Gestational conditions (second) Flashcards
Refers to the low
implantation of the
placenta
Placenta Previa
Clinical Findings of Placenta Previa
- Painless hemorrhage
- Bleeding onset without warning
- Some abortion from abnormal location of
the developing placenta
What is the immediate care measure for the therapeutic management of placenta previa?
bed rest in a side-lying position
Women between 24 and 34 weeks’ gestation with bleeding should receive (asnwer) to promote fetal lung maturity.
betamethasone
- placenta appears to have
been implanted correctly - occurs in about 10% of
pregnancies - most frequent cause of
perinatal death - unknown cause
Abruptio Placenta / Premature Separation of
the Placenta
What are the major signs and symptoms of Abruptio Placenta?
External and Internal bleeding.
What is the condition called if the Uterus has a hard boardlike surface with bleeding
present? It is also called “woody” Uterus.
Couvelaire uterus or
uteroplacental apoplexy
How many grades are there in the assessment of Abruptio Placenta?
Grade 0 - 3
Hypertension in pregnancy is defined as one of the following:
- One measurement of diastolic BP of (answer) mmHg or more;
or
- Two consecutive measurements of diastolic BP of greater than (answer)
- 110
- 90 mmHg 4 hours or more apart
Proteinuria is defined as one of
the following:
- Twenty four hours urine
sample collection with a total
protein excretion of (answer)
or
- Random clean catch urine
specimen with a (answer)
reagent strip
- 300mg or more
- 2+ or more
- Is an idiopathic disorder of pregnancy characterized by proteinuric hypertension.
- 2nd largest cause of both direct maternal and perinatal loss
- The condition can give rise to severe multisystem complications: cerebral hemorrhage; hepatic and renal
dysfunction; and respiratory compromise.
Pre-eclampsia
Classification of hypertensive disorders during pregnancy
➢(Answer) = arising for the 1st
time after the 20th week of gestation in the absence of proteinuria.
➢(Answer) = hypertension associated with
proteinuria arising after 20th week of gestation.
- Gestational hypertension
- Pre-eclampsia
Classification of hypertensive disorders during pregnancy
➢(answer) = apparent prior to, in the 1st half of, or persisting more than 6 weeks after pregnancy
➢(answer) = chronic hypertension may be complicated by preeclampsia, evolution of other S/S of preeclampsia after 20th week gestation.
- Chronic hypertension
- Pre-eclampsia superimposed on chronic
hypertension
- A disorder characterized by three symptoms of
hypertension, edema and proteinuria appearing
after the 20th to 24 week of pregnancy and
disappearing 6 weeks after delivery. - 7-10% of all pregnancies; one of the major
causes of maternal and fetal/ neonatal
mortality.
PREGNANCY INDUCED HYPERTENTION
- A test to assess the risk of
toxemia in pregnant women. - A comparison of blood pressure
is made with the woman lying on
her left side and on her back. - An excessive increase in blood
pressure when she rolls to the
supine position indicates
increased risk of toxemia.
Roll-Over Test
Eclampsia is associated with
convulsions and coma.
Severe HA and epigastric pain
may mean incoming
convulsion.
The first action if
the clients complains of
severe HA or Epigastric pain
(answer)
The first
objective sign of convulsion is
(answer)
- Check the BP
- Rolling of the Eyes
What is the desired bed position for patient’s with Preeclampsia?
left lateral [Sim’s] position
What is the grave sign of Preeclampsia?
Oliguria
What is a good sign of Preeclampsia?
Diuresis
What drug prevents convulsions to patients with Preeclampsia?
Magnesium Sulphate
What is the antidote for Magnesium Sulphate?
10% Calcium Gluconate
(answer) can be mixed with MgSO4 to make it less irritating and painful; requires a doctor’s order.
Procaine hydrochloride
Drugs ordered for the treatment of Preeclampsia:
Administer drug as ordered:
- Magnesium Sulphate – prevents convulsions
- Hydralazine [apresoline]: monitor BP
- Diazepam [valium] : monitor BP
- Diuretics: Rare; now it is considered inappropriate as it further decrease circulating volume resulting in decrease renal, cerebral and uterine perfusion
- Blood volume expanders
During convulsion management, what are the priorities?
- Maintain a patent airway [1st priority] gentle suctioning; provide oxygen as ordered
- Promote safety/prevent injury [2nd priority] do not apply restrain [may fracture the long bones]
is a well-known variant of
pre-eclampsia pregnancy complication.
The syndrome was first described in 1982 as
characterised by hemolysis (H), elevated liver
enzymes (EL) and low platelet count (LP), to
which the acronym HELLP refers.
HELLP syndrome
is an obstetric complication that is frequently
misdiagnosed at initial presentation. Many
investigators consider the syndrome to be a
variant of preeclampsia,
HELLP syndrome
to be the most reliable
indicator of the presence of
HELLP syndrome
Platelet count
Classification on the basis of platelet
count:
class I - (Answer)
class II - (Answer)
class III - (Answer)
Classification on the basis of platelet
count:
class I - less than 50,000 per mm3
class II - 50,000 to less than 100,000 per mm3
class III - 100,000 to 150,000 per mm3
When considering termination of
gestation in a patient with HELLP,
determine:
Gestational age.
Maternal and fetal conditions.
Fetal presentation.
Cervical maturity
Management of labor and delivery (HELLP SYNDROME)
Timing of delivery:
–if > 34 weeks gestation, (Answer)
–if < 34 weeks gestation, (Answer)
Management of labor and delivery
Timing of delivery:
–if > 34 weeks gestation, deliver
–if < 34 weeks gestation, administer
corticosteroids, then deliver in 48
hours
The absence of improvement of the
thrombocytopenia within 72-96 hours
postpartum indicates severe compromise
of compensatory mechanisms and possible (Answer)
MULTIPLE ORGAN FAILURE.
The risk of recurrence of
preeclampsia -eclampsia is
(Answer) and for the HELLP
syndrome: (Answer)
- 42-43%
- 19-27%.
The risk of recurrence of
preterm delivery is high,
about 61%.
61%.
