High risk antepartum

Question 1

What are maternal risks and complications?

Answer 1

Macrosomia 
Polyhydramnios
Ketoacidosis
Hyperglycemia
Hypoglycemia

Question 2

What are fetal and neonatal risks?

Answer 2

Sudden and unexplained stillbirth 
Congenital malformations
Cardiovascular system
Central nervous system
Skeletal system
Other problems that cause significant neonatal morbidity

Question 3

What consists of an antepartum evaluation?

Answer 3

Interview
Physical examination
Laboratory tests
Baseline renal function
Glycosylated hemoglobin A
Patient needs much more frequent monitoring

Question 4

list diabetic managements…

Answer 4

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

Question 5

When do you screen for gestational diabetes?

Answer 5

Between 24-28 weeks

Question 6

Tell me about gestational diabetes during antepartum?

Answer 6

Diet and exercise
Monitoring blood glucose levels
Insulin/medication therapy
Fetal surveillance

Question 7

Tell me about gestational diabetes during intrapartum?

Answer 7

Monitor patient closely
Complications
May require a cesarean birth

Question 8

Tell me about gestational diabetes during postpartum care?

Answer 8

Insulin requirements decrease substantially
Encourage breastfeeding
Contraception

Question 9

If hypothyroidism isn’t treated during pregnancy what can it cause?

Answer 9

If untreated at risk for infertility and miscarriage

Question 10

Tell me about hyperthyroidism in pregnancy?

Answer 10

Graves’ disease is 90% to 95% of cases

Rare in pregnancy

Question 11

Should you breastfeed with maternal phenylketonuria?

Answer 11

no it is advised against.

Question 12

What is maternal phenylketonuria and what does it cause?

Answer 12

• 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

Question 13

Women in reproductive years show prediction of what?

Answer 13

autoimmune disorders (e.g., systemic lupus erythematosus and myasthenia gravis) and may occur during pregnancy

PRECONCEPTION COUNSELING IS KEY

Question 14

Major cardiovascular changes in pregnancy ?

Answer 14

• Increased intravascular volume
• Decreased systemic vascular resistance
• Cardiac output changes during labor and birth
• Intravascular volume changes that occur just after childbirth

Question 15

What are the cardiovascular disease classifications?

Answer 15

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

Question 16

How do cardiovascular diseases affect pregnancy?

Answer 16

• 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

Question 17

What are congenital cardiac diseases?

Answer 17

• Atrial septal defect
• Ventricular septal defect
• Coarctation of the aorta
• Tetralogy of Fallot

Question 18

What are acquired cardiac disease?

Answer 18

Mitral valve prolapse
Mitral valve stenosis
Aortic stenosis

Question 19

Plan of care and implementation for cardiac problems?

Answer 19

• 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

Question 20

What are the anemias?

Answer 20

Iron deficiency anemia

Folic acid deficiency anemia

Sickle cell hemoglobinopathy

Thalassemia

Question 21

What are women in pregnancy who have asthma at risk for?

Answer 21

POSTPARTUM HEMORRHAGE

therapy objectives? relieve bronchospasm

Question 22

What are skin disorders aggravated by pregnancy?

Answer 22

Acne vulgaris
Neurofibromatosis
Pruritic urticarial papules and plaques
Intrahepatic cholestasis

Question 23

What should HIV infected women be treated with?

Answer 23

highly active antiretroviral therapy

Question 24

What is the goal in pregnant women infected with HIV?

Answer 24

Goal is to minimize neonate’s exposure to blood and secretions.

Question 25

Does pregnancy accelerate the condition of

HIV?

Answer 25

No

Question 26

Nursing care management?

Answer 26

• 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

Question 27

Barriers to treatment?

Answer 27

Less than 10% of pregnant women receive treatment
Substance-abuse treatment programs
Long waiting lists and lack of health insurance
Drug use often denied

Question 28

Care management substance abuse?

Answer 28

Drug testing during pregnancy
Screening for substance abuse
Initial care
Methadone maintenance program
Follow-up care
Non-judgmental attitude is crucial
Breastfeeding is contraindicated