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OB > OB Test 2: High Risk Pregnancy > Flashcards

OB Test 2: High Risk Pregnancy Flashcards

0
Q

What are psychosocial risk factors for high risk pregnancies?

A

History of mental illness
Depression
Substance use
Family violence

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1
Q

What are the biophysical risk assessment?

A 
Hero-placental perfusion
Preeclampsia 
Diabetes
History of preterm labor
Diseases
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2
Q

What are socio-demographic risk factors for high risk pregnancies?

A 
Poverty
Lack of insurance 
No prenatal care
Level of family support
Age
Education level
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3
Q

What are environmental factors of high risk pregnancy?

A 
Saftey
Home
Workplace
Exposure
Pollution
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4
Q

When do kicks start?

A

28 weeks

Can be formal or instinct

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5
Q

What can decreased fetal movement indicate?

A

Chronic hypoxia

Gives mother anxiety

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6
Q

What are the different uses of obstetric ultrasound?

A 
Confirm pregnancy: # and presentation
Evaluate placenta: location, size, grade
Fetal anomalies
Fetal maturity 
Complications
Amniotic fluid: placental abruption, fetal demise
BPP testing
Fetal procedures
Doppler blood flow
Fetal well being
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7
Q

When can you do an ultrasound?

A

16 weeks and mother drink water to raise uterus

External or transduced

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8
Q

What a BPP?

A

Biophysical profile

Evaluates fetal oxygenation & well being in utero

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9
Q

What is AFP?

A

Alpha fetoprotein
MsAFP: maternal serum which increases neural tube defects and decreases downs
Screening tool only

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10
Q

When should you do an amniocentesis?
What color should it be?
What should the LS ratio be?
What d the different colors mean?

A 
15-20 weeks 
Clear color
Chromosomal analysis 
At 30-35 weeks fetal lung maturity 
2:1

Yellow: increased bilirubin
Green: meconium
Bloody: placenta

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11
Q

What are the risks of amniocentesis?

A 
Spontaneous abortion
Trauma
Bleeding
PTL: per term labor
Infection
RH sensitization (mom may be exposed)
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12
Q

What is CVS?

A

Chorionic villus sampling
Genetic testing
10-12 weeks, can be as early as 8 weeks
Early diagnosed for rH negative mom needs RhoGAM

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13
Q

What are the risks of CVS?

A

Miss digits & limbs
Spontaneous abortion
Limb reduction

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14
Q

What is PUBS

A

Percutaneous umbilical blood sampling
Draw baby blood out from umbilical cord
Done in 2 and 3 trimester

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15
Q

What are other genetic tests?

A 
Coombs test: moms blood
Fetal fibronectin: protein in fetal membranes, May predict preterm labor
Endocervical length 
L:S ratio
PG
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16
Q

What is fetal heart rate testing?

A

Non stress test used for at risk women such as diabetes, hypertension, decrease fetal movement, multiple gestation
Criteria: 2 accelerations of 15 bpm X 15 sec in 20 min

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17
Q

What is a CST?

A

Contraction stress test
Determines if fetus will tolerate labor

Contraction:

  • 3 moderate contractions in 10 minutes to determine how fetus will respond
  • nipple stimulation: pill roll 2 min, stop 2 min then switch nipples
  • oxytocin: low levels
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18
Q

What are the different gestational hypertensive disorders?

A

Preeclampsia
Eclampsia
Prevalence

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19
Q

What is the etiology of gestational hypertensive disorders?

A

No cause
Some sort of immunological problem
Only cure is delivery

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20
Q

What is preeclampsia?

A

Hypertension
Proteinuria
After 20 weeks

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21
Q

Eclampsia

A

Results in seizure

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22
Q

What is the prevalence of gestational hypertensive disorders?

A

3-7%

Usually in primagravida

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23
Q

What are the signs and symptoms of preeclampsia?

A

Vasodpasm and organ perfusion
Intra vascular coagulation.
Increased permeability & capillary leakage

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24
Q

What is mild preeclampsia?

A

Blood pressure >140/90
Proteinuria:
- 1+ to 2+ on urine sample
> 300 mcg in 24 hour urine

30/15 increase from baseline blood pressure

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25
Q

What is severe preeclampsia?

A

BP > 160/110 on 2 occasions 6 hours apart

Proteinuria
2+ to 3+
> 5 grams in 24 hour urine

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26
Q

What are signs of worsening preeclampsia?

A 
Severe headache
Hyper reflexia
Visual disturbances
Epigastric pain
Sudden severe edema
Oliguria
Pulmonary edema
Fetal distress
Seizures
Stroke
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27
Q

What is treatment of mild eclampsia?

A

Goals: prevent progression to eclampsia
Limit activity
Environment
Delivery: induce when feel fetus in mature is 36 or 37 do amniocentesis to see if lungs mature

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28
Q

What is treatment of severe eclampsia?

A

Hospitalization
Bed rest
Quiet environment, side rails up, restrict visitors, less stimulation, always auction & oxygen in room
Seizure precautions
Medications: bethamethazone to enhance fetal lung development
Delivery: by 34 weeks or if it worsens

29
Q

What are medications for preeclampsia?

A

Betwmethosone 12.5mg IM x 2 doses 24 hours apart

Magnesium sulfate 4-6 g loading dose IVPB

30
Q

What are the precautions of magnesium sulfate?

A

Blood levels
Toxicity: respiration and reflex
Urine output: 30 mL/hour excreted by kidneys
Antidote-calcium gluconate: dose 1 g IVP

31
Q

Eclampsia signs, nursing care and treatment

A

Seizures, cyanosis and distress, dilation of cervix
Nursing carer: airways, protection, position of left side, oxygen, suction if needed
Placental abruption
Treat through delivery

32
Q

What is HELLP syndrome?

A

Hemolysis
Elevated liver enzymes
Low platelets

33
Q

What is a spontaneous abortion?

A

Pregnancy loss before 20 weeks

50% time is a chromosomal abnormality in embryo by 12 weeks

34
Q

What are the different types of abortions?

A

Threatened: bleeding/cramping indicated cervix closed
Inevitable: bleeding/cramping with cervix open
Incomplete: cramp/bleeding tissue passed but incomplete
Complete
Missed: fetus dies but not expelled. Brown vaginal discharge
Septic: shock
Recurrent: habitual abortion. Spontaneous loss of more then 3 before 70 weeks. Hormonal imbalance or hostile cervix

35
Q

What are the nursing assessment for abortion?

A 
Last menstration 
When it began
How much blood 
Passed any tissue
How much cramping and when did it begin
And do a psychosocial assessment of how they feel
36
Q

What are Interventions for abortion?

A 
Vital signs
Assess bleeding and tissue lost
Lab values (h&h, platelets, fibrinogen)
IV
Oxygen
Prep for D&C
Support without false hope
RhoGAM 
dilation and curettage
37
Q

What is an incompetent cervix?

A

Painless preterm dilation of the cervix
Risk factors include preterm labor
Cervical length is under 25 mm Hg

38
Q

How do you treat a incomplete cervix?

A

Two types:

  1. Left in, c-section
  2. Sipped at labor and vaginal delivery
39
Q

What is an eptopic pregnancy?

A

A symptomatic until rupturing

Symptoms include severe localized pain, abdominal rigidity, vaginal bleed and shock

40
Q

How do you Greg ectopic pregnancy?

A

Surgery
Methotrexate
Large bore IV, oxygen, type and cross match of blood, NPO, post-op care

41
Q

What is hydatidiform mole?

A

Molar pregnancy
Gestational trophoblastic disease: develops abnormally
Abnormal chorionic villi: grow into clusters, fluid filled uterus
Risk for chorizo carcinoma: cancer of chorion

42
Q

What are assessments you can do with molar pregnancy?

A 
Vaginal bleeding by 12 weeks
Increase hCG
Hyperemesis gravidarum: severe nausea and vomiting
Increase fundal height
Ultrasound findings
Preeclampsia before 20 weeks 
Incidence increases when older or asian
43
Q

Eat is the treatment of molar pregnancy?

A

Uterine evacuation: clean out, suction, hysterectomy

Follow up by monitoring hCG every year and avoid pregnancy

Emotional support when lose pregnancy and worry about cancer

44
Q

What is placenta previa?

A

Abnormal implantation of the placenta over or near the cervical os

45
Q

How do you assess placenta previa?

A

Painless bright red vaginal bleeding, cervix pulls away around 20 weeks, sent home on rest
Ultrasound confirmation
Incidence increases for multiple gestation, increase multigravida and infertility

46
Q

What is treatment for placeta previa?

A 
No vagina exa 
NPO
EFM
IV
VS
EBL
Labs
Risk for DIC
47
Q

What is abruption placentae?

A

Painful
Premature separation of the normally implanted placenta
Third trimester
Hypocalcemic shock

48
Q

What are the signs of abruptio placentae? What can it be caused by?

A

Rigid abdomen, dark red bleeding, hypertonic contraction

Cocaine use, abdominal trauma, and car accident

49
Q

What are assessment for placental abruption?

A

Bleeding: profuse or minimal
Abdominal pain: uterus irritable, rigid, growing abdominal girth, grows for bleeding
Fetal distress: loss variability
Hypovolemic shock: decrease blood pressure, increase pulse, lose 40% volume first
Uterine irritation

50
Q

What are te interventions of placental abruption?

A 
Oxygen 10-12L/min, rebreather mask
IVF: good IV, 18 gauge
EFM
Vitals every 5 minutes
I&O: put in cath if worried about shock
Abdominal girth is the level of umbilicus
Labs: clotting disorders can go into DIC
Delivery via c-section
51
Q

What is abnormal cord insertion?

A

Vasa previa
Placental blood vessels go through cord into fetal membranes and great big blood vessels are shown when membranes rupture the baby can bleed to death

52
Q

What is disseminated intra vascular coagulation

A

Commotion coagulopathy: patient used up all coagulation factors

53
Q

What are the causes and symptoms of DIC

A

Cause: blood loss through placental abruption, sepsis, pulmonary embolus, preeclampsia
Symptoms: clotting cascade, uncontrolled abnormal bleeding, potichea, bleeding puncture site, bleed from hemorrhage

54
Q

How do you treat DIC?

A

Remove cause

Replace fluid, blood and platelets

55
Q

What is diabetes mellitus?

A

Hyperglycemia

Insufficient insulin production or inability to use insulin to meet body’s carbohydrate metabolism needs

56
Q

What are the NH classifications?

A

Type 1: insulin dependent. Beta cells in pancreas destroyed, heist risk in pregnancy
Type 2: insulin resistant
GDM: glucose intolerance I. Pregnancy 5% due to HPL and interfere with mom ability to store glucose develops in 2 trimester

57
Q

What are pregnancy complications for IDDM

A

Insulin dependent diabetes mellitus

Maternal: increase yeast infection, polyhydramous, preeclampsia, dytocia, risk of PP hemorrhage, ketoacidosis, retinopathy
Fetal: increase risk spontaneous abortion, IVGR (not enough food), still born
Neonatal: hypoglycemia, respiratory distress, LS 3:1, congenital anomalies, neural tube defects, polycythemia, hyperbilirubinemia

58
Q

What are some diabetes risk factors?

A

Family history
Maternal characteristics: obese, >40 yr, hypertension
Previous pregnancy history: large birth, unexplained stillbirth, renal agenasis

59
Q

What is a blood glucose screening?

A

1 hour OGTT: <140 mg/dL
3 hour OGTT: > 95 (f), 180 mg/dL
Glycosylated hemoglobin < 6

60
Q

What are different diabetes treatments?

A

Team approach: obstetrician, perinatologist, diabetic nurse educator
Diet: dietician
Insulin: regulated during pregnancy, only human insulin, upto 4 Injections per day
Fetal well being: carefully monitored, 16-20 week ultrasound for growth, anomalies, increase risk stillbirth, non stress test

61
Q

What does diabetes have to do with the labor and birth process?

A

Timing: 38 weeks, deliver as long as lungs mature
Glucose monitoring: hourly during labor
Insulin
Birth and postpartum: D/C at birth r/t drop after pregnancy

62
Q

What is Hyperemesis gravidarum? What is the key symptom?

A

Morning sickness on steroids. Excessive vomiting

63
Q

How do you assess Hyperemesis Gravidarum?

A 
Diagnostic criteria
Dehydration
Electrolyte imbalance
Ketouria
Weight loss
Metabolic alkalosis
64
Q

What is treatment for Hyperemesis Gravidarum?

A

Hospitalization
Assessments
IV fluids
Nutrition: IV, followed by oral fluids

65
Q

What is the connections between heart disease and pregnancy?

A

Have to do with hemodynamics changes, increase CO, fluid change at delivery

Cardiac decompensation: heart cant keep up, unable to maintain CO, tachycardia, pulmonary edema, fatigue, cyanosis

66
Q

What is general cardiac care?

A

Rest 8-10 hours a night
Nutrition: adequate iron & protein, low sodium
Avoid straining: stool softener may need to be given
Avoid infection: avoid sick, report symptoms
Fluid balance

67
Q

What are the classifications and treatment of heart disease?

A

Class 1: a symptomatic with normal activity.

  • symptoms: SOB, angina, fatigue
  • treat: rest, infection prevention, side lying, no stirrups, epidural, vaginal delivery with forceps or vacuum

Class2: no s&s at rest, symptomatic with increasing activity. Avoid strenuous exercise and frequent rest
-treat: rest, prophylactic antibiotics, oxygen

Class 3: symptomatic with less rid are activity
-treat: avoid emotional stress, prophylactic antibiotics, digoxin, diuretics

Class 4: symptomatic at rest
-treat: should not become pregnant 50% mortality rate. Therapeutic aborption

68
Q

What are medications for heart disease?

A

DON’T GI E TERBUTALINE it ncreases the heart rate

Give magnesium sulfate and Heprin

69
Q

What is postpartum care for heart disease?

A 
Pt at risk upto 72 hours after and at delivery. 
Assaultate lung every 4 hours
Assess vitals, I&O, edema, chest sounds
Need additional rest
Good nutrition 
Pain relief, stool softener
If breastfeed then check meds
Good education and counseling

OB (10 decks)

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