high risk pregnancy Flashcards
what do we expect blood sugars to look like in early vs later in pregnancy?
early: low
later: hyperglycemia and resistance to insulin
normal 1 hr GTT results (50gm oral glucose)
135-140 mg/dL
3 hr GTT (100gm oral glucose)
1 hr: > 180 mg/dL
2 hr: > 155 mg/dL
3 hr: 140 mg/dL
how is gestational diabetes diagnosed?
1 hr GTT –> 3 hr GTT –> 2 values must meet or exceed the value = diagnosis
maternal implications od diabetes
- ketoacidosis
- vascular disease
- nephropathy
- retinopathy
- hydramnios
- HTN
- dystocia
fetal implications of diabetes
- higher risk for fetal death
- congenital anomalies
- LGA
- IUGR
- RDS
- hyperbilirubinemia
- hypocalcemia
what are the insulin requirements early in pregnancy?
insulin needs typically decrease
what are the insulin requirements later in pregnancy?
insulin needs greatly increase
what are the insulin requirements postpartum?
insulin needs decrease
insufficient hemoglobin production
r/t nutritional deficiency
ex: iron deficiency, folate deficiency
hemoglobin destruction
r/t inherited disorders
ex: sickle cell anemia
possible maternal complications in iron deficiency anemia
- infections
- fatigue bc they have less ability to carry O2
- preeclampsia
- tolerate blood loss poorly
possible fetal complications in iron deficiency anemia
- low birth weight
- preterm delivery
- fetal demise
- neonatal death
prevention of iron deficiency anemia in pregnancy
- prenatal vitamins
- 60-120 mg of iron/day
- iron rich diet
possible fetal complication of megaloblastic anemia (folate deficiency)
neural tube defects
prevention of megaloblastic anemia (folate deficiency)
- 0.4 mg folate/day
- 1 mg folate + iron supplement
possible fetal complications of sickle cell anemia
- fetal death
- prematurity
- IUGR
pre-existing heart disease (repaired or not) is associated with…
cyanosis = greater maternal/fetal risk
peripartum cardiomyopathy
- no previous hx of heart disease prior to pregnancy
- left ventricle dysfunction
- occurs during second half of pregnancy
management of labor in a patient with heart disease
- may labor naturally w/ close observation
- may limit pushing (may use forceps, vacuum)
- limit pain and anxiety
threatened abortion
- unexplained bleeding, cramping
- cervix is still closed
imminent abortion
- imminently going to have a miscarriage
- increased bleeding and cramping
- cervix may start to dilate, and membranes will rupture
incomplete abortion
- parts of products of conception are retained
- delivers or miscarries some of the pregnancy but some is still retained
complete abortion
all products of conception are expelled
missed abortion
- fetus dies in utero but is not expelled at all
- note decrease in uterine size and changes in pregnancy begin to regress
nursing considerations for spontaneous abortions
- physiologically stable (bleeding)
- pain r/t cramping
- grief r/t loss
preeclampsia
- increase in BP after 20 weeks gestation
- positive proteinuria
eclampsia
presence of a seizure in the preeclamptic woman
what labs would we expect in a preeclamptic patient?
- elevations in ALT/AST
- elevated BUN/creatinine
- low PLT count
assessment of eclamptic patient
- body involvement
- duration
- fetal status
- prevent injury
- maintain respiratory ability
HELLP syndrome associated with preeclampsia
H: hemolysis
E: elevated
L: liver enzymes
L: low
P: platelets (< 100,000)
symptoms of HELLP syndrome
- N/V
- malaise
- flu like symptoms
- epigastric pain
goal of management of severe preeclampsia
prevent seizures, prevention of liver and kidney disease, maintain pregnancy
direct coomb’s test
testing newborn for sensitization to antibody that mom produced against fetus blood
indirect coomb’s test
testing the mother for sensitization
what does a negative coomb’s test indicate?
no sensitization = her antibodies haven’t become active
kleihauer-betke test
estimates the extent of bleeding for administration of the appropriate amount of Rh immune globulin
maternal medical risks with advanced maternal age
- diabetes
- HTN
- placenta previa
- dystocia
fetal/newborn risks with advanced maternal age
- miscarriage
- genetic issues (down syndrome)
- preterm birth
- low birth weight
fetal kick counts
same time everyday, one hour after meals
count the number of fetal movements in 30 min, 3x/day
there should be at least 3 movements in 30 min
when should we be concerned with fetal kick counts?
if there’s < 10 movements in 3 hrs anytime through the day
non stress test
observation of accelerations with fetal movement
- FHR monitored for 20 min
reactive NST
(normal) 2 accelerations at least 15 bpm above baseline, lasting at least 15 seconds in duration
nonreactive NST
(abnormal) lacks sufficient accelerations
contraction stress test
- assessing response of FHR to contractions
- 3 cx that last at least 40 seconds w/in 10 min
negative contraction stress test
reassuring!! no significant decelerations
positive contraction stress test
presence of late decels w/ at least 50% of cxs
biophysical profile
- includes NST and US (up to 30 min)
- considers accelerations, breathing, movements of extremities, tone, amniotic fluid volume (2 pts for each)
- lower scores are associated w/ higher perinatal mortality and may indicate moving toward delivery
