High Risk PowerPoints (Week 7) Flashcards by Lani Manners

biophysical risk factos

originates with mother or fetus
may affect development and functioning of both
genetic disorders, nutritional and general health status, and medical or obstetric related illness

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kick count that needs to seek help

less than 3 / hr

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crown rump length

crown to sacram

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what is the most valuable diagnostic tool used in OB

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BPP

physical exam of fetus, US, fluid and body/breathing tone, HR

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good BPP scoer

greater than 8

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modified BPP

non stress test and amniotic fluid volume

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US look at

placenta, fetus, and amniotic fluid

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oligo amniotic fluid

1-2cm
not much

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poly amniotic fluid

over distended
>8com

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amniocentesis

after 15 weeks
evaluate genetics = neural tube defects

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moms who are Rh- need

rofolac

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chorionic villus sampling

placental biopsy

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maternal assay

multiple marker screen
- not diagnosis

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first line of fetal testing

kick count

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what do we want for nonstress test

no deceleration
look for variability
acceleration: 15/15, 10/10

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gestational HTN

onset HTN without other findings after 20 weeks

BP >140/90 resolves after giving birth

can develop chronic HTN

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preeclampsia

HTN Proteinuria
develops after 20 weeks
can also develop in PP

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preeclampsia
- in absence of proteinuria

thrombocytopenia
impaired liver funciton
new onset renal insuff
pulmonary edema
new onset cerebral or visual disturbances

The little rabbit poked carrots violently

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BP for severe preeclampsia

160/110

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eclampsia

onset of seizure activity/coma in women with preeclampsia
can develop in PP

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chronic HTN

HTN present before preg or before 20 weeks

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preeclampsia common risk factor

multifetal gestation, HX of preeclampsia, chronic HTN, preexisting diabetes and/or thrombophilias, paternal factors

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cause of preeclampsia

unknown
placental

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preeclampsia - increased endothelial cell perm

water/prtoein leaking out = edema

preeclampsia - reduced kidney perfusion

decrease UO

preeclampsia - decreased liver perfusion

epigastric pain = RUQ pain

preeclampsia - neurological complicatpms

check DTR, HA

HELLP syndrome

hemolysis elevated liver low plateleth

how to diagnose protein uric

24hr urine is best

what might help prevent preeclampsia

low dose aspirin

when to go to ER

abdominal pain, significant headache, vaginal spotting, decrease fetal movement

common SE of mag

flushed warm burning at IV site diaphoretic

therapeutic mag

4-7

medication choies for preventing/treating seizure activity

mag

how is mag given

IVPB

is mag good for BP

no it is neuroprotective

BP meds

Procardia hydrazine labetalol

loading dose of BP

4-6g 15-30min

continue maintenance dose

1-2g / hr

reversal of mag

ca gluconate

s/s of mag tox

lethargic decrease RR no DTR

mag tox what is the priority

turn off mag

seizure care

don't put anything in mouth note time and symptoms

PPH priority

fundus

risk of miscarriage

pregnancy ends in result of natural cause before fetal viability

miscarriage

pregnancy ends as result of natural casuse before fetal viability

beta in miscarriage

go down

miscarriage meds

oxytocin to prevent hemorrhage IM methrogen/hemobate rh-

if there is fever or foul smell

call dr

cervical insuff

passive and painless dilation of the cervix during 2nd tri

diagnosis of cervical insufficient

measurement of vertical length

tx of cervical insuff

cerclage

suture is placed around the cervix beneath the mucosa to constrict the internal os of cervix

cerclage 12-14

profilaxis

cerclage 14-23

rescue

when is a cerclage removed

ectopic preg

the fertilized ovum is implanted outside the uterine cavity

what is the leading cause of infertility

ectopic pregnancy

t/f uterus is the only organ capable of containing and sustain a pregnancy

true

ectopic preg 3 Classic symptoms

abdominal pain delayed menese abnormal vaginal bleeding dull lower quad pain referred pain to the shoulder

beta in ectopic

high

US in ectopic

nothing

ruptured ectopic

non ruptured ectopic

methotrexate - chemo drug destroys rapidly dividing cells

for ectopic we should avoid meds stronger than

Tylenol we do not want to mask s/s of rupture

molar preg

trophoblastic disease no placenta no embryonic or fetal parts

placental previa

painless bright red vaginal bleeding abdominal examination usually reveals a soft, relaxed, nontender uterus and normal tone

placental previa

placenta is over the internal os

placental preja vag exam

placental abruption

detachment of part or all of the placental form implantation site after 20 weeks gestation

placental abruption

vag bleeding, abdominal pain, uterine tenderness, contractions, board line admen

can abruption always able to tell on US

no 50%

velamentous insertion of the cord

cord vessels branch at membranes and then into the placenta umbilical cord does not attach to the placenta correctly

glucose crosses insulin crocess

glucose does insulin docent

dm not in good control

increase risk for miscarriage

preconception counseling

tight glycemic control

does the insulin regimen change frequently

yes

t/f first 24 hours insulin requirements drop substinally

yes

hyperemesis gravidarum

so much vomiting there is wt loss, electrolyte imbalance, nutritional def, ketonuria

hyperemesis gravidarum tx

B6 and doxalamine