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Unit 4 > High risk pregnancy > Flashcards

High risk pregnancy Flashcards

1
Q

What is abruptio placentae?
—Also called abruption—

A

Premature separation of placenta from endometrium.

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2
Q

What is cervical insufficiency?

A

Sometimes called cervical incompetence. Anatomical defect. Means cervix dilates and effaces (without pain) in second trimester. Weight of baby contributes to cervix’s inability to hold baby in place. Results in spontaneous abortion.

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3
Q

What is cerclage?

A

Procedure for cervical insufficiency. Suture put in place in cervix to support weight of fetus. Removed when to term.

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4
Q

What is perinatal loss? What can we do?

A

Loss of pregnancy in any stage.
“I am so sorry for your loss. What can I do that would helpful to you today?”
Support and listen. Don’t be in a hurry. “Do you want to talk?” Allow them to see, touch, hold and spend time with this baby. They will hold onto those memories for a long time. Prepare baby to look and smell his best. Do not hide any defects but allow them to examine and say goodbye. Prepare a memory packet and help them practice how they will tell others. (including siblings)

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5
Q

What is D&C?

A

Dilation and vacuum curettage.
Cleans the uterus (usually after a spontaneous abortion)

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6
Q

What are signs of ruptured ectopic pregnancy?

A

Sharp one sided pain
Syncope
Shoulder or neck pain that is worse on inspiration.

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7
Q

What is a molar pregnancy?
—also called gestational trophoblastic disease or hydatidiform mole–

A

Fertilized egg develops abnormaly, results in placenta with no fetus. Grape like vesicles fill the uterus.

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8
Q

What are signs of molar pregnancy?

A

Brown Vag bleeding, large uterus, excessive N/V.
Usually early ultrasound detects.

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9
Q

What is classic sign of placenta previa?

A

Sudden onset of painless bleeding in latter half of pregnancy. Different degrees of severity depending on how much placenta occludes cervix.

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10
Q

Risk factors for abruptio placentae.

A

Smoking
Cocaine
HTN
Trauma
Multigravida
Autoimmune diseases
Preeclampsia

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11
Q

S/sx of abruptio placentae.

A

Vag bleeding (may be slight or absent)
Extremely painful
Uterine irritability
High uterine resting tone
Uterine tenderness
Hard abdomen
Increased uterine height

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12
Q

What is the first sign (in fetus) of maternal hypovolemia?

A

Tachycardia

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13
Q

Early signs of hypovolemia.

A

Tachycardia
Decreased BP
Increased respiratory rate
Low pulse ox
Cool, pale skin/mucous membranes

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14
Q

What are late signs of hypovolemia?

A

Big drop in BP
Pallor
Decreased urine output
Change in mental status

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15
Q

What position should mom be put in to increase fetal circulation?

A

Lateral and flat

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16
Q

What is rule of thumb for normal amount of urine output?

A

1 mL/kg/hour

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17
Q

What is gestational hypertension?

A

BP elevated after 20 weeks gestation without proteinuria.

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18
Q

What is pre-eclampsia?

A

SBP >140 OR DBP >90 after 20 weeks gestation with proteinuria

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19
Q

What is difference between pre-eclampsia and eclampsia?

A

Eclampsia is preeclampsia with seizures.

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20
Q

What are risk factors for development of pre-eclampsia?

A

Primipara
Obesity
Diabetes
Hx of hypertension
Hx of renal disease
Extremes of age
Black women
Multifetal

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21
Q

What causes increase in BP in pre-eclampsia?

A

Generalized vasospasm.

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22
Q

What is first indication of pre-eclampsia?

A

Increased BP

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23
Q

What is happening inside body during pre-eclampsia state?

A

Decreased perfusion to other organs.
Kidneys=BUN, creatinine, uric acid levels increase from decrease in perfusion and function of kidneys
Liver= Elevated liver enzymes due to decreased perfusion
Brain and eyes=decreased perfusion means visual disturbances and small cerebral hemorrhages
Placenta=Increased risk for abruption
HELLP syndrome
Pulmonary edema

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24
Q

What is HELLP syndrome?

A

Hemolysis
Elevated Liver Enzymes
Low Platelets

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25
Q

What is treatment for pre-eclampsia?

A

Depending on the severity
The goal is to allow baby to develop as long and safely as possible.
Kick counts, reduce BP, activity restrictions. No reversal, just control until pregnancy over. Try to deliver vaginally.
Mag Sulfate, steroids, antihypertensives, anticonvulsants

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26
Q

What is first line med for hypertension in pregnancy?

A

Short term=hydralazine
Long term=nifedipine and labetalol

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27
Q

How does mag sulfate reduce BP?

A

Smooth muscle relaxant

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28
Q

How does mag sulfate work to stop seizures?

A

CNS depressant

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29
Q

How does mag sulfate stop premature labor?

A

Relaxes uterus to stop contractions

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30
Q

What should be monitored closely in mag sulfate administration?

A

Respiratory rate and O2 sats (depresses RR)
BP (can drop BP too low)
Deep tendon reflexes (if decreased may have too much mag on board)
Urinary output (Mag is excreted by urine, if output is too low, mag levels climb)

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31
Q

What is deep tendon reflex scale?

A

0=absent
1=hypo
2=normal
3=too fast
4=hyper

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32
Q

What are presenting symptoms of HELLP?

A

Pain in right upper quadrant, lower chest or epigastric area.
Abdominal tenderness
N/V
Severe edema
Flulike symptoms

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33
Q

What is erythroblastosis fetalis?

A

Also called hemolytic disease of NB.
Mom and baby’s blood incompatible
Mom’s immune system destroys baby’s RBC’s

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34
Q

What happens to baby when RBC’s are destroyed by mom’s immune system?

A

Bilirubin levels rise and can lead to severe brain damage
Anemia that can become so severe it leads to CHF

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35
Q

What is a Coombs test?

A

An antibody titer test to determine if antibodies present. (If Rh neg mom has antibodies) OR (if Rh positive baby has mom’s antibodies in blood)

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36
Q

Risks if baby is Coombs positive.

A

Elevated bili levels and anemia.

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37
Q

When is Rho-Gam shot necessary?

A

Mom is Rh negative and baby is Rh positive. Given within 72 hours of delivery.

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38
Q

What is polyuria?

A

Excessive urination

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39
Q

What is glycosuria?

A

Glucose in urine

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40
Q

What is effect of early pregnancy on blood sugar?

A

Hypoglycemia

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41
Q

What is effect of late pregnancy on blood sugar?

A

Hyperglycemia
—This is because hormones made by placenta create insulin resistance to supply lots of glucose to growing fetus.—

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42
Q

What is definition of gestational diabetes mellitus? (GDM)

A

Diabetes mellitus that was diagnosed in pregnancy.

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43
Q

What are risk factors for GDM? (gestational diabetes mellitus)

A

Over 25 yo
Black, latina, Native American
Obesity

44
Q

What are fetal effects of pre-pregnancy DM?

A

Increased risk of spontaneous abortion
Neural tube defects
Caudal regression syndrome
Cardiac defects
Large for gestational age (LGA)
Macrosomia (larger than 4000 grams)
Polycythemia
Hyperbilirubinemia

45
Q

What is caudal regression syndrome?

A

Failure of sacrum and lumbar spine and lower extremities to develop

46
Q

What are the four major complications for the newborn of mom with DM?

A

Hypoglycemia
hypocalcemia
hyperbilirubinemia
respiratory distress syndrome

47
Q

What is hydramnios?

A

Excess volume of amniotic fluid (usually associated with DM)

48
Q

S/Sx of hyperglycemia

A

Fatigue and drowsiness
Headache
Flushed, hot skin
Dry mouth and polydipsia
Frequent urination
Rapid, deep breathing with acetone breath
Depressed DTR (reflexes)

49
Q

What is DIC?

A

Very serious condition
Occurs in complicated pregnancies
Disseminated intravascular coagulation
A coagulation defect
If fetal demise is retained too long or other pregnancy complications
—Unable to clot—
Body uses up all platelets (systemic clotting) THEN has no ability to clot

50
Q

What are fetal effects of sickle cell disease?

A

FGR (fetal growth restriction)
prematurity

51
Q

What is thalassemia?

A

Genetic disorder that shortens life of RBC’s. Many different types but result in anemia and failure to thrive (in babies)

52
Q

What is the effect of SLE (lupus) on pregnancy?

A

Increase in miscarriages and fetal demise, preeclampsia, premature ROM.
Concern for mother’s renal system

53
Q

What is biggest concern with history of seizures in pregnant women?

A

Medications for seizures are teratogenic. Cause severe birth defects (called fetal hydantoin syndrome)

54
Q

What is the leading cause of hearing loss in children?

A

Cytomegalovirus infection in utero
—importance of handwashing if pregnant mom is around lots of children—

55
Q

Can herpes type 2 spread from mom to baby?

A

Yes two ways:
1. After ROMembranes when active lesions present
2. During birth when fetus contacts vaginal secretions

56
Q

What are herpes type 2 effects on neonate?

A

Local infection of skin, mouth, eyes
Encephalitis
Disseminated HSV (really bad with high mortality or permanent damage)

57
Q

What is concern with hep B infection in pregnant mom?

A

Passes through placenta and increased risk of prematurity, low birth weight and death. Newborn at risk for acute infection.

58
Q

Treatment for newborn exposed to hep B.

A

HBV vaccine and Hep B immune globulin (HBIG)
Skin must be thoroughly cleaned to prevent hep B on skin surface from penetrating with needle stick.
Once baby vax can breastfeed.

59
Q

Concerns for neonate born to HIV postive mom.

A

Doesn’t necessarily mean baby will have HIV. The risk to baby depends on mom’s viral load and med regimen. But will test positive for up to 18 months because of passive maternal antibodies. Baby will begin ZDV therapy immediately. Breastfeeding is contraindicated.

60
Q

What is Group B Strep infection? (GBS)

A

This bacteria colonizes the vagina in some women. Can cause premature ROM and premature birth. Transmission to NB is dangerous and can cause sepsis, pneumonia and meningitis.
C-Section needed

61
Q

What are risks to pregnant mom with DM?

A

Hydramnios
Preeclampsia/Eclampsia
Ketoacidosis
Vaginitis
UTI

62
Q

What is the most common medical complication of pregnancy?

A

Anemia

63
Q

What is FASD in newborns?

A

Fetal Alcohol Spectrum disorder
Range of physical and mental abnormalities

64
Q

What are implications of cocaine use in pregnancy?

A

IUGR
Spontaneous abortion
Premature labor
Abruptio Placentae
—Stimulant that causes vasoconstriction, tachycardia, HTN–

65
Q

What are implications of meth use in pregnancy?

A

SGA (small)
LBW (low birth weight)
Decreased arousal
Mental and motor delays

66
Q

What are implications of heroin or methadone use in pregnancy?

A

IUGR
Meconium aspiration
SGA (small)
preeclampsia
placenta problems
Baby–shrill cry, vomiting, sucking fist, irritability, seizures
—-Stopping abruptly is not recommending, Increases risk to fetus—-

67
Q

What are implications of mental health disease in pregnancy?

A

Increase incidence of
LBW (low)
SGA (small)
Preterm birth
—-Poor bonding, overwhelmed, irritable, self medicating—

68
Q

What are implications of schizophrenia in pregnancy?

A

Meds for schizophrenia are contraindicated because teratogenic.
Increase chance of:
Preterm
LBW
SGA
Placenta problems
Antenatal hemorrhage

69
Q

Can a person on medications to lower thyroid levels breastfeed?

A

No-not recommended.

70
Q

What are implications of hypothyroidism in pregnancy?

A

If UNTREATED-fetal loss is high, NB will have serious neuro and goiter problems

71
Q

What is PKU?

A

phenylketonuria
also called hyperphenylalaninemia
Genetic disorder.
Person lacks enzyme to break down certain proteins.
Build up of proteins can cause brain damage to fetus.
Strict, low protein diet for life.
Routinely tested in NB

72
Q

What is effect of pregnancy on someone with MS?

A

Doesn’t exacerbate MS but DOES get worse postpartum
Need lots of rest

73
Q

What is effect of pregnancy on RA?

A

Symptoms reduced during pregnancy. Relapse after delivery.
Need lots of rest. Usually stop meds during pregnancy.
Increased risk of PROM, SGA

74
Q

What are complications for mom with preeclampsia?

A

Renal failure
Abruptio Placentae
DIC
Ruptured liver
PE

75
Q

What are complications for baby in preeclampsia?

A

IUGR
Hypoxia
Prematurity
Over sedation
Hypermagnesemia (from medication)

76
Q

Other than elevated BP, what are s/sx of preeclampsia?

A

Headache
Pulmonary edema
Visual changes
N/V
Dyspnea
Epigastric pain

77
Q

What is HELLP syndrome associated with?

A

Severe preeclampsia

78
Q

What is hydrops fetalis?

A

Fetal edema

79
Q

What is tocolysis? What meds are involved?

A

Using medication to stop labor
Mag sulfate (IV)
Brethine (SQ)
Procardia (oral med)
indomethacin

80
Q

What is fetal fibronectin?

A

Lab test to determine lung maturity

81
Q

What are risk factors for PROM?
(Before 37 weeks)

A

Low economic status
Smoking
Low body weight
Infection
Hydramnios
Multiples
UTIs
Placenta previa
Abruption

82
Q

What are implications to fetus for PROM?

A

Fetal sepsis
Respiratory distress syndrome
Malpresentation
Prolapse of cord
Prematurity

83
Q

What is hydramnios?

A

Too much amniotic fluid
Fetal malformation possible
Can be a gradual or acute increase in fluid

84
Q

What is oligohydramnios?

A

Insufficient amniotic fluid
Fetal skin, skeletal, renal or pulmonary abnormalities, cord or head compression

85
Q

What is post term pregnancy?

A

Pregnancy past 42 weeks

86
Q

What is hypotonic labor?

A

Contractions of low intensity.
Usually from uterus being overstretched (multiples or macrosomia)

87
Q

What is hypertonic labor?

A

Also called Tachysystole
Increased uterine resting tone
Can lead to fetal hypoxia

88
Q

What is baby at risk for in fetal malpresentation?
—anything other than occiput in anterior quadrant–

A

Meconium aspiration
Asphyxia
Shoulder dystocia
Fractures or damage to clavicle, shoulder
Cord involvement
Hypoglycemia
Hyperbili
Polycythemia

89
Q

What interventions needed if we see non-reassuring fetal heart tones?

A

Correct maternal hypotension (left lateral)
Stop pitocin
Increase IV fluids
O2 admin 7-10 LPM
Fetal stimulation (if bradycardia)
Vag exam (looking for prolapsed cord)

90
Q

What interventions for prolapsed cord?

A

Relieve compression with fingertips
Position mom to relieve pressure (either knee to chest (McRoberts position) or Trendelenburg)
O2 (7-10 LPM)

91
Q

What is amniotic fluid embolism?

A

Amniotic fluid enters mom’s circulation.
Rare, sometimes happens after hard, fast, complicated labor.
Sudden respiratory distress, circulatory collapse, acute hemorrhage or cor pulmonale.
Dyspnea and cyanosis progressing to hemorrhage, shock, death.

Treatment is fluids, blood, O2.

92
Q

Fetal tachycardia is symptom of what in mom?

A

Fever

93
Q

If see variable decelerations think….

A

Cord compression

94
Q

If see late decelerations think…

A

Placental deficiency or hypoxia

95
Q

What are basic steps of fetal resuscitation in utero?

A

Left lateral position
O2 8-10 lpm
Stop pit
Bolus of IV fluids

96
Q

What is an alpha fetoprotein test for? AFP

A

Can be done on blood or amniotic fluid
Test for chromosomal or neural tube defects

97
Q

What is a biophysical profile? BPP

A

Fetal well being
Two points each (but amniotic fluid volume is most important)
NST
Fetal breathing
Gross fetal movements
Fetal tone
Amniotic fluid volume

98
Q

What is progression of hypoxia and acidosis in baby?

A
  1. Late decels
  2. Acels disappear
  3. Fetal breathing decreases
  4. Movement decreases
  5. Tone decreases
99
Q

What is normal range of kick counts?

A

10 movements in 12 hours

100
Q

What is Bishop score?

A

Scores likelihood of vag delivery:
Considers:
Fetal station
Effacement
Dilation
Position of cervix
Cervix soft or firm?

101
Q

What is drug of choice for cervical ripening?

A

Cytotec (vaginal suppository)

102
Q

What is chorioamnionitis?

A

Infection in amniotic fluid

103
Q

What is secret sign of PTL (preterm labor)?

A

Low dull back ache
–Remember cervical change is the big indicator of PTL–

104
Q

PTL is considered labor before ____ weeks.

A

36

105
Q

What is the McRoberts maneuver?

A

Used for shoulder dystocia..
Pushes baby’s shoulder under symphysis pubis

Unit 4 (4 decks)

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