High Risk Preg Flashcards
What are the two broad categories of high risk pregnancies?
- Those specific to pregnancy
- Those that occur anytime but complicate a pregnancy
A hemmorhagic condition of early pregnancy is ____
Abortion
What is an abortion?
Loss of pregnancy before the fetus is viable or capable of living outside of the uterus
Abortions occur before ____ weeks
20
____% of pregnancies end in a spontaneous abortion
18-31%
___% of spontaneous abortions occur during the first trimester. May before ___ occurs
50-70%
-Implantation
What is the most common cause of spontaneous abortions?
Sever congenital abnormalities
What are the three types of abortions?
- Threatened
- Inevitable
- incomplete
What is a threatened abortion?
When vaginal bleeding occurs
What is a inevitable abortion?
When the membranes rupture and the cervix dilates
What is an incomplete abortion?
When some products of conception have been expelled but some remain
What are some caused of recurrent spontaneous abortions?
- Cervical incompetence
- Decreased progesterone
- Incompatability
How may a ruptured etopic pregnancy present?
- Severe pelvic pain
- Bleeding may be concealed
What are some s/s of a SAB?
- Bleeding
- Pain
- Uterine cramping
What is the focus of care after a SAB?
- Determie the amount of blood loss and pain assessment
- Est blood loss by examining linen or peripads
- Vitals
- H/H
What are the two hemorrhagic conditions of late pregnancy and when do they occur?
20 weeks or more
- Placenta previa
- Placental abruption
What is placenta previa?
Abnormal implantation of the placenta in the lower uterus
What are the three classifications of placenta previa?
- Marginal
- Partial
- Total
What is a marginal placenta previa?
-Implanted in lower uterus but its lower border is more than 3cm away from cervix
What is a partial placenta previa?
-implanted in lower uterus but is within 3cm of cervix without fully covering it
What is a total placenta previa?
Placenta completely covers the cervix os
What is the classic sign on a placenta previa?
Sudden onset of painless uterine bleeding in the last half of pregnancy
-Bleeding may only start at the onset of labor
If placenta previa is suspected, what is the major consideration?
- No vaginal exams until location of the placenta is determined
- Stop oxytocin
What are the options of management for placenta previa?
- 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
What conditions need to be met for a woman to have home care with placenta previa?
- 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
What are the 4 teaching points for Placenta Previa?
- 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
What is Abruptio Placentae?
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
What are the major effects of Abruptio Placentae on the mom?
are hemorrhage and consequent hypovolemic shock and clotting abnormalities
What are the What are the major effects of Abruptio Placentae on the fetus?
asphyxia, excessive blood loss, and prematurity
What are the classic s/s of Abruptio Placentae?
- 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
What are the two type of placenta abruption?
- Concealed
- Hemorrhage apparent
Describe the therapeutic management of a woman with abruptio placentae
- Hospitalization
- Focus on CV status and fetal condition
- If compromise occurs immediate delivery is needed
- rhogam if indicated
If the Abruptio Placentae is mild, what is the management like?
- Bedrest
- Tocolytic use possible
- Steroids to help fetal lung maturity
- Rarely is this done
What are the nursing considerations if a Abruptio Placentae indicates an immediate c-section?
- 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
Assessments during a Abruptio Placentae include,
- Amount and nature of bleeding
- Pain
- Maternal VS
- FHR/contractions
- OB hx
- Length of gestation
When assessing the fundal height to determine gestational age during a Abruptio Placentae, what is considered?
-Fundal tone/height can be elevated and may not give an accurate measure
What lab data is collected in a Abruptio Placentae?
- CBC
- T and S
- Blood type and Rh factor
- Coag studies
- Drug screen to detect cocaine
What is DIC?
What happens?
Life-threatening defect in coagulation
-Some factor initiates clotting mechanisms inappropriately
Describe metabolic changes in early pregnancy that are important for DM management
- Early metabolic rates have little change
- Insulin response accelerates to make more glucose available for fetal cells
- Hypoglycemia can occur
What two common occurrences during early pregnancy can lead to increased hypoglycemia?
- N/V
- Anorexia
Describe metabolic changes in Late pregnancy that are important for DM management
- 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
How does PP breast feeding help with a mother who has insulin resistance?
The increased caloric use reduced the amount of insulin needed
Describe the reason for neonatal hypoglycemia? link it to mothers with DM
- 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
How does maternal DM cause neonatal hypocalcemia?
Hyperparathyroidism in the DM mother causes low calcium levels in the fetus
Link Neonatal RDS with maternal DM
- too much insulin will retard cortisol production
- Cortisol is needed for the infant to produce surfactant
What are the fetal risks involved with a mother with DM?
- Congenital abnormalities
- NTD’s
- Polyhydramnios
- LGA
- Hypoglycemia
What type of fetal surveillance should be done for a pregnant mother with DM
- 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
Describe the therapeutic management of a pregnant mother with DM
- 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
Describe the timing of delivery for moms with DM
- Preg should be allowed to progress past 39 weeks
- Amnio is needed to determine FLM if before 38 weeks
What are the major risk factors for GDM?
- 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
When are women screened for GDM and what are the two main screening tools?
When she has one or more risk factors
- Glucose challenge test
- 3-hour OGTT (gold standard)
Describe the Glucose Challenge test
- 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)
Describe the 3-hour OGTT
Fasting plasma gluco level is determined. Ingest 100 g of oral glucose solution. Plasma glu done at 1, 2, and 3 hours.
When is GDM diagnosed via the 3-hour OGTT?
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
Describe the ther. management of a mother with GDM
- Diet and exercise
- Glu monitoring
- Pharm treatment if needed
HEart disease complicates ____ pregnancies
1-4%
What are the two categories of heart disease?
- Acquired
- Congenital
What are the main types of acquired heart disease?
- Rheumatic
- Valvular stenosis
- MI
- Cardiomyopathy
What are the common s/s of a heart disease?
- Dyspnea, syncope (fainting) with exertion
- Hemoptysis
- Paroxysmal nocturnal dyspnea
- Chest pain with exertion
- Additional signs
__ delivery is recommended for women with heart disease
Vaginal
What are two interventions to prevent complications of heart disease during labor?
- Minimze pushing
- Limit prolonged labor
Mothers with a heart disease are at high risk for
- PP decompensation
- infection
- Hemorrhage
- thromboembolism
What are some s/s of congestive heart failure
- 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
