High Risk Pregnancy (1) Flashcards
what is an endocrine disorder involving inadequate insulin
diabetes mellitus
describe diabetes in early and late pregnancy?
- early = hormones stimulate insulin prod. and increase insulin response (low sugar)
- late = hyperglycemia and resistance to insulin, may have ketones in urine d/t fat metabolism (high sugar)
what is diabetes diagnosed through preganacy
gestational DM
will a gestational diabetic be diabetic for the rest of her life?
no
what is the normal reading of a 1hr gluc tolerance test?
135-140
what happens if a 1hr GTT exceeds 140?
3hr GTT is ordered
what are suspicious 3hr GTT results by hour?
- fasting= >95
- 1hr= >180
- 2hr= >155
- 3hr= >140
what is hyperglycemia from low insulin, inc. ketones in blood when fatty acids metabolize
ketoacidosis
what is when blood settles in the vasculature, associated w/ high blood sugar
vascular disease
what is neuropathy implication of pregnancy
settling sugar inc. blood sugar
what is when sugar settles in microvasculature of eyes
retinopathy
what is an increased amniotic fluis
hydramnios
what is dystocia
cephalic dysproportion (difficult labor)
what are some fetal implications of diabetes?
- inc. risk fetal death
- congenital abnormalities
- LGA/macrosomia
- intrauterine growth restriction!!! (IUGR)
- resp. distress syndrome
- hyperbilirubinemia
- hypocalcemia
if the baby is LGA and the mother has gestational diabetes, what can this mean for labor?
baby has low sugar! its not diabetic, lots of insulin
what are the insulin requirements in early and late pregnancy along with postpartum
- early= insulin need decreases
- late= insulin need greatly increases
- PP= insulin need decreases
who is at risk for gestational diabetes?
- women w/ hyperglycemia, glucosuria, obesity
- fam history
- prior LGA baby
- previous fetal demise
what diet should be encouraged with GDM?
ADA diet, low in carbs and calorie counting
what 3 things should be assessed in GDM/DM
- height/weight
- preg dates and fundascopic exam
- neuropathy and infection
what tests are used to assess the fetus of a diabetic mother?
- presence of fetal mvmt
- non stress test (NST)
- bio physical profile (BPP)
- ultrasound
what are the 2 types of anemia?
- insufficient hemoglobin production
- hemoglobin destruction
what are the types of insufficient hemoglobin production anemia and what is it r/t?
- iron deficient and folate deficient
- r/t nutritional deficiency
what is the main tyoe of hemoglobin desctruction anemia and what is it from
- sickle cell anemia
- r/t inherited disorders
what are possible complications from iron deficient anemia
-infection
-fatigue
-preeclampsia
tolerate blood loss poorly
what are possible fetal complications of iron deficient anemia
- low birth weight
- preterm delivery
- fetal demise
- neonatal death
prevention of iron deficienct anemia
- prenatal vitamins
- 60-120 mg iron/day
- iron rich diet
what are maternal complications of folate deficient (megaloblastic) anemia?
- n/v
- anorexia
prevention of folate deficient anemia
- 0.4 mg foalte/day
- 1 mg folate+iron supplement
what are possible fetal complications of folate deficient anemia
neural tube defects
who is at risk for sickle cell
autosomal recessive disorder
symptoms/complications of sickle cell
- abd/joint pain
- infection, CHF, renal failure
treatment of sickle cell anemia?
folic acid, prompt infection treatment, hospitalization during crisis
what are possible fetal complications of sickle cell
- fetal death
- prematurity
- IUGR
what is when abnormal hemoglobin is made and there is resulting excessive breakdown of blood cells. hepatosplenomegaly and bony formations may be present
thalassemia
who is at risk for thalassemia?
those from greece, italy, and china
what is treatment for thalassemia
folic acid, transfusion, chelation
what is the life expectancy of thalassemia without treatment
20-30 yr
describe mitral valve prolpase
mitral vlave leaflets prolapse into the left atrium
-regurgitation may result
-genrally asymptomatic
what is mitral valve prolapse treated with?
inderal
what is peripartum cardiomyopathy and when does it occur
- left ventricle dysfunction w/ no previous hx of herat diease
- occurs in second half of pregnancy
what are symptoms of peripartum cardiomyopathy
CP, dyspnea, orthopnea, weakness, edema
what is management of labor with heart disease
- no/slight limitation= may labor normal
- may limit pushing
- limit pain/anxiety (can inc. stress to heart)
what are the criteria for spontaneous abortion?
miscarriage prior to 20w
what kind of abortion is unexplained bleeding, cramping, cervix closed, possible abortion
threatened abortion
what kinf of abortion is where she is going to miscarry, inc. bleeding/cramping, cervix dialted, membrane rupture
imminent abortion
what kind of abortion is where parts of products are retained
incomplete abortion
what kind of abortion is where all products of cenception are expelled
complete abortion
what kind of abortion is where fetus dies in utero and is not expelled
missed abortion
what is a preganncy that implants outosde of the uterus
ectopic pregnancy
what is the most common site of an ectopic pregnancy
fallopian tube
is an ectopic pregnancy viable?
no
if an ectopic pregnancy is in the fallopian tube, does the tube have to be removed?
yes
what does hydratiform molar pregnancy consist of?
- gestational trophoblastic disease
- trophoblastic cells abnormally proliferate
- loss of pregnancy
- possible choriocarcoma
what is n/v so severe that it affects hydration and nutritional status
hyperemesis
what is the possible cause of hyperemesis?
- control n/v
- correct fluid/electrolyte imbalance
- adequate nutrition
- meds (B6, phenergan, reglan, zofran)
- TPN
- BRAT diet (banana, rice, applesause, toast)
what classifies as preeclampsia?
- inc. BP after 20 wk
- proteinuria
what classifies eclampsia?
presence of seizure in preeclamptic woman
what are maternal vasospasms result in decreased perfusion
preeclampsia
what comes from dec. uteroplacental perfusion
IUGR
what is from decreased hepatic perfusion
- liver enzymes, RUQ pain
what is from dec. renal perfusion
dec, urine output, proteinuria, BUN inc, creatinine inc., edema
what are some assessment details for preeclampsia?
- BP
- fetal HR
- bleeding
- HA
- DTRs!!
- clonus (push feet back, they would flutter)!!!
- edema
- urinary output/protein
- BUN/creatinine
- LOC
assessment parts of eclampsia?
- body involvement
- duration
- fetal status
- prevent injury
- maintain resp ability
what is HELLP syndrome
- Hemolysis
- Elevated (down)
- Liver enzymes
- Low
- platelets (less than 100,000)
what are some symptoms of HELLP syndrome
n/v, malaise, flu-like, epigastric
what is the goal of severe preeclampsia
prevent seizures, prevention of liver disease, and maintain pregnancy
what are some managemant of preeclampsia?
- bedrest
- mag sulfate (CNS depression)
- corticosteroids
- antihypertensives
what is the only sure for preeclampsia?
birth
what is the loading dose of mag sulfate?
6 gm bolus over 20-30 mins
what is the maintenance dose of mag sulfate
2-3 gm/hr
what is the antidote of mag sulfate?
calcium gluconate
what are side effects of mag sulfate (toxic?)
- flushing/warmth
- HA
- blurred vision
- lethargy
- pulmonary edema
nursing assessment of mag sulfate?
- HA
- vision changes
- DTRs
- CP/SOB
- arousal
what blood type does Rh incompatibility effect?
Rh- mom, Rh+ baby
what is erythroblastosis fetalis?
severe hemolytic disease of the fetus and newborn
what is hydrops fetalis
edema r/t anemia
what can come from Rh alloimmunization
- erythroblastosis fetalis
- hydrops fetalis
- CHF
- hyperbilirubinemia
- kernicterus
what test tests the newborn for Rh sensitization
direct coomb’s test
what test tests the mother for Rh sensitization
indirect coomb’s test
in a direct or indirect coomb’s test, ____ reult means no sensitization
negative (good result)
what estimates the extent of bleeding for administration of the appropriate amount of Rh immune globulin
Kleihauer-Betke test
hiw can an ABO blood incompatibility cause anemia in the newborn?
if mother in type o and baby is A or B, anti a and anti b are naturally occuring
when does puberty occur in women
12-13
what are the contributing factors of teen pregnancy
- lack of foresight
- peer pressure
- sex is popular in music/tv
- family dysfunction
- r/o incest
what are maternal physiologic risks of teen pregnancy
- many dont follow through with prenatal care
- smoking
- greater STIs
- greater preeclampsia risk
what are newborn physiologic risks of teen pregnancy
- preterm birth
- low birth weight
- cephalopelvic disproportion
are the fathers of teen pregnancy usually older or younger than the mother?
older! most are older than 20
what is defined as advanced age in pregnancy
35
what are maternal medical risks of advanced age pregnancy?
- higher incidence of chronic med conditions
- diabetes
- HTN
- placenta previa
- dystocia
what are fetal/newborn medical risks of advanced age pregnancy?
- miscarriage
- genetic issues (downs)
- preterm birth
- low birth weight
what maternal conditions are indications for fetal assessment?
- HTN
- diabetes
- renal and heart diease
- hyperthyroidism
- hemolobinopathies
what prenatal factors are indications for fetal assessment?
- preeclampsia
- dec. fetal mvmt
- oligohydramnios (dec. amnio fluid)
- hydramnios
- IUGR
- post-term preg
- Rh incompat (isoimmunization)
- previous demise
- multiples
- fetal anolamy
what does presence of fetal mvmt indicate
fetal oxygenation and CNS integrity
when should fetal kick counts be done
same time every day, one hour after meals
how should fetal kick count be counted, and what is the minimum norm?
- count # of fetal mvmts within 30 mins, 3 times per day
- should be at least 3 mvmts in 30 mins
what is a concerningly low fetal kick count
less than 10 mvmts in 3 hours or mvmt slowing in morning
normal fetal HR?
110-160
what is tachycardia in fetal monitoring?
greater than 160 for at least 10 mins
what is bradycardia in fetal monitoring?
less than 110 for 10 mins (concerning!!)
what causes late decels?
uteroplacental insufficiency
what causes variable decelerations
cord compression
what causes early decelerations
head compression
what is the use of external fetal monitoring for observation of accelerations with fetal mvmt
nin stress test (NST)
how long is fetal HR monitored in an NST?
20 mins
what does a reactive NST show?
- normal
- 2 accelerations at least 15 bpm above base, lasting at least 15 secs
what does a nonreactive NST show?
- abnormal
- lack sufficient acceleration
what test assesses response of FHR to contractions
contraction stress test
how many contractions and length are needed for contraction stress test?
3 contractions of 40 sec within 10 mins
are contraction stress test contractions induced or spontaneous? what are risks?
could be either, risk is going inti labor
what does a negative contraction stress test mean?
there are no signoficant decels (good!!!!!)
what does a positive contraction stress test show?
presence of late decels with at least 50% of contractions
what does a biophysical profile include?
NST and ultrasound
what 5 factors are considered for a bio physical profie
- FHR accelerations
- fetal breathing
- fetal mvmt
- fetal tone
- amniotic fluid volume
what is the highest score of a BPP and how is it scored
max 10, each has 2 points
what are lower BPP scores associated with?
perinatal mortality, may indicate moving toward delivery
what is when a needle is inserted through the maternal abdomen and into the uterus to aspirate a small amnt of amniotic fluid
amniocentesis
what is amniocentesis fluid tested for?
genetics or lung maturity
what causes genetic testing to be done?
- advanced maternal age
- hx of birth defect
- abnormal screening
what are the rare risks of amniocentesis
cramping, fluid leakage, fetal injury, infection
what is the process of obtaining a fetal blood sample percutaneously through the umbilical cord?
percutaneous umbilical cord sampling (PUBS)
what is a percutaneous umbilical cord sampling usually done to test for?
Rh and blood type or genetics
