High risk antepartum Flashcards
What are maternal risks and complications?
Macrosomia Polyhydramnios Ketoacidosis Hyperglycemia Hypoglycemia
What are fetal and neonatal risks?
Sudden and unexplained stillbirth Congenital malformations Cardiovascular system Central nervous system Skeletal system Other problems that cause significant neonatal morbidity
What consists of an antepartum evaluation?
Interview Physical examination Laboratory tests Baseline renal function Glycosylated hemoglobin A Patient needs much more frequent monitoring
list diabetic managements…
Diet and exercise Insulin therapy ( see picture below!) Monitoring blood glucose levels Urine testing Determination of birth date and mode of birth Complications requiring hospitalization Fetal surveillance
When do you screen for gestational diabetes?
Between 24-28 weeks
Tell me about gestational diabetes during antepartum?
Diet and exercise
Monitoring blood glucose levels
Insulin/medication therapy
Fetal surveillance
Tell me about gestational diabetes during intrapartum?
Monitor patient closely
Complications
May require a cesarean birth
Tell me about gestational diabetes during postpartum care?
Insulin requirements decrease substantially
Encourage breastfeeding
Contraception
If hypothyroidism isn’t treated during pregnancy what can it cause?
If untreated at risk for infertility and miscarriage
Tell me about hyperthyroidism in pregnancy?
Graves’ disease is 90% to 95% of cases
Rare in pregnancy
Should you breastfeed with maternal phenylketonuria?
no it is advised against.
What is maternal phenylketonuria and what does it cause?
- Toxic accumulation of phenylalanine in blood
- Cause of mental retardation caused by deficiency in enzyme phenylalanine hydrolase
Mental retardation, microcephaly, congenital heart disease, and intrauterine growth retardation
Women in reproductive years show prediction of what?
autoimmune disorders (e.g., systemic lupus erythematosus and myasthenia gravis) and may occur during pregnancy
PRECONCEPTION COUNSELING IS KEY
Major cardiovascular changes in pregnancy ?
- Increased intravascular volume
- Decreased systemic vascular resistance
- Cardiac output changes during labor and birth
- Intravascular volume changes that occur just after childbirth
What are the cardiovascular disease classifications?
Cardiovascular disease classification
Class I: Asymptomatic
Class II: Symptoms with greater than normal activity
Class III: Symptoms with regular activity
Class IV: Symptoms at rest
How do cardiovascular diseases affect pregnancy?
- Increased incidence of miscarriage
- Preterm labor and birth more prevalent
- Intrauterine growth restriction is more common
- Incidence of congenital heart lesions
- Standard cardiac life support measures without modification should be implemented
What are congenital cardiac diseases?
- Atrial septal defect
- Ventricular septal defect
- Coarctation of the aorta
- Tetralogy of Fallot
What are acquired cardiac disease?
Mitral valve prolapse
Mitral valve stenosis
Aortic stenosis
Plan of care and implementation for cardiac problems?
- Therapy focused on minimizing stress on heart
- Signs and symptoms of cardiac decompensation
- Bed rest
- Nutrition counseling
- Cardiac medications as needed
- Anticoagulant therapy
- Heparin: large-molecule drug does not cross placenta
- Intrapartum care
- Care focuses on promoting cardiac function
- Prophylactic antibiotics
- Postpartum care
- Monitoring for cardiac decompensation
What are the anemias?
Iron deficiency anemia
Folic acid deficiency anemia
Sickle cell hemoglobinopathy
Thalassemia
What are women in pregnancy who have asthma at risk for?
POSTPARTUM HEMORRHAGE
therapy objectives? relieve bronchospasm
What are skin disorders aggravated by pregnancy?
Acne vulgaris
Neurofibromatosis
Pruritic urticarial papules and plaques
Intrahepatic cholestasis
What should HIV infected women be treated with?
highly active antiretroviral therapy
What is the goal in pregnant women infected with HIV?
Goal is to minimize neonate’s exposure to blood and secretions.
Does pregnancy accelerate the condition of
HIV?
No
Nursing care management?
- Immediately after birth infants
- No fetal scalp electrode
- Babies will be treated
- ↑ viral load= c/section
- Goal is to ↓viral load
- Infection control - Observe Standard Precautions for -blood and other body fluids
Barriers to treatment?
Less than 10% of pregnant women receive treatment
Substance-abuse treatment programs
Long waiting lists and lack of health insurance
Drug use often denied
Care management substance abuse?
Drug testing during pregnancy Screening for substance abuse Initial care Methadone maintenance program Follow-up care Non-judgmental attitude is crucial Breastfeeding is contraindicated
