High Risk Pregnancy-7 Flashcards
Common risk factors for high risk pregnancy
● Existing health conditions
● A history of prior pregnancy complications
● Complications that arise during pregnancy, such as gestational diabetes or preeclampsia
● Being overweight or obese
● Carrying more than one fetus
Being ≤ 18
● Advanced maternal age
General nursing actions for complication
● Provide time for the woman and family to express their concerns and feelings
● Provide information repeatedly with patient and significant other(s) to facilitate a realistic appraisal of events.
● Facilitate referrals related to the condition
● Encourage the woman and her family to participate in decision making
● have flexible guidelines for the family to minimize separation.
● Be a skilled communicator
● Be a witness to events
Preterm labor (PTL)
regular contractions of the uterus resulting in changes in the cervix before 37 weeks of gestation.
Preterm birth (PTB)
birth between 20 °/7 weeks of gestation and 36 % weeks of gestation.
Spontaneous preterm labor and birth- what and why
unintentional, unplanned delivery before the 37th week of pregnancy.
A history of delivering preterm
infection or inflammation or unknown cause
Medically indicated preterm birth
health care provider recommends preterm delivery in the existence of a serious medical condition such as preeclampsia.
Non-medically indicated (elective) preterm delivery
inducing labor or having a cesarean delivery in the absence of a medical reason to do so, even though this practice is not recommended.
Late preterm infant
34 and 37 weeks of gestation
Very preterm infant
before 32 completed weeks of gestation
Viability
at 25 and rarely, fewer completed weeks gestation
Periviability
before the third trimester of pregnancy
Long term potential issues from preterm babies
cerebral palsy, hearing and vision impairment, and chronic lung disease.
four major factors leading to preterm labor
excessive uterine stretch or distension, decidual hemorrhage, intrauterine infection, and maternal or fetal stress.
Other factors leading to preterm labor
● Uteroplacental vascular insufficiency exaggerated ●inflammatory response ● hormonal factors ●cervical insufficiency ● genetic predisposition ●Excessive uterine stretch or distention ●Decidual activation
3 most common risk factors for preterm birth
● Prior preterm birth
● Multiple gestation
● Uterine/cervical abnormalities, diethylstilbestrol (DES) exposure
Other risk factors
● Fetal anomalies
● History of second trimester loss, incompetent cervix or cervical insufficiency
● IVF pregnancy
● Hydramnios or oligohydramnios
● Infection, especially genitourinary infections and periodontal disease
● Premature rupture of membranes
● Short pregnancy interval
● Pregnancy associated problems such as hypertension, diabetes, and vaginal bleeding
● Chronic health problems such as hypertension, diabetes, or clotting disorders
● Inadequate nutrition, low BMI, low pre-pregnancy weight, or poor weight gain
● Age younger than 17 or older than 35 years old
● Late or no prenatal care
● Obesity, high BMI, or excessive weight gain
● Working long hours, long periods of standing
● Ancestry and ethnicity
● Maternal unmarried status
● Preterm birth is more likely in the presence of intimate partner violence (IPV), mental health issues, substance abuse
● Lack of social support
● Smoking, alcohol, and illicit drug use
● Lower education and socioeconomic status, poverty
Preterm birth screening
● Transvaginal cervical ultrasonography
● Fetal fibronectin
S/S preterm birth
● Change in type of vaginal discharge (watery, mucus, or bloody)
● Increase in amount of discharge
● Pelvic or lower abdominal pressure
● Constant low, dull backache
● Mild abdominal cramps, with or without diarrhea
● Regular or frequent contractions or uterine tightening, often painless
● Possible ruptured membranes
Tocolytic drugs
medications used to suppress uterine contractions in preterm labor.
Antibiotics use in preterm labor
preterm premature rupture of membranes and group B streptococci carrier status
Progesterone supplementation
useful to prevent preterm birth for women with a history of spontaneous preterm birth
Neonatal neuroprophylaxis with intravenous magnesium sulfate
reduce microcapillary brain hemorrhage in premature birth of the neonate.
Corticosteroid therapy with antenatal steroids
accelerate fetal lung maturity
24 weeks and 34 weeks of gestation who are at risk of delivery within 7 days
Will raise blood sugar
Premature rupture of membranes (PROM)
rupture of membranes before the onset of labor
preterm PROM.
Membrane rupture before labor and before 37 weeks of gestation
Risk factors for preterm PROM
● Previous preterm PROM or preterm delivery
● Bleeding during pregnancy
● Short cervical length
● Hydramnios
● Multiple gestation (up to 15% in twins, up to 20% in triplets)
● Sexually transmitted infections (STIs)
● Low body mass index
● Low socioeconomic status
● Cigarette smoking and illicit drug use
pre PROM mom risks
● Maternal infection (i.e., chorioamnionitis, endometritis)
● Abruptio placenta and retained placenta
● Increased rates of cesarean birth
pre PROM baby risks
● Fetal or neonatal sepsis
● Fetal deformities before 26w
● Preterm delivery and complications of prematurity
● Hypoxia or asphyxia
Nursing actions pre PROM
● Assess FHR and uterine contractions
● Assess for signs of infection
● Monitor for labor and for fetal compromise.
● Provide antenatal testing including non-stress tests (NSTs) and biophysical profiles (BPPs)
Cervical insufficiency
inability of the uterine cervix to retain a pregnancy in the absence of the signs and symptoms of clinical contractions, or labor, or both in the second trimester
Cervical insufficiency risks mom
● Repeated second trimester or early third trimester births
● Reported complications of cerclage include rupture of membranes, chorioamnionitis, cervical lacerations, and suture displacement
Cervical insufficiency risks baby
● Preterm birth and consequences of prematurity
S/S Cervical insufficiency
usually are asymptomatic, some may report nonspecific symptoms, such as backache, uterine contractions, vaginal spotting, pelvic pressure, or mucoid vaginal discharge.
Indications for Cervical Cerclage (singleton pregnancies)
● History of one or more second-trimester pregnancy losses related to painless cervical dilation and in the absence of labor or abruptio placentae
● Prior cerclage due to painless cervical dilation in the second trimester
● Painless cervical dilation in the second trimester
● Current singleton pregnancy, prior spontaneous preterm birth at less than 34 weeks of gestation, and short cervical length (less than 25 mm) before 24 weeks of gestation
Postoperative Nursing Actions cerclage
● Monitor for uterine activity with palpation.
● Monitor for vaginal bleeding and leaking of fluid/rupture of membranes.
● Monitor for infection
●Patient teaching
Transvaginal McDonald cerclage remova
36 to 37 weeks of gestation
Multiple gestation
more than one fetus. They result from either the fertilization of one zygote that subsequently divides (monozygotic) or the fertilization of multiple ova.
Risks of multiple gestation mom
● Hypertensive disorders and preeclampsia
● Gestational diabetes
● Antepartum hemorrhage, abruptio placenta, placenta previa
● Anemia related to dilutional anemia
● Peripartum cardiomyopathy, pulmonary edema, and pulmonary embolism
● Intrahepatic cholestasis
● Acute fatty liver
● Cesarean birth
Risks of multiple gestation baby
● Increase in fetal morbidity and mortality
● Increase of low birth weight neonates
● Increase of intrauterine growth restriction (IUGR) and discordant growth
● Monochorionic twins have a shared fetoplacental circulation- specific serious pregnancy complications
● Increase of congenital, chromosomal, and genetic defects, in particular structural defects, with monozygotic twins.
Hyperemesis gravidarum
vomiting during pregnancy that is so severe it leads to dehydration, electrolyte and acid-base imbalance, starvation ketosis, and weight loss.
Hyperemesis gravidarum medical management
● Treatment of nausea and vomiting of pregnancy with vitamin B6 or vitamin B6 plus doxylamine
● Intravenous hydration
● Laboratory studies to monitor kidney and liver function
● Correction of ketosis and vitamin deficiency
● Medication may be needed in refractory cases of nausea and vomiting
Hyperemesis gravidarum- nursing actions
● Assess factors that contribute to nausea and vomiting.
● Reduce or eliminate factors that contribute ●ginger ●antiemetics as ordered ●early treatment ●emotional support ●comfort measures ●IV and meds as ordered ●daily weight ●monitor I/Os ●labs ●NPO until vomiting controlled ●prenatal vitamins with snack at night ●minimize fluid intake with meals ●complementary therapies
Intrahepatic cholestasis of pregnancy (ICP)
most common pregnancy-specific liver disease. It is a reversible type of hormonally influenced cholestasis and frequently develops in late pregnancy in individuals who are genetically predisposed.
causes pruritus of hands and feet
Type 1 diabetes
autoimmunity of beta cells of the pancreas resulting in absolute insulin deficiency and is managed with insulin.
Type 2 diabetes
insulin resistance and inadequate insulin production.
Pregestational diabetes
categorized as either type 1 or type 2 diabetes.
Gestational diabetes mellitus (GDM)
glucose intolerance that does not present prior to pregnancy.
Pregestational diabetes
blood glucose (BG) levels that are found to be above the normal range but below the cutoff for diagnosing overt or clinical diabetes in the nonpregnant woman
