renal failure
  • Liver hemorrhage or failure
  • Disseminated intravascular coagulation (DIC)
    > use up all clotting factors; bleed out of all holes
  • Placental abruption
  • Acute resp distress syndrome
  • Sepsis
  • Stroke
  • Fetal & maternal death
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12
Q

Identifying & Preventing Preeclampsia

LILI LUK

A
  • Physical Examination
    > dependent, pitting edema
    > DTR (clonus): suppose to be negative
    > blurred/double vision
    > RUQ pain: liver ischemia
    > listen to lungs/HR: pulm edema
    > SOB
  • Lab Tests
    > urine output (oliguria)
    > kidney labs (Cr/proteinuria)
    > low platelets
    > incrs factor 8
    > liver func tests
    > lipids incrd
    > incrd Hct
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13
Q

Mild Gestational HTN & Mild Preeclampsia

treatment
diet

A
  • Treatment:
    > BP control
    > May have some restriction
    > Maternal/fetal assessment
  • Diet
    > don’t reduce salt
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14
Q

Severe Gestational HTN & Severe Preeclampsia

cure
med

A
  • Cure
    > delivery
  • Drug used during delivery to prevent eclampsia
    > magnesium sulfate: prevent & treat a seizure
  • severe GHTN & preeclamp put pregnancy at greater risk for complications
    > control BP
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15
Q

Magnesium Sulfate

how to admin
therapeutic lvls
excretion

A
  • Drug of choice for prevention & treatment of eclampsia
  • Administered almost excusively IV
    > 4-6gram loading dose over 15-20mins
    > followed by maintenance dose of 2gram/hr after delivery
    > big bore IV
  • Therapeutic lvls
    > 4-7mEq/L
  • Excreted by kidneys
    > if compromised, lvls will rise
    > watch I&Os for toxicity
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16
Q

Magnesium Sulfate - Adverse Effects

A
  • Warming
  • Flushing
  • Diaphoresis
  • IV site irritation
  • may need Pitocin to help contract since mag causes relaxation
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17
Q

Magnesium Sulfate - Mild Toxicity

A
  • Appears drunk:
  • Lethargy
  • Muscle weakness
  • Dcrd DTRs
  • Double vision
  • Slurred speech
  • draw labs, watch I&Os
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18
Q

Magensium Toxicity - Severe Toxicity

A
  • Maternal hypotension
  • Bradycardia
    > dcrd HR
  • Bradypnea
    > dcrd RR
  • Cardiac arrest
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19
Q

Magnesium Toxicity - Managing Toxicity

A
  • Discontinue infusion
    > priority
  • Notify HCP
  • Administer Calcium Gluconate
    > antidote
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20
Q

Hyperemesis Gravidarum - Define

A
  • Excessive vomiting accompanied by dehydration, electrolyte imbalance, ketosis, & acetonuria
  • last entire pregnancy
21
Q

Hyperemesis Gravidarum - Etiology

A
  • Relaxation of the smooth muscle of the stomach
  • Incrd hCG lvls
22
Q

Hyperemesis Gravidarum - CMs

A
  • Weight loss <5%
  • Dehydration
  • Electrolyte imbalance
23
Q

Hyperemesis Gravidarum - Care Management

A
  • IV fluids
  • Pyridoxine (vit B6)
24
Q

Hemorrhagic Disorders - Maternal Risks

A
  • Hemorrhagic disorders in pregnancy are medical emergencies
  • Maternal blood loss dcrs oxygen-carrying capacity
    > incrd risk for: hypovolemia, anemia, infection, preterm labor & birth
    > adversely affects oxygen delivery to fetus
25
Q

Hemorrhagic Disorders - Fetal Risks

A

Fetal risks includes blood loss or anemia, hypoxemia, hypoxia, anoxia, & preterm birth

26
Q

Spontaneous Abortion

A

Spontaneous abortions often lead to a D&C

27
Q

Reduced Cervical Competence (Cerclage)

A
  • A procedure in which the cervical opening is stitched closed to prevent or delay preterm birth due to premature dilation
  • Prophylactic Cerclage
    > placed at 11-15wks of gestation
28
Q

Ectopic Pregnancy

A
  • Fertilized ovum implanted outside the uterine cavity
  • Most occur in fallopian tube(Ampulla)
29
Q

Ectopic Pregnancy - CMs

A
  • Abdominal pain
  • Delayed menses
  • Abnormal vaginal bleeding
  • Unilateral pelvic pain
30
Q

Ectopic Pregnancy - Management

A
  • Medical
    > Methotrexate: stops growth and prevents rupture
  • Surgical
    > Salpingectomy: removal of one or both fallopian tube, cannot come to term
31
Q

Gestational Trophoblastic Disease - Define

& education

A
  • Define: abnormal fertilization w/out viable fetus
    > tumor, mass of cells
  • Education:
    > risk for developing a type of cancer
    > measure hCG for a year
    > don’t get pregnant for next year: monitoring hCG
32
Q

Gestational Trophoblastic Disease - CMs

A
  • Vaginal bleeding
  • Significantly larger uterus
33
Q

Gestational Trophoblastic Disease - Management

A
  • Most end up passing spontaneously
  • Suction curettage (D&C) is safe, rapid, and effective if necessary
  • Do NOT recommend induction of labor w/ oxytocin or prostaglandins
34
Q

Late Pregnancy Bleeding: Placenta Previa - Define

& fetal risks

A
  • Placenta implanted in LOWER uterine segment near or over interal cervical
  • Excessive bleeding
  • Fetal risks include malpresentation, preterm birth, fetal anemia, & congenital anomalies
35
Q

Late Pregnancy Bleeding: Placenta Previa - Classification & CMs

A
  • Classified based on
    > complete; more painless bleeding
    > marginal
  • CMs
    > abnormal placental attachment
    > excessive bleeding: ask if painful
36
Q

Late Pregnancy Bleeding: Placenta Previa - Diagnosis

A

Transabdominal ultrasound examination

37
Q

Late Pregnancy Bleeding: Placenta Previa - Management

A
  • Expectant management: observation & bed rest
    > no treatment unless symps appear
  • Alternative birth:
    > cesarean birth
    > home care
  • Active Management:
    > birth regardless of gestational age if excessive bleeds or complications arise
38
Q

Late Pregnancy Bleeding: Abruptio Placentae - Define

A
  • Premature separation of placenta
  • Biggest concern w/ pre-existing conditions & trauma
39
Q

Late Pregnancy Bleeding: Abruptio Placentae - Classifications

A
  • Grade 1 (mild)
  • Grade 2 (moderate)
  • Grade 3 (severe)
40
Q

Late Pregnancy Bleeding: Abruptio Placentae - CMs

A
  • Vaginal bleeding
    > very painful
  • Abdominal pain
  • Uterine tenderness
  • Contractions
41
Q

Late Pregnancy Bleeding: Abruptio Placentae - Maternal Outcomes

A
  • Blood loss
  • Coagulopathy
  • Need for transfusion
  • End-organ damage
42
Q

Late Pregnancy Bleeding: Abruption - Etiology

A
  • Maternal HTN, chronic or pregnancy related, is the most common risk factor
  • Drugs/trauma
42
Q

Late Pregnancy Bleeding: Abruptio Placentae - Fetal Outcomes

A
  • Fetal growth restriction
    > low birth weight, organ dysfuntion
  • Oligohydramnios
    > low amniotic fluid
  • Preterm birth
  • Hypoxemia
    > low oxygen in blood
  • Stillbirth
43
Q

Late Pregnancy Bleeding: Abruption - Management

A
  • Depends on severity, if stable they will just watch
  • Unstable then active management & delivery required
44
Q

Disseminated Intravascular Coagulation (DIC) - Pathophysiology

A
  • Diffuse clotting causing widespread external & internal bleeding
  • Triggered by large amounts of tissue thromboplastin
    > placental abruption or dead fetus
  • Triggered by widespread damage to vascular integrity
    > severe preeclampsia, HELLP, gram neg sepsis
45
Q

Disseminated Intravascular Coagulation (DIC) - Management

A
  • Correction of underlying cause
  • Volume expansion
  • Rapid replacement of blood products and clotting factors
  • Optimization of oxygenation
  • Continued reassessment of lab parameters
46
Q

Trauma During Pregnancy - Maternal Physiologic Characteristics

A
  • Requires strategies adapted for appropriate resuscitation, fluid therapy, positioning, assessments:
  • Cardiac Output
    > could have no signs of shock until more than 30% of blood lost
  • Circulating Blood Volume
    > can lose 1000mL of blood
  • Decreased Intolerance for Hypoxia Apnea
    > risk for acidosis
  • Uterus & Bladder Positioning
    > risk for vena caval compression in supine
  • Elevated Lvls of Progesterone
    > relaxes LES and an incr in hydrochloric acid, can result in aspiration, protect airway
47
Q

Trauma During Pregnancy - Fetal Physiologic Characteristics

A
  • Careful monitoring of fetal status assists greatly in maternal assessment
  • Fetal monitor tracing works as “oximeter” of internal maternal well-being
48
Q

Trauma During Pregnancy - Nursing Care Management

A
  • Immediate stabilization
  • Primary Survey
    > cardiopulm resuscitation
  • Seconday survey
  • Electronic fetal monitoring
  • Fetal-maternal hemorrhage
    > ultrasound
    > radiation exposure
  • Perimortem cesarean delivery

OB Exam 2 (11 decks)

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