Module 03: Pregnancy At Risk: Gestational Problems Flashcards
This is defined as one in which the health of the mother or the fetus is in jeopardy.
High Risk Pregnancy
Why is early and consistent assessment important in high-risk pregnancy?
It ensures a positive outcome for both the mother and fetus by identifying risk factors early.
What are the three major risk factor categories in high-risk pregnancy?
(A) Physiological
(B) Psychological
(C) Social
Give an example of a physiological risk factor.
If client is diabetic, hypertensive, or has a heart problem
Give an example of a psychological risk factor.
If the client had been raped, cannot accept pregnancy, or is depressed.
Give an example of a social risk factor.
If the client has addiction to any illegal substances
What must an OB nurse develop to identify high-risk pregnancies effectively?
A clinical eye to differentiate between normal and abnormal findings.
What is a key principle in managing high-risk pregnancies?
If the mother has a health problem, the fetus is also at risk.
Why is early detection important for biophysical risks?
If the mother had a previous child with a medical condition, there is a risk of passing it on to the next child.
This category of high risk pregnancy includes genetic factors from the mother and father, as well as medical conditions like Trisomy 21 (Down Syndrome).
BIOPHYSICAL
What are the different categories of high risk pregnancy?
(A) Biophysical
(B) Behavioral
(C) Psychological
(D) Socio-demographic
What is an example of a biophysical risk?
A history of genetic disorders in the family, such as Down Syndrome.
This category of high risk pregnancy pertains to the way the mother perceives and behaves toward her pregnancy.
BEHAVIORAL
Give examples of behavioral risks in pregnancy.
Skipping check-ups, unhealthy diet, poor hygiene, substance abuse, and smoking.
How does stress affect pregnancy internally?
It can cause hormonal imbalances, unstable vital signs, and increased blood pressure due to stress-related pathophysiology.
What are external signs of stress in a pregnant woman?
She may appear irritable, sad, or withdrawn.
What other factors can affect the behavioral category of high risk pregnancies?
Environment may have an effect on the mother, e.g working place (might inhale harmful chemicals), living conditions.
What are common psychological risks in pregnancy?
Depression, anxiety, stress.
How can psychological risks affect pregnancy outcomes?
They can lead to abortion, negligence, or hemorrhage due to poor maternal self-care.
What are examples of modifiable psychological risk factors?
A young mother’s level of independence/dependence on her family.
What are non-modifiable psychological risk factors?
Age and family history of a medical condition.
Why is maternal age a risk factor in pregnancy?
Pregnant women below 18 and above 35 are at higher risk due to physical, emotional, and medical concerns (Example: preeclampsia (under 18) , hypertension (over 35).
What makes multiparity a high-risk condition?
Overly stretched uterus → lesser pain perception, no feeling of bearing down → higher risk for hemorrhage.
How can marital status affect pregnancy?
Single or married status may have psychological effects on the mother, impacting emotional well-being.
Why is residence considered a risk factor in pregnancy?
Access to healthcare services may vary based on location, affecting prenatal care quality.
How can ethnicity and cultural beliefs impact pregnancy?
Some cultural practices, myths, or medical restrictions may affect maternal and fetal health.
What is the effect of the mother’s racial or ethnic origin?
(A) There may be medical and/or food restrictions based on their traditions and/or beliefs
(B) Myths
What is the effect of occupational hazards on pregnancy?
Exposure to chemicals, radiation, or physical strain can increase pregnancy complications.
What is a nurse’s primary role in high-risk pregnancy?
To have a clinical eye and identify risk factors affecting pregnancy outcomes.
What are the four key responsibilities of a nurse in high-risk pregnancy care?
(A) Assessment
(B) Health promotion and health prevention
(C) Give health teaching
(D) Provide emotional support
Why is early risk assessment important in pregnancy?
It helps in estimating potential effects on pregnancy outcomes and preventing complications.
These are diseases that can be transmitted from one person to another with heterosexual or homosexual intercourse or intimate contact with the genitalia, mouth and rectum.
Sexually Transmitted Diseases (STD)
These do not thrive among warm environments; patient education is important to correct common misconceptions.
What are the different risk factors for STD?
(A) Lower socio-economic status
(B) Lower educational level
(C) Sexual activity with multiple partner
(D) Unsafe sexual intercourse
How many new cases of STDs occur annually among young people aged 15-24?
An estimated 9 million new cases per year.
Which age group has the highest STD rates?
Sexually active youth aged 15-24.
How do STDs affect pregnant women?
They increase the risk of miscarriage and premature delivery.
Can a pregnant woman transmit an STD to her baby?
Yes, in some cases, infections can be passed to the baby.
Which region has the highest number of new STD infections?
South & Southeast Asia.
Which region has the second-highest number of new STD infections?
Sub-Saharan Africa.
Which region ranks third in new STD infections?
Latin America & the Caribbean.
What is the etiological agent of bacterial vaginosis?
Gardnerella vaginalis.
Bacterial vaginosis is common among which group of women?
Pregnant women.
What are the characteristic symptoms of bacterial vaginosis?
Grayish vaginal discharge with a fishy or musty odor, and pruritus (itchiness).
What tests are used for screening and diagnosing bacterial vaginosis?
(A) Complete history taking
(B) Report of fishy odor and increased vaginal discharge
(C) Normal saline smear (10% of potassium hydroxide to see gram negative rods adhering to epithelial cells)
(D) Check vaginal pH using nitrazine paper and amine odor. (4.5 ph or greater)
Name one reproductive complication caused by bacterial vaginosis.
(A) Pelvic inflammatory disease (PID)
(B) Post hysterectomy vaginal cuff cellulitis
(C) Endometritis
(D) Amniotic fluid infection
(E) Preterm delivery, preterm labor
(F) Premature rupture of the membranes (PROM)
(G) Spontaneous abortion
What is the first-line topical treatment for bacterial vaginosis?
Metronidazole or flagyl (0.75% vaginal gel) or Clindamycin (2% vaginal cream).
What is the recommended oral antibiotic treatment for bacterial vaginosis?
(A) Metronidazole 500 mg orally BID; does not cross placental barrier
(B) Clindamycin 300 mg orally BID (2006 Canadian Guidelines on Sexually Transmitted Infections)
This pertains to the absence of the lactobacilli in the vaginal flora. Common among women during their childbearing age.
Bacterial Vaginosis (Vagina becomes alkalotic).
What is the etiologic agent of candidiasis?
Candida albicans.
Why is pregnancy a risk factor for candidiasis?
Increased estrogen levels create a glycogen-rich environment, promoting fungal growth.
Name the major risk factors for developing candidiasis.
(A) Oral contraceptives (increases estrogen)
(B) Antibiotic therapy (broad spectrum antibiotics, like ampicillin and tetracycline, destroy normal vaginal flora)
(C) Immunosuppression (high possibility that pt has increased blood sugar)
(D) Diabetes mellitus
(E) Pregnancy due to high estrogen levels and glycogen levels
What are the key symptoms of candidiasis?
(A) Reddened vulva
(B) Pruritus (itchiness)
(C) White patches on the vaginal wall
(D) Thick, cream cheese-like discharge
(E) Pain during intercourse (dyspareunia)
(F) Painful urination (dysuria)
What is the first-line medical management for vaginal candidiasis?
Vaginal suppositories or vaginal cream for 7 days (preferably at bedtime).
Name two antifungal vaginal creams used to treat candidiasis.
(A) Miconazole (Monistat)
(B) Clotrimazole (Lotrimin)
What is the oral antifungal medication given for candidiasis, and how many doses are required?
Fluconazole (Diflucan), single dose.
What are the different screening and diagnosis tools to detect candidiasis?
(A) Complete history taking
(B) Physical Exam
(C) KOH Wet Smear
(D) Checking of Vaginal Ph (ALKALOTIC VAGINA)
What are the etiologic agents of Chlamydia?
Chlamydia vaginalis and Chlamydia trachomatis.
1 week to 5 weeks (SYMPTOMS)
What are the common symptoms of chlamydia infection?
(A) Heavy, grayish-white vaginal discharge
(B) Pruritus (itchiness)
Sometimes asymptomatic. The woman may experience spotting and post-coital bleeding.
What complications can arise from untreated chlamydia?
(A) Cervicitis
(B) Urethritis
(C) Vaginitis
(D) Pelvic inflammatory disease (PID)
How is chlamydia diagnosed in pregnant women?
(A) Complete history taking and physical examination
(B) Cervical culture during the first prenatal visit (alternative: urine specimen)
(C) If positive, repeat testing at 36 weeks gestation
(D) After taking the medicine, come back after 3 to 4 weeks for retesting.
In chlamydia, the partner should also be tested to avoid the woman from being reinfected.
What are the first-line antibiotics for chlamydia in non-pregnant women?
(A) Tetracycline
(B) Doxycycline (teratogenic—can cause fetal musculoskeletal deformities)
What antibiotics are safe for treating chlamydia in pregnant women?
(A) Amoxicillin
(B) Erythromycin
(C) Azithromycin (1g orally, single dose)
What is the risk of transmission to an infant born through an infected birth canal?
60-70% risk of acquiring the infection.
What are the effects of chlamydia on pregnancy and newborns?
(A) Ectopic pregnancy
(B) Preterm birth
(C) Premature rupture of membranes (PROM)
(D) Amniotic fluid infection
(E) Premature delivery
(F) Newborn complications:
Conjunctivitis and pneumonia
What are the other effects of Chlamydia on the infant based on research?
(A) 25.50% Conjuctiivitis
(B) 10% with pneumonia
What is the etiologic agent of gonorrhea?
Neisseria gonorrhoeae (Gram positive diplococci)
This condition is characterized to be easily transmitted among sexual partners.
Gonorrhea
(This is concurrent with chlamydia)
What are the effects of gonorrhea in men?
(A) Epididimitis
(B) Permanent sterility
(C) Urethritis for men if left untreated
(D) Scarring of the tissue which could lead to infertility.
How is gonorrhea transmitted?
Through sexual contact:
(A) Genital to genital
(B) Anal to genital
(C) Oral to genital
(D) Vagina to rectum
What are the common symptoms of gonorrhea in women?
(A) Yellowish vaginal discharge
(B) Inflamed Bartholin’s glands
(C) Painful Bartholin’s glands
2 to 7 days incubation so easily transmissible
What diagnostic tests are used to confirm gonorrhea?
(A) Urine culture
(B) Vaginal culture
(C) Urethral culture
(D) Anal culture
(E) Oral culture
What are the first-line treatments for gonorrhea?
(A) Cefixime (Suprax) 400 mg PO once
(B) Ceftriaxone (Recephin) 125-250 mg IM once (depending on the patient’s weight)
(C) Doxycycline and erythromycin (may cause nausea and vomiting)
Can use azithromycin.
Educate the patient to come back after 7 days to get retested.
How soon after treatment does a patient become non-infectious?
24 hours after treatment
What are the effects of gonorrhea on pregnancy and newborns?
(A) Severe eye infections in newborns
(B) Blindness
(C) Endocervicitis
(D) Intrauterine growth restriction
(E) Premature rupture of membranes (PROM)
(F) Preterm birth
(G) Maternal postpartum sepsis
What is the etiologic agent of herpes genitalis?
Herpes simplex virus type 2 (HSV-2), Herpesvirus hominis type 2
How is herpes genitalis transmitted?
(A) Skin-to-skin contact
(B) Direct contact with lesions
(C) Break in skin or mucous membrane
What is the incubation period for herpes genitalis?
3-14 days
Is there a cure for herpes genitalis?
No, it is a lifelong, reoccurring infection.
What are the symptoms of the primary stage of herpes genitalis?
(A) Pinpoint vesicles (lesions) on external genitalia
(B) Flu-like symptoms (fever, malaise)
(C) Profuse vaginal discharge
(D) Intense pain when in contact with clothing or acidic urine
What diagnostic tests confirm herpes genitalis?
(A) Appearance of lesions
(B) Pap smear
(C) Vesicle culture
(D) ELISA (enzyme-linked immunosorbent assay)
What medications are used to manage herpes genitalis?
(A) Acyclovir (Zovirax) – inhibits viral replication
(B) Valacyclovir (Valtrex) – preventive measure
(C) Topical imiquimod (Aldara)
(D) Foscarnet (Foscavir) – for resistant lesions
What additional management strategies help with herpes symptoms?
(A) Sitz bath (TID)
(B) Use of condoms
(C) Annual Pap tests
(D) Proper protection when administering medications
How can herpes genitalis affect pregnancy and newborns?
(A) Can cross the placenta
(B) Can be transmitted to the newborn during birth
(C) Congenital herpes may cause severe systemic infection (fatal)
(D) Cesarean section (CS) is scheduled if active lesions are present
(E) Vaginal birth is allowed if no active lesions are present
What is the etiologic agent of HIV/AIDS?
Human Immunodeficiency Virus (HIV), a human retrovirus
(targets white blood cells and incubation period is 10 years)
How is HIV transmitted?
(A) Intimate sexual contact
(B) Parenteral exposure (blood, breastmilk, semen, vaginal discharge)
(C) Perinatal transmission (mother to child)
What are the stages of HIV infection?
(A) Acute Infection (Initial Invasion) – flu-like symptoms (fever, chills, fatigue, swollen lymph nodes) (2-4 weeks after exposure)
(B) Seroconversion – body develops HIV antibodies (6 weeks to 1 year after exposure)
(C) Asymptomatic Period – weight loss, fatigue (3-11 years)
(D) Symptomatic Period – opportunistic infections (oral/vaginal candidiasis, Kaposi sarcoma, herpes simplex, pneumocystis carinii pneumonia)
What tests confirm HIV infection?
(A) ELISA (screening test)
(B) Western Blot (confirmation test)
(C) CD4 cell count
How many lives has HIV/AIDS claimed to date?
An estimated 42.3 million lives.
How many people were living with HIV at the end of 2023?
Approximately 39.9 million people.
How many people died from HIV-related causes in 2023?
An estimated 630,000 people.
How many new HIV infections occurred in 2023?
Around 1.3 million new infections.
Is there a cure for HIV infection?
No, there is no cure for HIV infection.
How is HIV managed today?
With antiretroviral therapy (ART), allowing people to live long and healthy lives.
However, if the mother does not consume the ART, there will be placental transfer from the mother to the infant. All babies born from HIV positive mothers should be tested.
What is the nursing management for HIV/AIDS?
(A) Aseptic technique & hand hygiene
(B) Reverse isolation
(C) Administer antiretroviral therapy (Acyclovir, Zidovudine, Ritonavir, Indinavir)
(D) Educate on breastfeeding risks & safe sex practices
(E) Maintain CD4 cell count >200-500 cells/mm³
What is the medical management for HIV-positive pregnant women?
(A) Oral Zidovudine with Ritonavir or Indinavir
(B) TMP-SMZ (Bactrim) or Pentamidine for PCP pneumonia
(C) latelet transfusion if thrombocytopenic before birth
(D) Cesarean delivery to reduce transmission risk
What is the etiologic agent of HPV infection?
Human Papillomavirus (HPV)
(Tissue enlargement)
What cancers are associated with HPV infection?
(A) Penile cancer
(B) Cervical cancer
What are the common characteristics of HPV infection?
(A) Genital warts
(B) Affects the external vulva and penis
What are the key symptoms of HPV infection?
(A) Profuse vaginal discharge
(B) Itching
(C) Dyspareunia (painful intercourse)
(D) Post-coital bleeding
(E) Bumps on the vulva
What are the diagnostic tests for HPV infection?
(A) Physical exam
(B) Pap smear
(C) Histological biopsy (most definitive)
(D) ELISA
What is the medical management for HPV infection?
(A) Removal of warts
(B) Podophyllin (Podofin) for small lesions (not for pregnant women)
(C) TCA/BCA for pregnant women (applied weekly)
(D) Laser therapy, cryocautery, or knife excision for large lesions
What vaccine is recommended for HPV prevention?
(A) Gardasil
(B) Given in 3 doses
(C) Recommended for girls aged 9-14
How does HPV affect pregnancy?
(A) Increased HPV lesions
(B) Ulcerated and infected lesions
(C) Foul vulvar odor
(D) Cesarean birth indicated for large lesions
What is the etiologic agent of trichomoniasis?
Trichomonas vaginalis
What is the incubation period of trichomoniasis?
20 days
What are the key symptoms of trichomoniasis?
(A) Vaginal irritation
(B) Frothy white or grayish-green vaginal discharge
(C) Reddened upper vagina
(D) Pruritus (itching)
What are the effects of trichomoniasis?
(A) Preterm labor
(B) Premature rupture of membranes (PROM)
(C) Post-Cesarean section infection
What is the medical management for trichomoniasis?
(A) Metronidazole (anti-fungal)
(B) Not given during the 1st trimester of pregnancy 🤰.
What is the etiologic agent of syphilis?
Treponema pallidum (spirochete)
What is the incubation period of syphilis?
10-90 days
When does the spirochete cross the placenta in pregnancy?
16th - 18th week of pregnancy (when cytotrophoblast atrophies)
What are the stages of syphilis and their symptoms?
(A) Primary Stage – Small, hard-based chancre or sore (disappears after 2-4 weeks)
(B) Secondary Stage – Skin rashes (soles and palms), loss of patches of hair, malaise, low-grade fever
(C) Latent Stage – Asymptomatic for years, positive VDRL test
(D) Final Stage – Gamma formation (rubbery mass of tissue), affects major organs (heart, nervous system)
What tests are used for screening and diagnosis of syphilis?
(A) VDRL Test
(B) Done during the first prenatal visit
(C) Repeated in the 8th month of pregnancy
What is the medical management for syphilis?
(A) Benzathine penicillin G (for pregnancy)
(B) Procaine penicillin, IM 750 mg for 10 days
(C) Erythromycin 500 mg, 4 times a day for 14 days (if allergic to PenG)
(D) Azithromycin 500 mg
What is the Jarisch-Herxheimer Reaction in syphilis treatment?
(A) Caused by sudden destruction of spirochetes
(B) Lasts about 24 hours
(C) Symptoms: Hypotension, fever, tachycardia, muscle aches
What are the effects of syphilis during pregnancy?
(A) Spontaneous abortion
(B) Stillbirth
(C) Premature labor
(D) Congenital syphilis (enlarged liver & spleen, skin lesions, rashes, pneumonia, hepatitis)
(E) Congenital anomalies (extreme rhinitis, syphilitic rash, Hutchinson’s teeth, interstitial keratitis)
What should be included in the assessment for STIs?
(A) History Taking
(B) Multiple partners
(C) Unprotected sexual intercourse
(D) Drug-related risky behaviors
What are common nursing diagnoses for patients with STIs?
(A) Knowledge deficit
(B) Altered health perception
What are key nursing interventions for STIs?
(A) Facilitate learning
(B) Provide social and emotional support
(C) Promote self-care
What should patients be taught regarding hygiene and self-care?
(A) Proper perineal washing
(B) Frequent bathing and hand washing
(C) Douching is contraindicated unless prescribed
How can nurses promote healthy sexual attitudes?
(A) Encourage safe sex practices
(B) Educate on STI prevention
(C) Support open communication with partners
