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Nursing Obstetrics & Pediatrics > health challenges in pregnancy > Flashcards

health challenges in pregnancy Flashcards

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1
Q

what are some health challenges in pregnancy?

A
  • hypertension
  • diabetes
  • infection
  • carrying multiples
  • age-related
  • substance abuse
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2
Q

how common is hypertension in pregnancy?

A

-10% of pregnancies

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3
Q

what types of hypertensive disorders can be present in pregnancy?

A
  • pre-existing
  • gestational hypertension
  • preclampsia
  • eclampsia
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4
Q

what is the difference between gestational hypertension and preeclampsia?

A

-gestational hypertension is an elevated BP without protein in unrine

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5
Q

what are some adverse outcomes of hypertension during pregnancy?

A
  • headache
  • visual disturbances
  • abdominal/epigastric/RUQ pain
  • nausea/vomiting
  • chest pain/SOB
  • abnormal maternal lab values
  • fetal morbidity
  • edema/weight gain
  • hyperreflexia
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6
Q

what blood pressure parameters for preeclampsia?

A
  • systolic greater than 140

- diastolic greater than 90

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7
Q

what are some negative maternal outcomes that can occur because of preeclampsia?

A
  • stroke
  • pulmonary edema
  • hepatic failure
  • jaundice
  • seizures
  • placental abruption
  • acute renal failure
  • HELLP syndrome & DIC
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8
Q

What are some negative fetal outcomes that can occur because of preeclampsia?

A
  • IUGR
  • oligohydraminos
  • absent or reversed end diastolic umbilical artery flow by doppler
  • placental abruption
  • prematurity
  • fetal compromise (metabolic acidosis)
  • intrauterine death
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9
Q

what pregnancies is it more likely to have an onset of gestational hypertension or preeclampsia?

A
  • first pregnancy
  • first pregnancy with a new partner
  • if you have had it in previous pregnancies
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10
Q

what are some risk factors for developing gestational hypertension?

A
  • first pregnancy
  • first pregnancy with new partner
  • previous pregnancy with hypertension
  • personal/family history of hypertension
  • poor nutrition
  • obesity
  • ethnicity
  • advanced maternal age
  • multiple gestation
  • diabetes
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11
Q

what are some initial management strategies for hypertension in pregnancy?

A
  • stress reduction
  • reduced activity
  • regular maternal and fetal assessment
  • treatment of nausea, vomiting, and/or epigastric pain
  • drug treatment of blood pressure
  • consider seizure prophylaxis
  • regular NSTs and ultrasounds
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12
Q

what kind of management may be done in hospital for hypertension during pregnancy?

A
  • fetal movement counting
  • NST
  • biophysical profile
  • ultrasound
  • measurement of AFI
  • hourly intake and output
  • frequent BP measurements
  • other vitals
  • blood work
  • monitoring for adverse conditions
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13
Q

what medications may be used to treat hypertension in pregnancy?

A
  • labetalol (most common, is a beta blocker)
  • nifedipine (calcium channel blocker)
  • hydralazine (arteriolar dilator)
  • aldomet (centrally acting sympatholytic)
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14
Q

what common classification of antihypertensive drug is not appropriate for use in pregnancy?

A

ACE inhibitors because they can cause renal failure in fetus, cause hypoperfusion to fetus, and IUGR

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15
Q

why would magnesium sulfate be given to a woman with hypertension during pregnancy?

A
  • to reduce CNS irritability to prevent seizure in cases of severe hypertension
  • risk is that it can slow labor or cause CNS depression
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16
Q

what is the reversal agent for MgSO4?

A

calcium gluconate

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17
Q

what are some side effects of MgSO4?

A
  • tachycardia
  • kidney toxicity if urine output is decreased
  • can slow labour
  • muscle weakness
  • lack of energy/drowsiness
  • respiratory depression
  • low blood pressure
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18
Q

what are some signs of MgSO4 toxicity?

A
  • CNS depression
  • respiratory depression (rate less than 12)
  • oliguria
  • absent DTR
  • serum magnesium of 4.8 or more
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19
Q

what should be done for a pregnant woman admitted with eclampsia?

A
  • give a bolus of MgSO4
  • sedate and use another anticonvulsant like Dilantin
  • use diuretic like lasix to treat pulmonary edema if present
  • give digitalis for circulatory failure if needed
  • deliver baby - if less than 34 weeks, give corticosteriods to mature lungs
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20
Q

what is HELLP syndrome?

A

Hemolysis
Elevated Liver enzymes
Low Platelets (thrombocytopenia)

  • one of the worst outcomes of high BP in pregnancy
  • occurs in 4-12% of those with gestational hypertension
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21
Q

what types of diabetes can affect pregnant women?

A
  • pre-existing
  • gestational
  • pre-existing, not previously diagnosed
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22
Q

how is gestational diabetes differentiated from pre-existing, not previously diagnosed diabetes?

A

-if present before 20 weeks, considered pre-existing

23
Q

how prevalent is gestational diabetes in Canada?

A

3.6% of non-aboriginal women

18% of aboriginal women

24
Q

what are two ways pregnancy alters carbohydrate metabolism?

A
  • fetus continuously takes glucose from mother

- placenta creates hormones which alter effects and resistance to insulin as well as glucose tolerance

25
Q

how does carbohydrate metabolism change in the first trimester typically?

A
  • increase in hormones stimulates insulin production and increases tissue response to insulin
  • typically insulin needs decrease during this trimester
26
Q

how does carbohydrate metabolism change in the second and third trimester typically?

A
  • placenta begins to secrete human placental lactogen
  • increases resistance to insulin and decreases glucose tolerance
  • insulin needs increase (may double or triple by end of pregnancy)
  • increased insulin required to maintain normal concentration
  • results in renal threshold for glucose decreasing
27
Q

what are some negative outcome that can occur because of gestational diabetes?

A
  • increased risk of hypertension
  • polyhydramnios
  • PROM or PPROM
  • preterm labour
  • worsening myopathies (vascular, renal, retinal)
  • increases ketosis
  • increased risk of T2DM later in life
28
Q

why can gestational diabetes lead to polyhydramnios

A

because amniotic fluid is largely made of fetal urine and diabetes increases urine output

29
Q

what are some risk factors for GDM?

A
  • previous history
  • family history of diabetes
  • previous or suspected macrosomia (LGA baby)
  • obesity
  • previous unexplained stillbirth or miscarriage
  • previous infant with hypoglycemia or hyperbilirubinemia
  • polycyctic ovarian syndrome
  • repeated glycosuria or proteinuria in pregnancy
  • ethnicity
30
Q

what are some possible negative fetal effects from GDM?

A
  • macrosomia (LGA baby)
  • intrauterine growth restriction
  • fetal demise
  • congenital anomalies
31
Q

what are some possible negative neonatal effects of GDM?

A
  • hypoglycemia
  • hyperbilirubinemia
  • immature respirator development because insulin interferes with production of surfactant
32
Q

when is screening usually done for GDM?

A

24-28 weeks using a 50g glucose challenge test with a threashold of 7.8 mmol/L (140mg/dL)

-definitive diagnosis with a 75 or 100g GTT

33
Q

what are some strategies to treat GDM?

A
  • diet
  • insulin as needed
  • oral antiglycemics (gilburide or metformin)
  • increase in folic acid up to 5 mg/day
  • BGM 4-7x per day
34
Q

what percentage of women develop T2DM within 5 years of having GDM

A

45-50%

35
Q

why are the numbers of multiple gestations increasing in Canada?

A
  • use of assistive reproduction technologies

- increasing maternal age (which increases likelihood of more than one egg being released at once)

36
Q

what are risks associated with multiple gestation?

A
  • preterm labour
  • anemia
  • hypertension
  • abnormal fetal presentation
  • twin-to-twin transfusion syndrome
  • uterine dysfunction
  • abruptio placentae and placenta previa
  • prolapsed cord
  • PPH
37
Q

what are risks during pregnancy associated with obesity?

A
  • spontaneous abortion/stillbirth
  • hypertension
  • diabetes
38
Q

what are intrapartum risks associated with obesity?

A
  • macrosomia
  • shoulder dystocia
  • difficulty assessing fetus/contractions
  • increased need for C/S
  • anesthesia challenges
  • increased risk of thromboembolism
39
Q

what are neonatal risks associated with obesity?

A
  • hypoglycemia
  • breastfeeding issues
  • birth defects
40
Q

what are some postpartum risks associated with obesity?

A
  • infection
  • decreased mobility
  • thrombosis
  • increased recovery and healing time
41
Q

what are the SOGC recommendation related to obesity?

A
  • begin pregnancy with a BMI of less than 30 ideally
  • if starting with greater than 30, total weight gain should be 7kg
  • take more folic acid preconception and during first trimester
  • exercise
42
Q

what are some physical risks associated with adolescent pregnancy?

A
  • preterm birth
  • low birth weight infants
  • gestational hypertension
  • anemia
  • cephalopelvic disproportion
43
Q

what are some psychosocial risks associated with adolescent pregnancy?

A
  • interruption of maternal developmental tasks
  • substance abuse
  • poverty
  • interruption/cessation of education
  • less prenatal visits
44
Q

what are some risks to baby associated with methadone use by mother?

A
  • reduced head circumference
  • low birth weight
  • withdrawal symptoms
45
Q

what is the upper limit for caffeine per day a pregnant or breastfeeding mother should have?

A
  • no more than 300 mg of caffeine

- approximately 2 250ml cups

46
Q

what are some risks associated with large amounts of caffeine intake in a pregnant woman

A
  • miscarriage
  • premature delivery
  • low birth weight
  • withdrawal symptoms in newborn
47
Q

what does the acronym TORCH stand for?

A 
infections during pregnancy that can cause problems:
Toxoplasmosis
Other (STIs, HIV, Hepatitis, GBS)
Rubella
Cytomegalovirus
Herpes Simplex
48
Q

when are women typically screened for GBS during pregnancy?

A

35-37 weeks

49
Q

what are some risk factors for GBS infection in an infant?

A
  • preterm labour before 37 weeks
  • term rupture of membranes greater than 18 hours
  • unexplained mild fever during labour
  • previous baby with GBS infection
  • previous or present GBS bacteriuria
50
Q

Without treatment, what is the chance of HIV being transmitted from mother to baby?

A

25%

51
Q

with proper treatment, what is the chance of HIV being transmitted from mother to child?

A

2%

52
Q

what are factors that decrease transmission risk of HIV from mother to child?

A
  • mom having behaviors that support healthy immune system
  • combined anti-retroviral therapy
  • appropriate delivery mode based on maternal viral load
  • complimentary treatments
53
Q

what is the three part antiretroviral treatment regimen given to reduce risk of transmission of HIV to an infant:

A
  • pregnancy combination antiretroviral therapy for mom
  • added IV ZDV during labour and/or 3 hours prior to C/S
  • infant given ZDV oral suspension for 6 weeks

Nursing Obstetrics & Pediatrics (26 decks)

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