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Nursing > High Risk Pregnancy > Flashcards

High Risk Pregnancy Flashcards

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1
Q

Risk factors

A
  • Age
  • Race
  • Poverty
  • Marital status
  • Drug use
  • Adverse behaviors (psychosocial, smoking, drinking)
  • Biological (htn, overweight)
  • Nutrition (deficiency)
  • Genetic (older age)
  • Exposure to chemicals
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2
Q

CST

A

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)

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3
Q

NST

A

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

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4
Q

BPP

A

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.

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5
Q

Gestational hypertension (after 20 weeks)

A

High BP w/o protein in urine.

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6
Q

Preeclampsia

A

Elevated BP, with protein in the urine (affecting kidneys)

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7
Q

Eclampsia

A

Has had Seizure.

Can cut off oxygen supply to baby

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8
Q

Chronic hypertension

A

Already had high BP before pregnancy, can get added on preeclampsia with protein in urine.

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9
Q

Hypertension maternal complications

A

Placental abruption, ARDS, stroke, cerebral hemorrhage, hepatic or renal failure, DIC, and pulmonary edema.

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10
Q

Hypertension fetal complication

A

Related to placental insufficiency (IUGR, prematurity, hypoxia)

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11
Q

Mild preeclampsia

A

BP >140/90, >1+ proteinuria with dipstick, >300 mg protein in 24 hr urine, urine output=intake

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12
Q

Severe preeclampsia

A

BP > 160/110, > 3+ proteinuria with dipstick, output<400-500 ml in 24 hrs.,

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13
Q

Risk factors for preeclampsia

A 
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)
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14
Q

HELLP syndrome

A
  • 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.
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15
Q

HELLP assessment

A
  • 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
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16
Q

Severe preecampsia treatment

A
  • 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.
17
Q

Magnesium toxicity

A
  • 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)
18
Q

Miscarriage (causes)

A
  • 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.
19
Q

Ectopic pregnancy

A
  • 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.
20
Q

Ectopic pregnancy ( symptoms)

A
  • 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
21
Q

Ectopic pregnancy- medical management

A

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.
22
Q

Hydatiform Mole

A
  • 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.
23
Q

Placenta previa

A
  • 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.
24
Q

Placenta previa risk factors

A
  • Previous cesarean section
  • Advanced maternal age: greater than 35-40 years of age.
  • Mulitparity
  • History of prior curretage
  • Smoking
25
Q

Placenta previa treatment

A

C-section at or beyond 36 weeks

26
Q

Abruptio placenta (placental abruption)

A
  • Detachment of all or part of a normally implanted placenta
  • 1 in 75 to 1 in 226 pregnancies
  • More likely in twins
  • Bleeding may be apparent (may fill behind the placenta, uterus becomes board like..painful!)
  • Large abruption may lead to DIC
  • Prognosis depends on extent of placental detachment
  • Perinatal mortality rate of 20-30%
27
Q

Management of abruption

A
  • Depends on severity of abruption and gestation
  • NST & BPP
  • corticosteroids to accelerate fetal lung maturity
  • Large bore IV
  • Labs
  • Continuous EFM
  • VS
  • Indwelling catheter O=30/hr
  • Vaginal birth preferred
28
Q

Diabetes mellitus

A
  • Most common endocrine disorder associated with pregnancy
  • Occurs in 4% to 14% of pregnant women
  • Pregnancy complicated by diabetes considered high risk
  • Diabetes can be successfully managed with a multidisciplinary approach
29
Q

Diabetes- fetal risks

A
  • Congenital malformations
  • If diabetes occurs after 26 wks. gestation, may not affect baby
  • Birth injuries are at risk for infants with macrosomia (brachial plexus palsy, facial nerve injury, humerus or clavicle fracture and cephalahematoma.
30
Q

intrapartum with preexisting diabetes

A
  • hourly blood sugars and D5W IV fluid
  • Insulin via continuous infusion
  • Continuous EFM
31
Q

Postpartum diabetes

A
  • Insulin requirements decrease dramatically after birth

- may require 1/3 to 1/2 the amount of insulin than she needed prior to delivery

32
Q

Gestational diabetes- risk factors

A
  • Maternal age >25
  • previous infant
  • previous unexplained IUFD
  • previous pregnancy with GDM
  • strong family hx of GDM or type 2 diabetes
  • obesity
  • fasting blood glucose > 140
33
Q

gestational diabetes

A
  • no increased risk of birth defects because by the time women develop GDM, the critical period of organ development has already occurred
  • Most controlled with diet and exercise
  • Up to 20% will need insulin
  • postpartum, will return to normal glucose levels
34
Q

Anemia in pregnancy

A
  • Iron deficiency most common
  • fetus depletes mom’s levels
  • iron supplements
  • teach importance of taking iron supplements due to side effects (nausea/constipation)
35
Q

Asthma in pregnancy

A
  • 4-8% of pregnant women
  • 1/3 improve
  • 1/3 stay the same
  • 1/3 get worse
  • If asthma worsens, can be associated with uteroplacental insufficiency, IUGR, and preterm birth

Nursing (22 decks)

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