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NURS3112 > M3.2: Complications in Pregnancy > Flashcards

M3.2: Complications in Pregnancy Flashcards

1
Q

What is gestational hypertension?

A

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

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2
Q

How do you measure gestational hypertension?

A

≥ 140/90 mmHg based on the average of at least 2 measurements, taken at least 15 minutes apart, using the same arm.

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3
Q

What are the risks of high BP?

A

cerebral edema leading to overactive reflexes, seizures, strokes, blurred vision, headache, etc

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4
Q

What is preeclampsia?

A

Elevated BP after 20 weeks gestation with proteinuria

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5
Q

What is eclampsia?

A

Mother with preeclampsia after 20 weeks with seizures

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6
Q

How does preeclampsia occur?

A
  • 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
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7
Q

Preeclampsia = Results in Vasospasm, which leads to:

A
  • reduction in blood flow to all organs, particularly renal perfusion
  • reduction in intravascular volume
  • increased systemic resistance
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8
Q

What are the risk factors for preeclampsia?

A
  • 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
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9
Q

What are the symptoms of preeclampsia?

A
  • Increased BP
  • Edema
  • Utero-placental insufficiency
  • Proteinuria
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10
Q

What are the signs of worsening preeclampsia?

A
  • IUGR &/or fetal distress
  • Proteinuria / oliguria
  • Epigastric pain / liver tenderness / N&V
  • Visual disturbances / headaches
  • Increasing weight gain / edema
  • Hyperreflexia
  • *** Seizure activity= ECLAMPSIA
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11
Q

how can you manage sever preeclampsia?

A
  • Bed rest
  • Quiet environment (likely hospitalized)
  • Seizure precautions
  • Medications (anticonvulsant (Mg SO4) &/or antihypertensive)
  • Induce labour
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12
Q

What does magnesium sulfate do?

A

causes cerebral vasodilation= protect brain

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13
Q

What are some nursing care for preeclampsia?

A
  • 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
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14
Q

What is HELLP syndrome?

A

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
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15
Q

What is the difference between preeclampsia and HELLP syndrome?

A

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

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16
Q

What are some symptoms of HELLP syndrome?

A

Hypertension, nausea, vomiting, flu-like symptoms, epigastric pain, jaundice, proteinuria

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17
Q

what is nursing management for HELLP syndrome?

A
  • Blood tests for platelets
  • Steroids to reduce inflammatory response & babies surfactant levels
  • Strict Ins & outs, frequent vitals
  • Magnesium sulfate
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18
Q

What is chronic hypertension?

A

BP 140/90 or GREATER before pregnancy or before 20th week gestation (before 2nd trimester) or persists 42 days following birth

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19
Q

What are the risks of chronic hypertension/

A
  • IUGR/ SGA
  • Preterm birth
  • Need for C/S
  • Increase length of hospital stay for mom and newborn
20
Q

Nursing management for chronic hypertension

A
  • 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
21
Q

What to do if baby is not moving:

A

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.

22
Q

What is abruptio placenta?

A
  • Premature separation of the placenta (little tears because baby moving a lot)
  • Placenta detaches from uterine wall
23
Q

What are the risk factors abruptio placenta?

A
  • Increased parity (≥5 pregnancies over 20wks)
  • Maternal hypertension
  • Cigarette smoking, alcohol, & cocaine
  • Advanced maternal age
  • Short umbilical cord
  • Trauma (mom falls) & presence of fibroids
24
Q

What are the symptoms of abruptio placenta?

A
  • Sudden onset, intense, localized pain
  • May occur with or without vaginal bleeding
  • Abdomen/uterus can become hard and “board like”
  • +++Abdominal pain
25
Q

What is placenta previa?

A

Improper implantation of the placenta

26
Q

what are the classifications of placenta previa?

A
  • Low lying
  • Partial
  • Complete: placenta completly covering the cervical opening
27
Q

What are symptoms of placenta previa?

A
  • Can be asymptomatic
  • Painless uterine bleeding episode to frank red blood
  • Occurs in third trimester
28
Q

How can placenta previa be managed?

A

bed rest, delivery by C-section b/c baby is unable to come out

29
Q

What are signs of preterm labour?

A
  • 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
30
Q

What week is the more important for survivability for fetus?

A

24 - 28 weeks: when surfactant is produced

31
Q

what are risk factors for preterm labour?

A
  • 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
32
Q

What is PROM?

A

Premature rupture of membranes

SROM before the onset of labour at any gestational age

33
Q

What is PPROM?

A

Preterm premature rupture of membranes

Rupture occurs before 37 weeks of gestation

34
Q

What are the risk factors for PPROM?

A
  • 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
35
Q

What are the maternal risks of PPROM?

A
  • infection: chorioamnionitis or endometritis
  • abruptio placentae
36
Q

What is chorioamnionitis?

A

intra-amniotic infection resulting from bacterial invasion and inflammation of the membranes before birth

37
Q

What is endometritis?

A

postpartum infection of the endometrium that may be related to chorioamnionitis or may occur independently

38
Q

how does abruptio placentae occur in PPROM?

A

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

39
Q

what are fetal risks of PPROM?

A
  • 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
40
Q

What is gestational diabetes?

A

type of diabetes that can develop during pregnancy in women who don’t already have diabetes

41
Q

How does GDM occur?

A
  • Placenta produces hormones (estrogen, cortisol, and human placental lactogen)
  • These hormones inhibit the functioning of insulin
  • Blood glucose level is increased
42
Q

When do you screen for GDM?

A

24-28 weeks

43
Q

What is the screening method for GDM? (include range)

A
  • Fasting Glucose greater than 5.1
  • oral glucose tolerance test: greater than 10 within an hour or greater than 8.5 within 2 hours
44
Q

fetal risks of GDM

A
  • Heart, CNS, skeletal system
  • Hypoglycemia in immediate neonatal period
  • LGA/Macrosomic newborns/should dystocia (large babe)
  • hyperbilirubinemia
45
Q

How to manage GDM:

A
  • Diet and exercise
  • Metformin
  • Insulin injection
  • Do BGM at least 4 times a day

NURS3112 (10 decks)

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