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
1
Q
What are the biophysical risk assessment?
A
Hero-placental perfusion Preeclampsia Diabetes History of preterm labor Diseases
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
3
Q
What are environmental factors of high risk pregnancy?
A
Saftey Home Workplace Exposure Pollution
4
Q
When do kicks start?
A
28 weeks
Can be formal or instinct
5
Q
What can decreased fetal movement indicate?
A
Chronic hypoxia
Gives mother anxiety
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
7
Q
When can you do an ultrasound?
A
16 weeks and mother drink water to raise uterus
External or transduced
8
Q
What a BPP?
A
Biophysical profile
Evaluates fetal oxygenation & well being in utero
9
Q
What is AFP?
A
Alpha fetoprotein
MsAFP: maternal serum which increases neural tube defects and decreases downs
Screening tool only
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
11
Q
What are the risks of amniocentesis?
A
Spontaneous abortion Trauma Bleeding PTL: per term labor Infection RH sensitization (mom may be exposed)
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
13
Q
What are the risks of CVS?
A
Miss digits & limbs
Spontaneous abortion
Limb reduction
14
Q
What is PUBS
A
Percutaneous umbilical blood sampling
Draw baby blood out from umbilical cord
Done in 2 and 3 trimester
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
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
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
18
Q
What are the different gestational hypertensive disorders?
A
Preeclampsia
Eclampsia
Prevalence
19
Q
What is the etiology of gestational hypertensive disorders?
A
No cause
Some sort of immunological problem
Only cure is delivery
20
Q
What is preeclampsia?
A
Hypertension
Proteinuria
After 20 weeks
21
Q
Eclampsia
A
Results in seizure
22
Q
What is the prevalence of gestational hypertensive disorders?
A
3-7%
Usually in primagravida
23
Q
What are the signs and symptoms of preeclampsia?
A
Vasodpasm and organ perfusion
Intra vascular coagulation.
Increased permeability & capillary leakage
24
What is mild preeclampsia?
Blood pressure >140/90
Proteinuria:
- 1+ to 2+ on urine sample
> 300 mcg in 24 hour urine
30/15 increase from baseline blood pressure
25
What is severe preeclampsia?
BP > 160/110 on 2 occasions 6 hours apart
Proteinuria
2+ to 3+
> 5 grams in 24 hour urine
26
What are signs of worsening preeclampsia?
```
Severe headache
Hyper reflexia
Visual disturbances
Epigastric pain
Sudden severe edema
Oliguria
Pulmonary edema
Fetal distress
Seizures
Stroke
```
27
What is treatment of mild eclampsia?
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
28
What is treatment of severe eclampsia?
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
What are medications for preeclampsia?
Betwmethosone 12.5mg IM x 2 doses 24 hours apart
| Magnesium sulfate 4-6 g loading dose IVPB
30
What are the precautions of magnesium sulfate?
Blood levels
Toxicity: respiration and reflex
Urine output: 30 mL/hour excreted by kidneys
Antidote-calcium gluconate: dose 1 g IVP
31
Eclampsia signs, nursing care and treatment
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
What is HELLP syndrome?
Hemolysis
Elevated liver enzymes
Low platelets
33
What is a spontaneous abortion?
Pregnancy loss before 20 weeks
| 50% time is a chromosomal abnormality in embryo by 12 weeks
34
What are the different types of abortions?
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
What are the nursing assessment for abortion?
```
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
What are Interventions for abortion?
```
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
What is an incompetent cervix?
Painless preterm dilation of the cervix
Risk factors include preterm labor
Cervical length is under 25 mm Hg
38
How do you treat a incomplete cervix?
Two types:
1. Left in, c-section
2. Sipped at labor and vaginal delivery
39
What is an eptopic pregnancy?
A symptomatic until rupturing
| Symptoms include severe localized pain, abdominal rigidity, vaginal bleed and shock
40
How do you Greg ectopic pregnancy?
Surgery
Methotrexate
Large bore IV, oxygen, type and cross match of blood, NPO, post-op care
41
What is hydatidiform mole?
Molar pregnancy
Gestational trophoblastic disease: develops abnormally
Abnormal chorionic villi: grow into clusters, fluid filled uterus
Risk for chorizo carcinoma: cancer of chorion
42
What are assessments you can do with molar pregnancy?
```
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
Eat is the treatment of molar pregnancy?
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
What is placenta previa?
Abnormal implantation of the placenta over or near the cervical os
45
How do you assess placenta previa?
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
What is treatment for placeta previa?
```
No vagina exa
NPO
EFM
IV
VS
EBL
Labs
Risk for DIC
```
47
What is abruption placentae?
Painful
Premature separation of the normally implanted placenta
Third trimester
Hypocalcemic shock
48
What are the signs of abruptio placentae? What can it be caused by?
Rigid abdomen, dark red bleeding, hypertonic contraction
Cocaine use, abdominal trauma, and car accident
49
What are assessment for placental abruption?
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
What are te interventions of placental abruption?
```
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
What is abnormal cord insertion?
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
What is disseminated intra vascular coagulation
Commotion coagulopathy: patient used up all coagulation factors
53
What are the causes and symptoms of DIC
Cause: blood loss through placental abruption, sepsis, pulmonary embolus, preeclampsia
Symptoms: clotting cascade, uncontrolled abnormal bleeding, potichea, bleeding puncture site, bleed from hemorrhage
54
How do you treat DIC?
Remove cause
| Replace fluid, blood and platelets
55
What is diabetes mellitus?
Hyperglycemia
| Insufficient insulin production or inability to use insulin to meet body's carbohydrate metabolism needs
56
What are the NH classifications?
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
What are pregnancy complications for IDDM
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
What are some diabetes risk factors?
Family history
Maternal characteristics: obese, >40 yr, hypertension
Previous pregnancy history: large birth, unexplained stillbirth, renal agenasis
59
What is a blood glucose screening?
1 hour OGTT: <140 mg/dL
3 hour OGTT: > 95 (f), 180 mg/dL
Glycosylated hemoglobin < 6
60
What are different diabetes treatments?
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
What does diabetes have to do with the labor and birth process?
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
What is Hyperemesis gravidarum? What is the key symptom?
Morning sickness on steroids. Excessive vomiting
63
How do you assess Hyperemesis Gravidarum?
```
Diagnostic criteria
Dehydration
Electrolyte imbalance
Ketouria
Weight loss
Metabolic alkalosis
```
64
What is treatment for Hyperemesis Gravidarum?
Hospitalization
Assessments
IV fluids
Nutrition: IV, followed by oral fluids
65
What is the connections between heart disease and pregnancy?
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
What is general cardiac care?
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
What are the classifications and treatment of heart disease?
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
What are medications for heart disease?
DON'T GI E TERBUTALINE it ncreases the heart rate
Give magnesium sulfate and Heprin
69
What is postpartum care for heart disease?
```
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
```
