Gestational Conditions affecting Pregnancy Outcomes Part 1 Flashcards by CHRISTINE MAE CASANDRA

Hyperemesis Gravidarum

Pernicious or Persistent Vomiting

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is a medical term for SEVERE nausea and vomiting of pregnancy prolonged past week 16 of pregnancy or that is so severe that dehydration, ketonuria, and significant weight loss occur within the first 12 weeks of pregnancy

Hyperemesis Gravidarum

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Hyperemesis Gravidarum is a medical term for _____________________________________ of pregnancy prolonged past week __ of pregnancy or that is so severe that ________________________________________ occur within the first ____ weeks of pregnancy

SEVERE nausea and vomiting; 16; dehydration, ketonuria, and significant weight loss; 12

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Risk Factors of Hyperemesis Gravidarum

Increase Pregnancy Hormones
Trophoblastic Disease
Having a multiple pregnancy
Primigravida
Previous History

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Etiology/Pathophysiology of Hyperemesis Gravidarum
Etiology : __________________

May be related to ________________________________________________________
May be associated with ______________________

unknown; increased thyroid function because of the thyroid-stimulating properties of human chorionic gonadotropin; Helicobacter pylori

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Signs and Symptoms of Hyperemesis Gravidarum

Significant Weight Loss
Ketonuria
Elevated Haematocrit Concentration
Reduced Concentration of Na+, K+, Cl-
Hypokalemic alkalosis
Ataxia and Confusion
Weight loss
Intrauterine Growth Restriction
Preterm Birth

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Loss of hydrochloric acid from the stomach

Hypokalemic alkalosis

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Deficiency of vitamin B1 (thiamine)

Ataxia and Confusion

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Diagnostic Tests for Hyperemesis Gravidarum

Complete Blood Count
Urine Ketones
Urine Specific Gravity
Liver Enzymes. Elevation of AST and ALT
BUN
Serum Electrolytes
Ultrasound

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Medical Management for Hyperemesis Gravidarum

Hospitalization for about 24 hours
NPO for the first 24 hours
Intravenous fluids
Antiemetic

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Intravenous fluids e.g. for Hyperemesis Gravidarum

3000 mL Ringer’s Lactate with added vitamin B1

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may be prescribed to control vomiting

metoclopramide

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DIAGNOSIS for Hyperemesis Gravidarum

Imbalanced nutrition: less than body requirements related to prolonged vomiting

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INTERVENTIONS for Hyperemesis Gravidarum

Decrease Stimuli
Provide Emesis Basin
Do Not Urge a Woman to Eat
If on TPN: 1. Check blood glucose twice daily 2. Check urine ketones

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Ectopic pregnancy

Extrauterine Implantation

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happens when the implantation of the fertilized egg occurs outside the uterine cavity

Ectopic pregnancy

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In Ectopic Pregnancy, the implantation can either occur on the surface of the __________________________________________________________________________

ovary, in the cervix, in the abdomen and most commonly in the fallopian tube (95%).

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Approximately ___ of pregnancies are ectopic.

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Hyperemesis Gravidarum occurs at an incidence of ___ pregnant women.

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TYPES OF ECTOPIC PREGNANCY

Tubal pregnancy
Non tubal pregnancy

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it occurs when the egg has implanted in the fallopian tube

Tubal pregnancy

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This is the most common type of ectopic pregnancy and the majority of ectopic pregnancies are of this type

Tubal pregnancy

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comprise pregnancies implanted at sites other than the fallopian tube

Non tubal pregnancy

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These ectopic pregnancies may implant in the cervix, cesarean section scar, cornua of the uterus, ovary, or abdominal cavity.

Non tubal pregnancy

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Risk Factors of Ectopic Pregnancy

- Previous infection such as salpingitis or pelvic inflammatory disease - Scars from a tubal surgery - Congenital malformations - Uterine tumors - Use of intrauterine device - Smoking - A recent in vitro fertilization - Previous ectopic pregnancy

Signs and Symptoms of Ectopic Pregnancy

- Vaginal spotting - Sharp abdominal pain - Sharp, stabbing pain at the lower quadrant - Vaginal bleeding

This would rarely occur in conjunction with the pain, but this may be a sign that the ectopic pregnancy is nearing its rupture

Vaginal spotting

This is one of the symptoms which tell that the ectopic pregnancy has already ruptured.

Sharp, stabbing pain at the lower quadrant

occurs after the ectopic pregnancy has ruptured

bleeding

Diagnostic Tests for Ectopic Pregnancy

Culdoscopy Pelvic Ultrasound Magnetic Resonance Imaging

Medical Management for Ectopic Pregnancy

- Administration of methotrexate - Administration of mifepristone - Intravenous therapy - Withdrawing of blood sample - Laparoscopy - Salpingectomy

is a chemo-therapeutic agent that is a folic acid antagonist.

methotrexate

It destroys rapidly growing cells such as the trophoblast and the zygote.

methotrexate

This would be administered until a negative hCg titer results have been produced.

methotrexate

An abortifacient that causes sloughing off of the tubal implantation site.

mifepristone

This will be performed to ligate the bleeding blood vessels and repair or remove the damaged fallopian tube

Laparoscopy

This intervention would be performed if the fallopian tube is completely damaged. The affected tube would be removed and what would be left would be sutured appropriately

Salpingectomy

At __________ weeks of pregnancy, the trophoblast would be large enough to rupture the fallopian tube.

6-12

Sharp, stabbing pain in the lower quadrant is likely to be felt by the woman once a rupture has occurred, followed by _______________________________.

scant vaginal bleeding

Diagnosis for Ectopic Pregnancy

- Risk for Deficient Fluid Volume related to bleeding from a ruptured ectopic pregnancy. - Powerlessness related to early loss of pregnancy secondary to ectopic pregnancy.

EVALUATION Ectopic Pregnancy The patient must maintain adequate fluid volume at a functional level as evidenced by normal urine output at _______________________ and a normal specific gravity between the ranges of ______________________

30-60mL/hr; 1.010 to 1.021.

1 in every 1,000 pregnancies

Gestational Trophoblastic Disease Hyatidiform Moles (H-mole)

Due to low dietary intake of animal fats

Gestational Trophoblastic Disease Hyatidiform Moles (H-mole)

Common to women >35 y.o. and <15 y.o.

Gestational Trophoblastic Disease Hyatidiform Moles (H-mole)

history of H-mole, history of miscarriages, hyperthyroidism

Risk Factors for Gestational Trophoblastic Disease Hyatidiform Moles (H-mole)

- Low protein intake - Women older than 35 years old - Asian women - Women with a blood group of A who marry men with blood group O.

Signs and Symptoms of Gestational Trophoblastic Disease Hyatidiform Moles (H-mole)

- Uterus expands faster than normal. - A very high serum or urine test for hCg - Vaginal bleeding

When the H-mole is still not identified at the ___th week of pregnancy, it will identify itself through vaginal bleeding accompanied by clear fluid filled vesicles

16th

Diagnostic Tests for Gestational Trophoblastic Disease Hyatidiform Moles (H-mole)

Pregnancy test Urine test or serum for hCG Ultrasound

In H-mole, an ultrasound will show a _____________________________ with a _________________ pattern, filled with clear fluid instead of an embryo.

dense growth of grape-like vesicles; snowflake

Gestational Trophoblastic Disease Hyatidiform Moles (H-mole) Medical and Nursing Management PHARMACOLOGIC

- Methotrexate - Dactinomycin

This is ordered by the physician once metastasis occurs

Dactinomycin

Gestational Trophoblastic Disease Hyatidiform Moles (H-mole) Medical Management SURGICAL

Suction curettage

This is the ideal management of gestational trophoblastic disease, to evacuate the mole inside the woman’s uterus and avoid any further complications if it stays longer inside the reproductive system.

Suction curettage

Gestational Trophoblastic Disease Hyatidiform Moles (H-mole) ASSESSMENT Assess for signs and symptoms of pregnancy-induced hypertension, because for a woman with H-mole, they occur earlier than the ___________ week of pregnancy

20th

Gestational Trophoblastic Disease Hyatidiform Moles (H-mole) Nursing Management DIAGNOSIS

Grieving related to loss of pregnancy as evidenced by anger and social detachment

Incompetent cervix

Cervical Insufficiency

is a condition that refers to the inability of the cervix to hold the fetus any longer until term because it has dilated prematurely.

Incompetent cervix

When the fetus reaches its ___th week, it starts to become heavy and gain fats.

20TH

Risk Factors of Incompetent Cervix

Increased maternal age Congenital structural defects Trauma to the cervix

Signs and Symptoms of Incompetent Cervix

- Show - Increased pelvic pressure - Cervical dilation

Diagnostic Test for Incompetent Cervix

Ultrasound

This is the only test that the physician could order if an incompetent cervix is already suspected.

Ultrasound

This is a pink-tinged vaginal fluid that is discharged from the vaginal opening as a sign that the cervix has dilated.

Show

Medical and Nursing Management for Incompetent Cervix

McDonald’s Cervical Cerclage Shirodkar Cervical Cerclage

Nylon sutures are placed horizontally and vertically across the cervix. They are pulled back together until the cervical canal is only a few millimeters in diameter.

McDonald’s Cervical Cerclage

Sterile tape is used for this technique, where it is threaded in a purse-string manner under the submucous layer of the cervix. Then, it is sutured in place so it would close the cervix (1) These sutures are removed on the _______________ week of pregnancy for the fetus to be born vaginally. (2)

Shirodkar Cervical Cerclage ; 37th or 38th

Nursing Management for Incompetent Cerviz DIAGNOSIS

Anxiety related to impending loss of pregnancy as evidenced by premature dilation of the cervix.

signs of shock

rapid, thread pulse, rapid respirations, decreased blood pressure

the goal of evaluation in ectopic pregancy is

maternal blood loss is replaced and the bleeding would stop

what is needed for the development of trophoblastic villi?

protein

When the H-mole is still not identified at the 16th week of pregnancy, it will identify itself through ________________ accompanied by clear fluid filled vesicles

vaginal bleeding

Assessment (H-mole)

- assess abdominal girth - assess for signs and symptoms of PIH - instruct woman to save all perineal pads