OB Complication

Question 1

What is Hydramnios

Answer 1

To much fluid in the mother and happens between 32-36 weeks

Question 2

What are risk of hyrdamnios

Answer 2

Preterm births, fetal malpresentation, cord prolapse

Question 3

Causes of hydramnios

Answer 3

To much fluid producded or taken up to much room, maternal or fetal anomalies

Question 4

Therapuetic management of hydramnios

Answer 4

close monitoring, frequent follow ups, can do prostaglandin synthesis inhibitor to decrease amount of fluid volume by decreasing fetal urinary amount

Question 5

Nursing assessment of hydramnios

Answer 5

know risk factors (maternal disease, fetal anomalies such as fetal esophageal or intestinal atresia, neural tube defects, missing chromosomes),measure fundal height, palpate abdomen, and obtain FHR

Question 6

Management of hydramnios

Answer 6

Monitor abd pain, dyspnea, uterine contractions and edema

Question 7

What is Oligohydramnios

Answer 7

Decreased amount of fluid between 32-36 weeks gestation. Prevents fetus from making urine or blocks it from going into the amniotic sac. Naturally happens last 2 weeks.

Question 8

Therapeutic management of Oligohydramnios

Answer 8

Outpatient basis with US and fetal surveillance through nonstress test and biophysical profile. If fetal compromise amniofusion will start

Question 9

What is amniofusion

Answer 9

Transvaginal infusion of crystalloid fluid to compensate for lost amniotic fluid. Improves abnormal FHR patterns, decrease c-sections, and possibly minimize risk of neonatal meconium aspiration syndrome. given for oligohydramnios

Question 10

Nursing assessment for Oligohydramnios

Answer 10

Review risk factors (uteroplacental insufficiency, PROM, hypertension to pregnancy, maternal diabetes, polysystic kidneys UT obstruction) Look fo leaking fluids

Question 11

Nursing Management for Oligohydramnios

Answer 11

Continous monitoring, changing positions when variable dcells occur, assist with amnioinfusion

Question 12

What is placenta previa

Answer 12

After birth happens first

Bleeding condition that occur last two trimesters, the placenta implants over the cervical os.

Question 13

Consequences of placenta previa

Answer 13

Hemorrhage, abruption of placenta, or emergency c-section

Question 14

4 types of placenta previa

Answer 14

Total placenta previa: internal cervix os is covered by placenta
Partial placenta previa: internal os is partially covered
Marginal placenta previa: at the edge of os
low lying placenta previa: implanted in the lower uterine segment and is near os but does not reach it

Question 15

3 types of placental vascularization
Accreta placenta previa
Increta placenta previa
Percreta placenta previa

Answer 15

1. placenta attaches directly to myometrium
2. Deeply attached to myometrium
3. Infliltrates the myometrium

Question 16

Therapeutic management of placenta previa

Answer 16

depends on extent of bleeding, amount of placenta over the os, whether the fetus is developed enough to survive outside the uterus, position of fetus, mothers parity and labor.

Question 17

Risk factors for placenta previa

Answer 17

Advanced age, previous c-section, multiparity, uterine injury, cociane use, prior placenta previa, infertility treatments, asians, previous abortions, smoking, removal of fibriods (myemectomy), hypertension diabetes

Question 18

Nursing assessment of placenta previa

Answer 18

Exam would repot bright red painless vaginal bleeding during 27-32 weeks, bleeding occurs at implantation site and uterus cannot contract adequately and stop flow of blood. assess for contractions, uterus will be soft and nontender, no fetal distress noted,

Question 19

S/S of placenta previa

Answer 19

PAINLESS vaginal bleeding after 24 wks, Dx w/ transvag US, insidious onset, blood always visible

Question 20

expected plan of care for the term patient who is diagnosed with placental abruption.

Answer 20

delivery, bed rest, IV - tx is designed to assess, control, restore amount of blood lost, provide positive outcome for mom and baby, prevent DIC

Question 21

Risks for cord prolapse

Answer 21

malpresentation (breech/transverse), growth restriction, prematurity, ruptured membranes w/ fetus at high station, hydramnios, grandmultiparity, multifetal gestation, abnormal placentation

Question 22

Treatment for cord prolapse

Answer 22

IMMEDIATE DELIVERY - place pt in knee to chest, hold presenting part off the cord, wrap cord in warm normal saline gauze, O2 at 10 L/Min, fluids wide open

Question 23

implications of amniotic fluid embolism to mother and fetus.

Answer 23

Anaphylactic rxn to amniotic fluid S/S: hypoxia, hypoTN, consumptive coagulopathy, cardiopulmonary collapse - should be suspected in any woman w/ acute onset of dyspnea, hypoTN, DIC
no test to dx, tx: ABC, CPR, deliver infant w/in 5 min, inotropic drugs, control bleeding, seizure precautions, VS - maintain oxygenation and hemodynamic fx

Question 24

Pregnancy Induced Hypertension:

Answer 24

140/90 on 2 occasions at least 6 hours apart after 20th week - vasospasms → fluid volume excess, fluid retention

Question 25

Preeclampsia/Eclampsia

Answer 25

Underlying mechanisms: vasospasm and hypoperfusion, endothelial injury leads to platelet adherence, fibrin deposition, and schistocytes. Vasospasm = increase BP, decreased blood flow to brain (seizures), liver (causes hemorrhage), kidney (albumin escapes → PE), placenta (IUGR, placental abruption, hypoxia, acidosis), and lungs.

Question 26

HELLP

Answer 26

RBCs fragment when passing through vessels - hemolysis is called microangiopathic hemolytic anemia. Elevated Liver Enzymes - due to reduced blood flow to liver secondary to obstruction from fibrin deposits, Low Platelets - due to vascular damage as a result of vasospasms and aggregation at sites of damage - leads to thrombocytopenia

Question 27

Medical conditions which can serve as precursors to DIC.

Answer 27

placental abruption, infection, retained dead fetus, amniotic fluid embolism
Shock, cirrhosis, glomerulonephritis, acute fulminate hepatitis, acute bacterial and viral infections
Trauma, heat stroke, extensive burns, transplant

Question 28

normal levels of amniotic fluid during pregnancy, ames of the categories and functions of the fluid.

Answer 28

Normal levels 500-2000 mL @ 32-36 wks
Amniotic fluid Index: 8.1-24 is normal
pH of Am. Fl is 7-7.25
hydramnios - > 2000 mL @ 32-36 wks,
oligohydramnios - < 500 mL at 32-36 wks
Fx of amniotic fluid: protect cord blood flow, cushion baby, allow for fetal movement and limb development, development of GI and urinary system
Check for AROM: Nitrazine, ferning, amniosure

Question 29

risk factors for premature rupture of membranes

Answer 29

Prior PROM, smoking, nutritionally deficient, hydramnios, hx of multiple amniocentesis, inflammatory reactions, hx of multiple abortions, STDS, PTL, abruption, preeclampsia, AMA