High Risk Pregnancy Flashcards
Risk factors
- Age
- Race
- Poverty
- Marital status
- Drug use
- Adverse behaviors (psychosocial, smoking, drinking)
- Biological (htn, overweight)
- Nutrition (deficiency)
- Genetic (older age)
- Exposure to chemicals
CST
Contraction stress test.
Start pitocin, get pre contractions in 10 min, look at baby HR response to contractions, looking for late or significant variable decelerations in baby. WE want a negative CST test. Positive means (late decals more than 50& of the contractions). Equivocal CST (suspicious, no more than 50& of decels)
NST
non stress test.
Puttting mom on monitor, give her button when you feel baby move, HR should increase. Can be reactive or non-reactive.
We want reactive
BPP
biophysical profile. NST + (reactive strip =2), fetal breathing movements (with ultrasound), fetal movement, fetal tone (looking for extremity to extend, or hand open and close), amniotic fluid index (looking for pockets of amniotic fluid). Score of 8-10 is normal, 6 is suspicious (equivocal), less than/equal to 4 is abnormal, want to deliver baby.
Gestational hypertension (after 20 weeks)
High BP w/o protein in urine.
Preeclampsia
Elevated BP, with protein in the urine (affecting kidneys)
Eclampsia
Has had Seizure.
Can cut off oxygen supply to baby
Chronic hypertension
Already had high BP before pregnancy, can get added on preeclampsia with protein in urine.
Hypertension maternal complications
Placental abruption, ARDS, stroke, cerebral hemorrhage, hepatic or renal failure, DIC, and pulmonary edema.
Hypertension fetal complication
Related to placental insufficiency (IUGR, prematurity, hypoxia)
Mild preeclampsia
BP >140/90, >1+ proteinuria with dipstick, >300 mg protein in 24 hr urine, urine output=intake
Severe preeclampsia
BP > 160/110, > 3+ proteinuria with dipstick, output<400-500 ml in 24 hrs.,
Risk factors for preeclampsia
First pregnancy or new partner Age extremes (very young 40) Obesity Personal or family hx Multifetal pregnancy or hydatiform mole Poor outcome in previous pregnancy (IUGR, abruption, fetal death)
HELLP syndrome
- Laboratory diagnosis for a variant of severe preeclampsia involving liver dysfunction:
- H: Hemolysis
- EL: Elevated liver enzymes
- LP: Low platelet count
- Diagnosis of HELLP: Associated with increased risk of adverse outcomes including pulmonary edema, acute renal failure, DIC, liver hemorrhage or failure, ARDS, sepsis and stroke.
HELLP assessment
- Blood pressure
- Assessment of edema (facial & pulmonary edema)
- DTR’s and clonus
- Urine for protein
- Headache, epigastric or RUQ pain (liver), visual disturbances.
- FHM including uterine activity
Severe preecampsia treatment
- Quiet, darkened room
- Bedrest with side rails up
- Emergency drugs, oxygen and suction immediately available
- Magnesium sulfate IV (high risk medication) 2-4g bolus, over 20 min
- Limit fluids to no more than 125 ml/hr (IV and PO)- avoiding pulm. Edema.
Magnesium toxicity
- Discontinue infusion
- Calcium gluconate or calcium chloride are antidotes for magnesium sulfate
- may order blood levels for toxicity check
- 4-7 therapeutic mag. level
- Too much mag= stop breathing, can cause postpartum hemorrhage (relaxes blood vessels)
Miscarriage (causes)
- 10-15% of all pregnancies, most occur before 12 weeks.
- Causes: chromosomal abnormalities, endocrine imbalances, hypothyroidism, varicella (in first trimester), parvovirus B19 (Fifth’s Disease), IDDM with high glucose levels in the first trimester, immunologic factors, systemic disorders (lupus), genetic.
Ectopic pregnancy
- Fertilized ovum is implanted outside the uterine cavity.
- Accounts for 9% of all maternal deaths in the U.S.
- 95% are located in the fallopian tube
- Woman may exhibit signs of shock: Fainting, or dizziness related to the amount of bleeding in the abdomen, not necessarily vaginal bleeding.
- Key to diagnosis is to have a high index of suspicion.
Ectopic pregnancy ( symptoms)
- Abdominal pain
- Delayed menses
- Abnormal vaginal bleeding
- If not diagnosed and rupture occurs: Referred shoulder pain caused by irritation of the diaphragm by blood in the peritoneal cavity
Ectopic pregnancy- medical management
Medical management if tubal pregnancy is unruptured and less than 3.5 cm in diameter.
- Methotrexate is used: Avoids surgery, is safe, effective and cost effective management
- Surgery: Salpingotomy if not ruptured. Salpingectomy if ruptured is common.
Hydatiform Mole
- Benign proliferative growth of the placental trophoblast.
- Gestational trophoblastic disease
- No viable fetus.
- 1 in 1000 pregnancies in the U.S.
- May contain embryonic parts and an amniotic sac.
- Follow up for a year for rising beta hCG levels and an enlarging uterus, in addition to contraception for 6 months to a year after remission.
- At higher risk for another molar pregnancy in subsequent pregnancies.
Placenta previa
- Completely or partially covers the cervix or is close enough to the cervix to cause bleeding when the cervix dilates.
- 1 in 200 pregnancies at term.
- Can’t deliver vaginally, unless 2 cm away
- Painless bright red bleeding during 2nd or 3rd trimester.
- Nontender uterus with normal tone.
- Fetal malpresentation is common (breech, transverse or oblique lie).
- Hemorrhage is the major maternal complication.
- Preterm birth, stillbirth, fetal anemia, IUGR and malpresentation are risks to the fetus.
Placenta previa risk factors
- Previous cesarean section
- Advanced maternal age: greater than 35-40 years of age.
- Mulitparity
- History of prior curretage
- Smoking
