Maternity 1 Flashcards
what increases during pregnancy that often effects pre existing illness
cortisol
Describe the 3 trimesters in terms of weeks and what is full term
1rst- 0-13
2nd- 14-26
3rd - 26-40
When does blood volume peak and why
28-32 wks because hemorrhage risk may be high at this time
Considerations around Anemia during pregnancy
- Common for lower socio economic status
- Hemodilution in pregnancy exacerbates previous anemia
- Poorly perfused placenta leads to small child
- Hgb <110 = discuss symptoms and find issue
- 27mg iron daily requirement (120-2000 if anemic)
- Take with Vit C and Folic acid (allows absorption
- Ferrous sulphate common 400 mcg common in anemia
What is the most common form of Anemia in Pregnant women and what can be done?
• Most common, many women irn deficient entering pregnancy. (low diet, menstrual periods, weight loss efforts)
• Women should take iron supplements with vitamin (absorption)
o Iron sup can cause constipation (roughage and take with meals)
o Stool softeners may be needed
• Diet high in vit and iron (leafy greens, meat and legumes)
What is Megaloblastic Anemia? Tx?
AKA folic acid deficient Anemia
- Folic acid is a b vitamin
- r/t enlarge RBCS
- Deficiency r/t to increased fetus demands on RBC production
- Folic acid supplement required
Describe some common interventions during an obstetric emergency
- 02 10l by mask
- IV 16-18 g and RL
- EFM ( vital signs of fetus)
- Stat Bloodwork (platelets a major issue) D-dimer (mom/fetus blood mixing?) 2-3 bags set aside
- Catheterization (bladder can block hinder uterus + monitor renal Fx)
- Left lateral (vessels perfusing placenta on right can be cut off)
- Attending to anxiety and stress of mother and family
Describe Spontaneous Abortions
(miscarriage public term)
o 15 to 30% end in SA (bleeding post 12wks can be severe)
o Bleeding can often indicate pending SA
o Hemorrhage and shock are the major issues
o Infection r/t retained Products Of Conception (POC) a concern
o Significant event for patients*
Describe Placenta Previa
o 5/1000 births- Placenta develops over cervix
o life threatening for mom and babe, generally it means C section
o Tend to bleed pre and post (r/t decrease muscle concentration at bottom of uterus)UGR , smaller babies common
• (Living Ligature) Muscle concentrated up top
o NO PV Exams (placenta puncture concern)
o Painless Bright red blood
o hospitalization important as SA possible
o Betamethasone helps babies lungs mature (important for early delivery)
Describe Placental Abruption
o placenta peeling away from uterine wall
o Visiblle bleeding (Darker blood) or concealed (painful)
o can be partial of full
o Mostly happens in labour
o Pre-Labour (r/t to trauma or cocaine use)
o Risks- HTN, short cord, older mother, smokers, twin (r/t volume change)
o Couvelaire uterus (stiff uterus does not soften) r/t bledding into peritoneal cavity
Describe Preterm Labour
o 9-11%, responsible for 2/3 of neonatal deaths
o Danger because fetus is not developed enough to survive
o < 37wks gestation
o Causes- Dehydration, UTI’s, periodontal disease (bacteria from mouth can get to uterus and cause irritation), partner violence and stress (low Socioeconomic status)
o 4 or more contractions in 20 min span = hospital
• is it Braxton-hicks? – sit, drink water, feet up, hands on uterus, count
• Turbutalane may be used to stop contractions
• If it’s UTI it’ll be treated with Abx
Describe Preterm Rupture of Membranes
o 5-10% of pregnancies,
o loss of amiotic fluid puts pressure on fetus
o Infection r/t water breaking and bacteria heading in
o Want to keep baby in and growing as long as possible
o Water breaks r/t …
o Concern- umbilical cord pushed into vagina
• LL or on knee with bum in air
• Hand in vagina, push baby head off cord
o Ferning- (to differentiate urine from amniotic fluid
Describe Gestational HTN and it’s cardinal Signs
o Cause often r/t vasospasm during pregnancy
o Unknown underlying cause- Risks include antiphospholipid syndrome, multiple pregnancies, low socioecon, poor nutrition
o Cardinal signs Inc BP (30up form baseline), edema (cerebral and puffy eyes) (r/t Na retention), proteinuria (r/t renal damage from HTN)
Generally Proteinuria is considered a symptom of the more serious for of GES HTN - Pre eclampsia
Describe Pre Eclampsia and interventions
o Gestation HTN is consider mild Preeclamsia
o S&S of severe preeclampsia include headache and visual disturbances and all cardinal signs of Gestational HTN (~160/110 Bp) with more prevalent proteinuria
o Generally occurs in third trimester. Placenta is plays a key role. once delivered, risk is gone within 48hrs
INTERVENTIONS
o Low stimulation environment and Meds
• Antihypertensive (Labetelol) and anticonvulsant (MG sulfate) are common. Peripheral vasodilator (Hydralazine potentially)
o On going assessments- Reflexes (clonus) , headaches, vitals, weights
o Promote bedrest, good nutrition, emotional support
o Placenta is required, once delivered, risk is gone within 48hrs
Describe Eclampsia
o Eclampsia (Seizures or coma) and is a aggravation of preeclampsia r/t cerebral edema and inc ICP.
o Can occur up to 48hrs after Birth
o Blurry vision and inc BP key indicator of imminent seizure
o Tonic phase is full muscle contraction (~20s) respirations cease.
o Clonic- some muscle relaxation (breathing may begin) (~1min)
o Post ictal – Unconscious stage (~1hr)
