Maternity week 2-Workbook Flashcards
what developmental tasks might be interrupted by pregnancy in adolescence
- to establish a sense of self-worth or value system,
- to emancipate from parents
- to adjust to a new body image
- to choose a vocation
what are the 7 prominent complications of pregnancy for adolescents
- High risks of gestational HTN,-bed rest is best
- iron def anemia-d/t poor intake
- premature labor,-uterus not fully grown
- postpartum hemmorhage-as uterus not grown and gets distended by preg so it cant contract
- lack of knowledge of infant care
- disproportion of fetal and pelvic size,
- inability to adapt postpartally-talk to prevent postpartum dep
other issues are hemorhoids, intimate partner violence and low birth wt…
what is most effective for prenatal care of pregnant adolescent
one in particular is best and others?
- Minimizing the number of care providers may be most effective
- Early and consistent care
- Some like group care for peer interaction
is a woman >40 likely to have serious complications during pregnancy/delivery
why
what is most common
not generally. with good prenatal care she should be fine
fetal chromosomal abn have inc incidence in those >40
how might the physical health of a pregnant woman >40 be different than a younger one
what system in particular?
she will likely enter pregnancy with comorbidities
cardiovascular issues
what is the developmental task of those >40 and how would this affect their pregnancy
• their developmental task is to expand their awareness or develop generativity-a sense of moving away from themselves nad getting involved with the world or community. This might make them ambivalent towards preg as they want to continue their reg activities
what social, work, relationship, role issues might >40 pregnant woman face
- they might feel the clock is ticking and get preg immed after starting new relationship=many adjustments at once
- if she has high-paying job/career might be hard to stop work
- might be sandwich generation with multiple older and younger dependents
- may not have friends her age having babies-less peer support
what chromosomal risk do women >40 face inc risk of
• inc risk of Down Syndrome from 1/1500 to 1/1000
names of specific tests done for Down Syndrome
other tests done
• quad screen or integrated screen are done to see if open spinal cord or chromosomal defect could be present in fetus
• U/S for nuchal translucency
• Lab tests of alpha fetoprotein and
-test for hCG (hormone made by placenta)
-test for estriol (made by placenta and fetus
-test for inhibin A (made by ovaries and placenta done at 15-16wks)
when is ultrasound for nuchal translucency
if it is translucent it suggests Down syndrome and its done weeks 10-13
what is alpha fetoprotein
what does it mean if this and the other substances tested are high
alpha fetoprotein (protein made by fetus), hCG, estriol (made by fetus and placenta), inhibin A a protein made by placenta and ovaries. These substances will be inc in maternal serum if fetus has open spinal defect and lower than usual if a chromosomal abn is present
what does “substance dependent” mean
• A person is substance dependent when they have withdrawal symptoms following discontinuation of the substance, combined with abandonment of important activities, spending inc time in actitivities r/t substance use, using substances for longer time than planned, or continued use despite worsening problems because of substance use
how does being subsstance dependence impact the mother
• She may not have $ for supplements, nutrition, iron
• May have inc risk of Hep B or HIV, STIs
• Mum might have inc BP, tachycardia, vasoconstriction from the drugs
-likely she has less supports, less $ and poor nutrition
how does being substance dependent affect the fetus
-what beyond the direct and immediate effects of the drug will harm the fetus?
• She may not have $ for supplements, nutrition, iron
-she might not access prenatal care
• Infant may have drug withdrawal after birth if she was still using up to labour,
-is it easy for drugs to cross the placenta? how much?
- Illicit drugs are small molecular weight often and they can eaily cross the placenta
- Fetus has drug conc of 50% of the mom
what complications can result fom substance use in pregnancy
what is one of the main issues with durg use during preg beyond the direct toxins
- Can lead to fetal abn, preterm birth, abruption placentae.
- May have dec fetal heart rate variability from poor tissue perfusion (poor perfusion)
what are the 4 compications asso with >40 pregnancy
im not so sure which she means…
Gest HTN-inc risk d/t blood vessel elasticity dec. the HTN may have existed before preg
failure to progress in labour as cervical dilation doesnt happen as easily
post.p.hem-uterus might not contract as readily
, preterm birth-
or postterm birth,
cesarean
hemorrhoids, varicose veins, thrombophlebitis
what are the risks assoc with uterine rupture
- prolonged labor,
- abnormal presentation,
- multiple gestation
- , unwise use of oxytocin,
- obst labor,
- and traumatic maneuvers of forceps or traction
what are the sés of uterine rupture for mum and babe
• sudden, severe pain during a strong labor contraction. Rupture can be complete, going through the endometrium, myometrium, and peritoneum layers or incomplete leaving it intact
o 2 distinct swellings on abd: retracted uterus and exttrauterine fetus
• Hemorrhage from the torn uterine floods into abdcavicty and possibly vagina. Signs of hypotensive shock begin
• If rupture is incomplete, signs are less evident…localized tenderness and persistent aching pain over te area of lower uterine segment
• Fetal heart sounds, lack of contractions and the change in vital signs reveal fetal and maternal distress
what are the nursing and medical interventions for uterin rupture
- Administer IV fluid, maybe IV oxytocin to contract the uterus
- Prepare woman for possible laparotomy to control bleed
- They might do tubal ligation or hysterectomy as she is advised not to conceive again
what is uterine inversion and what two events might cause it
• Uterus turning inside out with either birth of the fetus or delivery of the placenta
2 events that cause inversion
• May occur if the traction is applied to the cord to remove the placenta or if pressure is applied to the uterine fundus when the uterus is not contracted. May also occur if the placenta is attaché at the fundus so that, during birth, the passage of the fetus pulls the fundus downward
how might the pt present or what can tell nurse that pt has uterine inversion
how can uterine inversion be prevented
Nurse might notice
• Lg amount of Blood gushes through vagina
• Fundus is no longer palpable
• S&S if her bleeding continues: dizziness. Hypotensive, pale, diaphoresis
To prevent in future after inversion occurs she will need c-section
how to respond to uterine inversion
what do you NOT do
- Don’t attempt to replace inversion-more bleeding
- Oxytocin should be d/c bc makes uterus more tense and difficult to replace. Will admin after physician replaces fundus manually to help uterus contract and remain in natural place
- IV fluid or blood
- O2 by mask and vitals
- Prepare for CPR in case too much blood loss
- Will be given general anesthesia, possibly nitroglycerin, or tocolytic drug to relax uterus
- Abx to prevent infection
what is an amniotic fluid embolism and how does it present
- Occurs when amniotic fluid is forced into an open maternal uterin blood isnus after a membrane rupture of partial premature separation of the placenta
- Humoral or anaphlactoid response to amniotic fluid in the maternal circulation. May occur in labor or postpartal period
S&S:
• sits up and suddenly grasps chest bc of sharp pain and inability to breath as pulmonary artery constriction occurs. Becomes pale then typical bluish gray associated w a PE and lack o blood flow to the lungs. Within min, LOC and fetus is in danger bc placenta circulation stops
what is amniotic fluid embolism assoc with and how can you prevent it
Associated with induction of labor, multiple pregnancy, and perhaps hydramnios,
Not preventable bc cant be predicted
still to do: substances, anomalies of placenta and cord…reflection questions..maybe the highlighted words.
x
placenta normal wt
how many cm diameter
• Normal weight = 500g, 15-20cm diameter, 1.5-3.0cm thick; weight ~1/6 of fetus
what are the 6 anomalies of the placenta
the placenta is the baby’s p-SAC…and VBV
placenta succentariata
placenta accreta
placenta circumvallata
vasa previa
battledore placenta
valamentous insertion of the cord
which types of placental anomalies are not assoc w abnormalities
which of these must be removed manually to prevent adverse effects
placenta succentariata-remove manually to prevent hem
placenta circumvallata
battledore placenta
what type of placenta abn can you not deliver with
Placenta Accreta
what is significant about pacenta accreta
- Unusually deep attachment of placenta to uterine myometrium
- Will not loosen + deliver
- Can’t remove d/t hem risk…may need hysterectomy or tx w methotrexate
Placenta Succentariata what is it and what is the danger
- One or more accessory lobes connected to main placenta by blood vessels
- No fetal abnormality
- Small lobes may be retained after birth severe maternal hem
- If recognized + removed manually, no adverse effects
which of the placental abn has some extent of the fetal side covered with chorion
placnta circumvallata
placenta circumvallata
how bad is it
what is it
- Usually chorion membrane extends from edge of placenta + goes over fetus
- Here, fetal side of placenta covered to some extent with chorion
- Umbilical cord enters placenta at usual midpoint + large vessels spread from there..but end abruptly at point where chorium folds back onto the surface
- In placenta marginata, fold of chorion reaches just to edge of placenta
- No abnormalities assoc with this
which placental abn has an Unusually deep attachment of placenta to uterine myometrium
what might be necessary
Placenta Accreta
• Will not loosen + deliver
• Can’t remove d/t hem risk…may need hysterectomy or tx w methotrexate
which of the placenta abn is most rare and not cliniclly significant
what occurs in this
3) Battledore Placenta
• Cord inserted marginally rather than centrally
• Rare + no clinical significance
Valamentous Insertion of the Cord
what is the issue
what is it often assoc with
what type of anomalies might result
- Cord, instead of entering placenta directly, separates into small vessels that reach placenta by spreading across fold of amnion
- Most frequently found with multi gestations
- Assoc with fetal anomalies d/t possible loss of blood supply
which placental abn has vessels laying across the cervical os that might be delivered before the baby and tear
vasa previa (i think “vas” like vessel and “previa” like previous. The vessels can come previous to the fetus)
- Umbilical vessels of a velamentous cord sertion cross the cervical os + deliver before fetus
- Vessels may tear w cervical dilation (just like placenta previa)
- Tear = sudden fetal blood loss (suspected if sudden painless blood loss occurs with cervical dilation)
- Careful when inserting fetal monitoring devices
- Identified by U/S
- Need C-section
what are the 2 anomalies of the cord
unusual cord length
two vesse cord
what are the vessels normally found in the cord and what do they contain
1 vein (the vein carries nutrient rich blood to babby, 2 arteries that carry waste back to placenta
what is 2 vessel cord
what systems might have been affected
consideration for checking the cord
- Here, only 1 artery
- Assoc with congenital heart + kidney anomalies (insult affected vessel also affected other mesoderm germ layer)
- Must check cord immed after birth for all vessels before drying occurs – if see this, baby needs to be assessed carefully
what are the problems with a umbilical cord that is too short or too long
- If short, can result in premature separation of the placenta or abnormal fetal lie
- If long, may twist + knot will most likely not affect blood supply
what is a nuchal cord and is it serious
• Nuchal cord – wraps around fetal neck. Not usually harmful.
who is most likely to be using substances during preg (age)
young weomen
how does cocaine affect the body of mom and therefore the fetus
what risks are there
- Affects CNS vasoconstriction inc resp + cardiac rates
- Effect can be so dramatic it leads to cardiac failure
- During preg, vasoconstriction severely compromised placental circ + premature separation of the placenta preterm labour or fetal death
how might a baby going through cocaine withdrawal look
beyond preterm labour, fetal death, cardiac failure what immediate risk is there to fetus
what type of long term deficits might be seen
- Infants suffer immediate effects of intracranial hem + abstinence syndrome of tremulousness, irritability, muscle rigidity
- Poss social + learning deficits in long term (not well documented)
Amphetamines
what effects do they have
name of meth that is smoked
Amphetamines • Methanphetamine = speed – neurostimulant + neurotoxin • Cheap, made in home labs • Effects similar to cocaine • Ice = rock type of meth smoked
what can amphetamine use look like in the woman
what would it ook like in the infant
- Women: blackened + infected teeth
* Infant: jitteriness + poor feeding at birth, growth restrictions
effects of marijauna and hashish
why might a woman use this
is it safe for breastfeeding
- Both from cannabis
- Produce tachycardia + sense of well-being
- May use pot for nausea in preg
- Effects not well documented, as often part of polydrug abuse
- Mom may be asked not to breast feed as have reduced breast milk + contains the drug
what effects is marijauna assoc w
• Assoc w loss of short-term memory + inc in resp infections in adults
what is pcp
whys it bad
- PCP-phenylcyclidine
- Used by rave culture, used to be used as anesthetic
- Leaves maternal cells + concentrates in fetal cells, may be particularly injurious to fetus
what result can drinking alohol during preg have for fetus
taching consideration for YA
what other drug seems to have sim effects
• Results in FASD (recognizable facial features, cognitive challenges, memory deficits)
• Ensure young adults know binge drinking is not safe for fetus (this seems a little obvious??)
-inhalants have sim effects
inhalants what are they and what causes the damage
what is the negative effect
- Glue, cooking sprays, computer keyboard cleaner
- Often done by adolescents
- Freon in these products resp + cardiac irregularities
- Appears to have similar effects to alcohol during preg
- Resp depression leads to dec O2 to fetus
what matures faster in infants whosse mums were substance dependent. how does this benefit them
• Fetal livers and lungs often mature faster w substance dependent mom can deal with bilirubin better + have less resp distress syndrome than average
what negative effects does heroin have for poor baby
• Heroin: can result in fetal opiate dependence + severe abstinence symptoms is child after birth
o Babies small, inc fetal distress + meconium aspiration
what are the abstinence symptoms of a baby from heroin
o Abstinence symptoms: NVD, abdm pain, shivering, insomnia, body aches, muscle jerks – can begin as soon as 6 hrs after last dose + continue for several days
if heroin taken what kind of complications can the pregnancy have
• Cocaine: pregnancy complications incl gestation HTN, phlebitis, subacute bacterial endocarditis, heb B and HIV (if injected)
benefits to mom on methadone vs heroin
what else might they use
- If possible, want mom in methadone program during preg – fetus still will have abstinence symptoms at birth…sometimes worse with methadone than heroin (but at least is being procide better nutrition, prenatal care, less exposure to hep B + HIV)
- Bupredorphine sometimes used if methadone not available or suboxone (naloxone + bupredorphine)
what unique considerations to include for woman over 40 physical assessment
• physical exam—esp circulatory problems. Get urine spec to test for renal fx and diabetes. Look for breast CA. Gestational trophoblastic disease (hydatiform mole) is more common so assess funal height and fetal movement
