M3.2: Complications in Pregnancy Flashcards
What is gestational hypertension?
Any time a women who is pregnant and has HTN is called gestational hypertension. It is an umbrella term, will discuss chronic HTN, pre-eclampsia
How do you measure gestational hypertension?
≥ 140/90 mmHg based on the average of at least 2 measurements, taken at least 15 minutes apart, using the same arm.
What are the risks of high BP?
cerebral edema leading to overactive reflexes, seizures, strokes, blurred vision, headache, etc
What is preeclampsia?
Elevated BP after 20 weeks gestation with proteinuria
What is eclampsia?
Mother with preeclampsia after 20 weeks with seizures
How does preeclampsia occur?
- Women’s blood vessels constrict as they become sensitive to:
- Vasoconstrictor substances in blood (pressor agents): Angiotensin ll, Thromboxane/ Prostacyclin
- These hormones are produced by the placenta
Preeclampsia = Results in Vasospasm, which leads to:
- reduction in blood flow to all organs, particularly renal perfusion
- reduction in intravascular volume
- increased systemic resistance
What are the risk factors for preeclampsia?
- Primigravida
- <18 years & >35 years
- Family history; genetic predisposition
- Women with pre-existing hypertension, renal disease
- Large placental mass (multiple gestation, Rh-incompatibility, diabetes mellitus)
- Assisted reproductive techniques
- Gestational diabetes
- Multiple pregnancies
- Obesity
What are the symptoms of preeclampsia?
- Increased BP
- Edema
- Utero-placental insufficiency
- Proteinuria
What are the signs of worsening preeclampsia?
- IUGR &/or fetal distress
- Proteinuria / oliguria
- Epigastric pain / liver tenderness / N&V
- Visual disturbances / headaches
- Increasing weight gain / edema
- Hyperreflexia
- *** Seizure activity= ECLAMPSIA
how can you manage sever preeclampsia?
- Bed rest
- Quiet environment (likely hospitalized)
- Seizure precautions
- Medications (anticonvulsant (Mg SO4) &/or antihypertensive)
- Induce labour
What does magnesium sulfate do?
causes cerebral vasodilation= protect brain
What are some nursing care for preeclampsia?
- Assessment of vital signs, reflexes, edema, proteinuria
- Assessment of fetal status
- Count fetal movement - at least 6 or more in 2 hour period
- Accuracy/ method of Blood pressure measurement
What is HELLP syndrome?
H: Hemolysis, breaking down of red blood cells (cells that carry oxygen from your lungs to the rest of your body).
EL: Elevated liver enzymes (chemicals that speed up body reactions, such as breaking down proteins).
LP: Low platelet count (parts of your blood that help with clotting).
- type of preeclampsia
What is the difference between preeclampsia and HELLP syndrome?
Preeclampsia leads to high blood pressure (hypertension) and proteinuria (high levels of protein in the urine).
HELLP syndrome is a separate disorder from preeclampsia as patients may not have high blood pressure or proteinuria. It can lead to serious blood and liver problems
What are some symptoms of HELLP syndrome?
Hypertension, nausea, vomiting, flu-like symptoms, epigastric pain, jaundice, proteinuria
what is nursing management for HELLP syndrome?
- Blood tests for platelets
- Steroids to reduce inflammatory response & babies surfactant levels
- Strict Ins & outs, frequent vitals
- Magnesium sulfate
What is chronic hypertension?
BP 140/90 or GREATER before pregnancy or before 20th week gestation (before 2nd trimester) or persists 42 days following birth
What are the risks of chronic hypertension/
- IUGR/ SGA
- Preterm birth
- Need for C/S
- Increase length of hospital stay for mom and newborn
Nursing management for chronic hypertension
- Bedrest 2x per day for 1hr
- Low sodium diet
- Monitoring any weight gain (edema?)
- BP monitoring
- Fetal movement counts (decreased movements indicates distress) Normal: 6 movements in 2 hours
What to do if baby is not moving:
Get up and move around, drink some OJ, and then count, the baby may be sleeping. Ive counted again, and its 4 movements and we are at 1 ½ hours?: go to hospital.
What is abruptio placenta?
- Premature separation of the placenta (little tears because baby moving a lot)
- Placenta detaches from uterine wall
What are the risk factors abruptio placenta?
- Increased parity (≥5 pregnancies over 20wks)
- Maternal hypertension
- Cigarette smoking, alcohol, & cocaine
- Advanced maternal age
- Short umbilical cord
- Trauma (mom falls) & presence of fibroids
What are the symptoms of abruptio placenta?
- Sudden onset, intense, localized pain
- May occur with or without vaginal bleeding
- Abdomen/uterus can become hard and “board like”
- +++Abdominal pain
What is placenta previa?
Improper implantation of the placenta
what are the classifications of placenta previa?
- Low lying
- Partial
- Complete: placenta completly covering the cervical opening
What are symptoms of placenta previa?
- Can be asymptomatic
- Painless uterine bleeding episode to frank red blood
- Occurs in third trimester
How can placenta previa be managed?
bed rest, delivery by C-section b/c baby is unable to come out
What are signs of preterm labour?
- Painful menstrual-like cramps
- Dull low backache
- Suprapubic pain or pressure
- Pelvic pressure or heaviness
- Change in character or amount of vaginal discharge (bloody, thinner, thicker)
- Diarrhea
- Uterine contractions felt every 10 minutes for 1 hour
- Leaking of water from vagina
- Visual disturbances
- Vaginal bleeding
What week is the more important for survivability for fetus?
24 - 28 weeks: when surfactant is produced
what are risk factors for preterm labour?
- Hx of medical conditions
- Present and past obstetric problems
- Infection
- Social and environmental factors including substance abuse
- Multifetal pregnancy (overdistension of uterus)
- Anemia (decreased O2 supply to uterus)
- Age <18, first pregnancy, age >40
What is PROM?
Premature rupture of membranes
SROM before the onset of labour at any gestational age
What is PPROM?
Preterm premature rupture of membranes
Rupture occurs before 37 weeks of gestation
What are the risk factors for PPROM?
- Cervicitis
- Urinary tract infection
- Gonorrhea infection
- Asymptomatic bacteriuria
- Amniocentesis
- Placenta previa
- Abruptio placentae
- Hydramnios
- History of laser conization or loop electrosurgical excision procedure (LEEP)
- Multiple pregnancy
- Maternal genital tract anomalies
- Smoking
- Substance abuse
- Connective tissue disorders
- Fetal anomalies
What are the maternal risks of PPROM?
- infection: chorioamnionitis or endometritis
- abruptio placentae
What is chorioamnionitis?
intra-amniotic infection resulting from bacterial invasion and inflammation of the membranes before birth
What is endometritis?
postpartum infection of the endometrium that may be related to chorioamnionitis or may occur independently
how does abruptio placentae occur in PPROM?
not clear whether infection causes inflammation of the decidua, which facilitates premature separation, or whether the bleeding episode contributes to a weakening of the membranes, which eventually leads to rupture
what are fetal risks of PPROM?
- most significant cause of neonatal morbidity and mortality is prematurity and its associated complications such as respiratory distress syndrome, necrotizing enterocolitis, and intraventricular hemorrhage
- Neonatal infection (sepsis) more likely
- Fetal hypoxia: from cord prolapse or cord compression
What is gestational diabetes?
type of diabetes that can develop during pregnancy in women who don’t already have diabetes
How does GDM occur?
- Placenta produces hormones (estrogen, cortisol, and human placental lactogen)
- These hormones inhibit the functioning of insulin
- Blood glucose level is increased
When do you screen for GDM?
24-28 weeks
What is the screening method for GDM? (include range)
- Fasting Glucose greater than 5.1
- oral glucose tolerance test: greater than 10 within an hour or greater than 8.5 within 2 hours
fetal risks of GDM
- Heart, CNS, skeletal system
- Hypoglycemia in immediate neonatal period
- LGA/Macrosomic newborns/should dystocia (large babe)
- hyperbilirubinemia
How to manage GDM:
- Diet and exercise
- Metformin
- Insulin injection
- Do BGM at least 4 times a day
