High Risk PowerPoints (Week 7) Flashcards
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
kick count that needs to seek help
less than 3 / hr
crown rump length
crown to sacram
what is the most valuable diagnostic tool used in OB
US
BPP
physical exam of fetus, US, fluid and body/breathing tone, HR
good BPP scoer
greater than 8
modified BPP
non stress test and amniotic fluid volume
US look at
placenta, fetus, and amniotic fluid
oligo amniotic fluid
1-2cm
not much
poly amniotic fluid
over distended
>8com
amniocentesis
after 15 weeks
evaluate genetics = neural tube defects
moms who are Rh- need
rofolac
chorionic villus sampling
placental biopsy
maternal assay
multiple marker screen
- not diagnosis
first line of fetal testing
kick count
what do we want for nonstress test
no deceleration
look for variability
acceleration: 15/15, 10/10
gestational HTN
onset HTN without other findings after 20 weeks
BP >140/90 resolves after giving birth
can develop chronic HTN
preeclampsia
HTN Proteinuria
develops after 20 weeks
can also develop in PP
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
BP for severe preeclampsia
160/110
eclampsia
onset of seizure activity/coma in women with preeclampsia
can develop in PP
chronic HTN
HTN present before preg or before 20 weeks
preeclampsia common risk factor
multifetal gestation, HX of preeclampsia, chronic HTN, preexisting diabetes and/or thrombophilias, paternal factors
cause of preeclampsia
unknown
placental
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
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
36
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
OR
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
no
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
