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OB > High Risk Preg > Flashcards

High Risk Preg Flashcards

1
Q

What are the two broad categories of high risk pregnancies?

A
  • Those specific to pregnancy

- Those that occur anytime but complicate a pregnancy

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2
Q

A hemmorhagic condition of early pregnancy is ____

A

Abortion

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3
Q

What is an abortion?

A

Loss of pregnancy before the fetus is viable or capable of living outside of the uterus

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4
Q

Abortions occur before ____ weeks

A

20

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5
Q

____% of pregnancies end in a spontaneous abortion

A

18-31%

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6
Q

___% of spontaneous abortions occur during the first trimester. May before ___ occurs

A

50-70%

-Implantation

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7
Q

What is the most common cause of spontaneous abortions?

A

Sever congenital abnormalities

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8
Q

What are the three types of abortions?

A
  • Threatened
  • Inevitable
  • incomplete
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9
Q

What is a threatened abortion?

A

When vaginal bleeding occurs

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10
Q

What is a inevitable abortion?

A

When the membranes rupture and the cervix dilates

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11
Q

What is an incomplete abortion?

A

When some products of conception have been expelled but some remain

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12
Q

What are some caused of recurrent spontaneous abortions?

A
  • Cervical incompetence
  • Decreased progesterone
  • Incompatability
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13
Q

How may a ruptured etopic pregnancy present?

A
  • Severe pelvic pain

- Bleeding may be concealed

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14
Q

What are some s/s of a SAB?

A
  • Bleeding
  • Pain
  • Uterine cramping
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15
Q

What is the focus of care after a SAB?

A
  • Determie the amount of blood loss and pain assessment
  • Est blood loss by examining linen or peripads
  • Vitals
  • H/H
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16
Q

What are the two hemorrhagic conditions of late pregnancy and when do they occur?

A

20 weeks or more

  • Placenta previa
  • Placental abruption
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17
Q

What is placenta previa?

A

Abnormal implantation of the placenta in the lower uterus

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18
Q

What are the three classifications of placenta previa?

A
  • Marginal
  • Partial
  • Total
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19
Q

What is a marginal placenta previa?

A

-Implanted in lower uterus but its lower border is more than 3cm away from cervix

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20
Q

What is a partial placenta previa?

A

-implanted in lower uterus but is within 3cm of cervix without fully covering it

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21
Q

What is a total placenta previa?

A

Placenta completely covers the cervix os

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22
Q

What is the classic sign on a placenta previa?

A

Sudden onset of painless uterine bleeding in the last half of pregnancy
-Bleeding may only start at the onset of labor

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23
Q

If placenta previa is suspected, what is the major consideration?

A
  • No vaginal exams until location of the placenta is determined
  • Stop oxytocin
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24
Q

What are the options of management for placenta previa?

A
  • It is based on the condition of the mother and fetus
  • If mother and fetus are healthy but immature, careful monitoring can be done
  • If conditions are poor, induction or hospitalization may be needed
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25
Q

What conditions need to be met for a woman to have home care with placenta previa?

A
  • No active bleeding
  • Able to maintain bed rest
  • lives close to hospital with emergency systems available
  • Can verbalize risks and management plans if Hemorrhage occurs
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26
Q

What are the 4 teaching points for Placenta Previa?

A
  • Assessing color and amount of vag d/c or bleeding
  • Assessing fetal activity daily
  • Assessing uterine activity at prescribed intervals
  • Refraining from sexual intercourse to prevent disruption of the placenta
27
Q

What is Abruptio Placentae?

A

Separation of a normally implanted placenta before the fetus is born occurs in cases of bleeding and formation of a hematoma on the maternal side of the placenta

28
Q

What are the major effects of Abruptio Placentae on the mom?

A

are hemorrhage and consequent hypovolemic shock and clotting abnormalities

29
Q

What are the What are the major effects of Abruptio Placentae on the fetus?

A

asphyxia, excessive blood loss, and prematurity

30
Q

What are the classic s/s of Abruptio Placentae?

A
  • Bleeding after 20w
  • Tender/irritable uterus
  • Abdominal/back pain
  • High uterine resting tone
  • Board like abdomine
  • Port wine AF
  • Nonreassuring FHR
  • Signs of hypovolemic shock
31
Q

What are the two type of placenta abruption?

A
  • Concealed

- Hemorrhage apparent

32
Q

Describe the therapeutic management of a woman with abruptio placentae

A
  • Hospitalization
  • Focus on CV status and fetal condition
  • If compromise occurs immediate delivery is needed
  • rhogam if indicated
33
Q

If the Abruptio Placentae is mild, what is the management like?

A
  • Bedrest
  • Tocolytic use possible
  • Steroids to help fetal lung maturity
  • Rarely is this done
34
Q

What are the nursing considerations if a Abruptio Placentae indicates an immediate c-section?

A
  • the woman may feel powerless as the health care team hastily prepares her for surgery
  • Nurse should explain the anticipated procedures to the woman and her family to reduce fear and anxiety
  • Excessive bleeding and fetal hypoxia are always major concerns – need continuous fetal monitoring
35
Q

Assessments during a Abruptio Placentae include,

A
  • Amount and nature of bleeding
  • Pain
  • Maternal VS
  • FHR/contractions
  • OB hx
  • Length of gestation
36
Q

When assessing the fundal height to determine gestational age during a Abruptio Placentae, what is considered?

A

-Fundal tone/height can be elevated and may not give an accurate measure

37
Q

What lab data is collected in a Abruptio Placentae?

A
  • CBC
  • T and S
  • Blood type and Rh factor
  • Coag studies
  • Drug screen to detect cocaine
38
Q

What is DIC?

What happens?

A

Life-threatening defect in coagulation

-Some factor initiates clotting mechanisms inappropriately

39
Q

Describe metabolic changes in early pregnancy that are important for DM management

A
  • Early metabolic rates have little change
  • Insulin response accelerates to make more glucose available for fetal cells
  • Hypoglycemia can occur
40
Q

What two common occurrences during early pregnancy can lead to increased hypoglycemia?

A
  • N/V

- Anorexia

41
Q

Describe metabolic changes in Late pregnancy that are important for DM management

A
  • Rise in placental hormones
  • Estrogen, progesterone, and hPL create a maternal insulin resistance to conserve blood glucose for the infant
  • This causes hypoglycemia in mom
42
Q

How does PP breast feeding help with a mother who has insulin resistance?

A

The increased caloric use reduced the amount of insulin needed

43
Q

Describe the reason for neonatal hypoglycemia? link it to mothers with DM

A
  • The fetus produced extra insulin to adjust for the mothers increased BG
  • This causes the infants pancreas to produce more insulin after birth
  • The increased insulin is too high for the now normal GB levels of the neonate
  • The excess insulin causes the use of the infants GB and causes Hypoglycemia
44
Q

How does maternal DM cause neonatal hypocalcemia?

A

Hyperparathyroidism in the DM mother causes low calcium levels in the fetus

45
Q

Link Neonatal RDS with maternal DM

A
  • too much insulin will retard cortisol production

- Cortisol is needed for the infant to produce surfactant

46
Q

What are the fetal risks involved with a mother with DM?

A
  • Congenital abnormalities
  • NTD’s
  • Polyhydramnios
  • LGA
  • Hypoglycemia
47
Q

What type of fetal surveillance should be done for a pregnant mother with DM

A
  • ID markers that suggest a poor intauterine environment
  • Kick counts, BPP, NST’s, CST’s
  • Serial sonograms to document fetal growth rates
  • Dopplers of the umbilical artery to assess vascular complications
48
Q

Describe the therapeutic management of a pregnant mother with DM

A
  • Maintain normal blood glucose levels
  • Facilitate the birth of a health baby
  • Avoid accelerated impairment of blood vessels and other major organs
  • Perinatologist/MFM
  • Preconception care important
49
Q

Describe the timing of delivery for moms with DM

A
  • Preg should be allowed to progress past 39 weeks

- Amnio is needed to determine FLM if before 38 weeks

50
Q

What are the major risk factors for GDM?

A
  • BMI > 25 to 25.9) obesity, or morbidly obese
  • Maternal age older than 25
  • Previous birth outcome often assoc with GDM (neonatal macrosomia, maternal HTN, infant with unexplained congenital anomalies, previous fetal death)
  • GDM in prvious preg
  • History of abnormal glucose tolerance
  • DM in a first-degree relative
  • Member of a high-risk ethnic group (A-A, Hispanic, latinao, American Indian, Asian American or pacific islander)
  • Hx of prediabetes
  • PCOS
51
Q

When are women screened for GDM and what are the two main screening tools?

A

When she has one or more risk factors

  • Glucose challenge test
  • 3-hour OGTT (gold standard)
52
Q

Describe the Glucose Challenge test

A
  • Administered between 24 and 28 weeks
  • Fasting is not necessary for a GCT
  • No need to follow any pretest dietary instructions
  • Ingest 50 g oral glucose solution
  • Blood sample is taken 1 hour later
  • If the blood glucose is > 140 mg/dl one hour later, a 3-hour GTT is recommended (some use > 135 mg/dl)
53
Q

Describe the 3-hour OGTT

A

Fasting plasma gluco level is determined. Ingest 100 g of oral glucose solution. Plasma glu done at 1, 2, and 3 hours.

54
Q

When is GDM diagnosed via the 3-hour OGTT?

A 
Dx of GDM is made if two or more of the values meet or exceed the threshold:
Fasting 95 mg/dl
1 hour: 180 mg/dl
2 hours: 155 mg/dl
3 hours: 140 mg/dl
55
Q

Describe the ther. management of a mother with GDM

A
  • Diet and exercise
  • Glu monitoring
  • Pharm treatment if needed
56
Q

HEart disease complicates ____ pregnancies

A

1-4%

57
Q

What are the two categories of heart disease?

A
  • Acquired

- Congenital

58
Q

What are the main types of acquired heart disease?

A
  • Rheumatic
  • Valvular stenosis
  • MI
  • Cardiomyopathy
59
Q

What are the common s/s of a heart disease?

A
  • Dyspnea, syncope (fainting) with exertion
  • Hemoptysis
  • Paroxysmal nocturnal dyspnea
  • Chest pain with exertion
  • Additional signs
60
Q

__ delivery is recommended for women with heart disease

A

Vaginal

61
Q

What are two interventions to prevent complications of heart disease during labor?

A
  • Minimze pushing

- Limit prolonged labor

62
Q

Mothers with a heart disease are at high risk for

A
  • PP decompensation
  • infection
  • Hemorrhage
  • thromboembolism
63
Q

What are some s/s of congestive heart failure

A
  • Cough (frequent, productive, hemoptysis)
  • Progressive dyspnea with exertion
  • Orthopnea
  • Pitting edema of legs and feet or generalized edema of face, hands, or sacral area
  • Heart palpitations
  • Progressive fatigue or syncope with exertion
  • Moist rales in lower lobes, indicating pulmonary edema
  • Altered level of consciousness

OB (14 decks)

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