OB Exam 3, High Risk Care, FHR, Labor Flashcards
what does blood loss lead to in pregnancy and for the fetus?
In preg: hypovolemia, anemia, infection
Fetus: premature birth, hypoxemia, death
Placenta previa, s/sx
placenta overlying os
1/200 pregs
s/sx = painless vaginal bleeding, 3rd trim, hypovolemia, decreased FHR
risk factors for placenta previa
Risk factors = c/s prior, endometrial scarring, abortion with dilation/curretage (D/C), short preg interval, AMA, DM, HTN, smoking, multipara
contraindication for placenta previa?
do not do vaginal exam
Placental abruption, s/sx
placental detachment before delivery
s/sx = PAINFUL bleeding, fetal hypoxemia bad FHR (late decelerations), hypertonic uterine ctx, tenderness
Risk factors for placental abruption
Risks = previous abruption, HTN, AMA, c/s prior, cocaine, meth, smoking, multipara, PPROM, abd trauma, thrombophilia
Placenta accreta
Placenta accreta = partial/complete placental invasion of uterine wall
what can placenta accreta lead to?
PPH→ DIC → hysterectomy due to risk of bleeding out
Blood loss 3000-5000mL, may need blood transfusion
abortion
Spontaneous (miscarriage) = before 20 weeks
non viable fetus
risk factors for abortion
Risk factors = increased parity, AMA, diabetes, drug use, autoimmune disease, infection, genetics, uterine/cervical abnormalities
what to give for abortion
Give rhogam w/in 72 hr
what are surgical treatments for an abortion?
D/C = dilation & curettage D/E = dilation & evacuation
when can medical abortions take place? What 2 meds are given
Medical = 1st trimester only (13-14 weeks), later surgical
Mifepristone, misoprostol
what is the main reason medical abortions take place
cancer in mother or fetal abnormalities
ectopic pregnancy, s/sx
Egg growing outside uterus, 95% in fallopian tube, Non viable–can result in hemorrhage
s/sx = sudden, sharp pain, one sided, referred shoulder pain, light bleeding, hypovolemia
risks for ectopic preg
Risks = prior EP, fallopian tube abnorm, pelvic inflammatory disease PID, infertility, pelvic abdominal surgery, endometriosis, STIs, tubal surgery
what is surgery for ectopic preg
Surgery = laparoscopic surgery
meds for ectopic preg
Meds = methotrexate (chemotherapy agent) dissolves ectopic mass
Gestational trophoblastic disease
Hydatidiform mole/molar pregnancy = abnormal fertilized egg by multiple sperm, splits and makes neoplasms, rare, trophoblast cell growth
risks factors for GT disease
Risks = <20 >35, previous hx, anemia, uterine enlargement, u/s no fetus, VERY elevated hCG
management for GT disease
Management = D/C, chemo drug, monitor for increased cancer risk (from incr hCG)
what is the leading cause of pregnancy death?
Trauma = leading cause of preg death, hemorrhagic shock
how are outcomes of trauma in pregnancy defined?
Outcome defined by injury and when in preg–750-1000mL/min, 8-10min, FHR changes indicate maternal deterioration
to which side do you displace the uterus for CPR?
L side
what do drugs/alcohol do to fetus?
Low birth weight, develop disabilities, preterm birth, infant death, teratogenic, addiction
Growth defects, facial dysmorphia, CNS impair, behavior disorders, imparied intellectual
why does alcohol affect fetus?
Baby has inadequate liver, can’t metabolize alcohol
What do illicit drugs do to mother and fetus?
Drugs (cocaine, amphetamines, heroin, ecstasy)
- Cocaine causes vasoconstriction of placenta/uterus→ placental abruption or PTB
what do cigarettes do to fetus/mother?
2x LBW, IUGR, increased preterm birth, miscarriage, stillbirth, placenta previa or abruption
3x likely SIDS, asthma, infantile colic, obesity in childhood
what is the 2nd leading cause of infant death? 1st?
2nd leading cause of infant death
1st is congenital malform & chromosome issues
what are the ages of very premature, premature, and late premature?
Very Premature: Neonates born at <32 weeks
Premature: Neonates born 32-34 weeks
Late Premature: Neonates born 32-37 weeks
What are 2 survival predictors of a premie?
Survival predictors = period of gestation & birth weight
What are some issues of premie babies?
Respiratory Distress Syndrome (RDS) Retinopathy of Prematurity (ROP) Bronchopulmonary Dysplasia (BPD) Patent Ductus Arteriosus (PDA) Periventricular-intraventricular hemorrhage NEC: Necrotizing Enterocolitis
an infant with inadequate muscle tone has:
hypotonia
when do eyelids open in fetus?
Eyelids fused in premie, (open 26-30 weeks)
What are some characteristics of premies?
Hypotonia Skin – translucent, transparent, red Decreased subcutaneous fat Lanugo Eyelids fused (open 26-30 weeks) Pinna (thin, soft, flat) Undescended testes Tremors/Jittery Weak Cry Diminished/Absent Reflexes Immature Suck/Swallow --> Unable to tolerate oral feedings Apnea (20 sec +) Heart Murmur
how to help premie with thermoregulation
To help = keep head covered, polyethylene barriers for <29 weeks, warming mattress
how to measure tube for gavage premie feedings
Measure tube from mouth to ear, ear to lower end of sternum
OG/NG route, 5-8 French, gravity or pump
What is RDS? s/sx?
decreased alveoli surface tension→ atelectasis (moms given betamethasone IM if preterm labor is happening)
s/sx = Tachypnea, Retractions (Seesaw Breathing), Nasal Flaring
→ Hypoxemia, hypercarbia → metabolic/resp acidosis
what are complications of RDS for the baby?
Complications = PDA, pneumothorax, BPD, hypotension, pulm edema, hypoglycemia, ROP, intraventricular hemorrhage
What med is administered for RDS?
admin exogenous surfactant
What is a CPAP used for in baby? What is used if CPAP doesn’t work
for neonates who are at risk for RDS or who have RDS. It can be administered by nasal cannula, nasal mask, nasal prongs, endotracheal tube, or nasopharyngeal route.
mechanical ventilation used when CPAP is not effective
what is HFOV?
High frequency oscillatory ventilation
used when mechanical ventilation has proven unsuccessful.
Delivers small volumes of gas at a high rate (greater than 300 breaths/minute). Less traumatic on fragile lung tissue
what are benefits of surfactant therapy?
Benefits of Surfactant Therapy = Prophylactic therapy decreases the occurrence of RDS and mortality in preterm neonates.
- Decreased risk of pneumothorax
- Decreased risk of intraventricular hemorrhage
- Decreased risk of bronchopulmonary dysplasia
- Decreased risk of pulmonary interstitial emphysema
What is necrotizing enterocolitis? s/sx?
Necrotizing enterocolitis–neonate GI disease from decreased blood flow, typically 3-10 days after birth
s/sx = Abdominal Distension Feeding intolerance Emesis Residuals Bloody stools
what causes necrotizing enterocolitis?
- Altered blood flow regulation, particularly to the intestines.
- Impaired gastrointestinal host defense when faced with stress/injury to the intestinal tissue.
- Alterations in the inflammatory response
- formula feeding increases risk
what meds given for necrotizing enterocolitis? what labs done?
what other interventions?
Meds = Antibiotics, Analgesia, Antihypertensive
Labs/tests = abd XR to see gas/lack of, labs (blood culture, CBC, CRP, Stool culture, CMP, ABG)
Gastric decompression
Surgery
what needs to be stopped for enterocolitis?
no oral feedings
Retinopathy of prematurity (ROP)
incidence of ROP increases as gestational age and birth weight decrease
Occurs primarily in neonates <29 weeks with LBW (<1500g)
what is prevention for ROP?
Administer Oxygen (87-94% SPO2)
Oxygen blenders & Oxygen calibrating systems for exact oxygen concentration
Avoid bright lights – cover isolettes with blankets
