Module 13 risk assessment in preg Flashcards
fetal assessments
fundal height
HFT: patterns
kick counts: 10 in 2 hours
high risk preg
condition that inc. risk for uteroplacental insufficiency - GDM, HTN Hx of previous stillbirth advanced maternal age spontaneous abortion risk genetic abnml nutritional deficiencies psychosocial concerns - substance abuse - domestic violence - STI multifetal post-term dec. fetal movement intrauterine growth retardation oligohydramnios hx congenital abnml chronic disease in mother
screenings
US doppler NIPT quad screen NST (non-stress test) US biophysical profile (BPP) - FHT, fetal breathing, fetal movements, fetal muscle tone, amniotic fluid CST (contraction stress test)
diagnostic tests
CVS
Amnio
- L/S ratio
vaginitis causes and s/s
Causes: - yeast - bacteria - protozoa s/s - itching - burning - malodorous discharge Tx: - 7 day topical vaginal azole cream
BV
associated with adverse preg. outcomes if left untreated.
- bacteria -> uterus -> preterm labor/ preterm rupture of membranes, intrauterine infection, postpartum endometritis
Help prevent vaginal infections
refrain from douching freq. wash hands wear cotton underwear and loose clothes keep underwear dry avoid scented liners; dont wear every day DO eat yogurt or use probiotics
N/V dietary changes
small, freq. meals eat first thing before rising high-protein avoid triggers of strong smelling foods carbonated drinks can help try ginger, acupressure, Vit B6
GERD prevention
raising HOB
eating small, bland meals
avoiding lying flat
constipation and hemorrhoids management
inc. water and fiber inc foods with laxative properties - prunes - decaf moderate physical activity avoid straining to pass BM
bleeding in the first trimester
25% of women will have this - only 50% of these will result in live infant Causes - cervical, uterine, or chromosomal abnormalities - ectopic pregnancy - hormonal or nutritional imbalance - trauma - poorly controlled DM - maternal infection - substance abuse
expectant management (non-viable fetus)
the expulsion of the uterine contents proceed spontaneously
- bleeding can last 7-10 days, significant
- if uterine contents have not passed in 7 days RTC
- inc. bleeding accompanied by pain, adnexal pain, or fever, or heavy bleeding with pain lasting longer than 1 hr -> RTC
medical management (non-viable fetus)
use of misoprostol
less than 13wks
- less pain, but more bleeding than surgical intervention
- if no expulsion by day 3 dose repeated
- > no expulsion by day 8 -> surgical management
surgical intervention
dilation and curettage
- may be needed if expulsion of uterine contents not completely evacuated or if woman develops sepsis
ectopic pregnancy
implantation outside uterus
- slowly rising or continued + b-hCG levels with no intrauterine preg seen with US
- poss. severe lower abd. pain, spotting, diaphragmatic irritation, especially w/ rupture
- need surgical intervention
bleeding in 2 and 3 trimester
usually related to benign causes - bloody show - postcoital or post-exam spotting - vaginal or cervical infection More serious - placenta previa - preterm labor - placental abruption
placenta previa
implantation of the placenta near or across the cervical os
- serial US important because the condition often resolves as the uterus enlarges
- delay vaginal exam until location of the placenta is confirmed
- complete previa: strict pelvic rest may be ordered
placental abruption
part or all of placenta separates from uterine wall. Risk factors - inc. age and parity - maternal HTN - PPROM - multiple gestation - smoking - cocaine
classic placental abruption s/s
blackish metrorrhagia
severe abd pan and/or back pain
uterine hypertonia
preterm labor risk factors
socioeconomic status genetic conditions periodontal disease uterine or cervical abnormalities multiple gestation substance use maternal infections diseases like pre-eclampsia
asthma
poorly controlled or severe asthma - more likely to have exacerbations increased risk for: - premature delivery - preeclampsia - intrauterine growth restriction - cesarean section
4 categories of HTN in preg
chronic HTN
gestational HTN
preeclampsia and eclampsia
preeclampsia superimposed on chronic HTN
Risk factors for preeclampsia
HTN chronic renal disease multiple gestations molar pregnancy African or asian maternal age <20 or >35 nulliparity hx preeclampsia new paternal partner obesity pregestational DM antiphospholipid antibody syndrome
Maternal consequences of HTN
preterm labor placental abruption disseminated intravascular coagulopathy HELLP syndrome inc. need of C-section postpartum hemorrhage GDM
Tx of HTN in preg
recommended in BP is higher than 160/105
- gestational HTN and preeclampsia
- expected management: deliver at 37 wks
s/s of severe preeclampsia
severe headaches - do not resolve with rest, tylenol, fluids, food RUQ pain visual changes SOB
severe preeclampsia expected tx
beyond 34 weeks is not recommended and referral is indicated.
eclampsia
requires emergent deliver regardless of age of fetus
