Pregnancy at Risk Flashcards
1
Q
abortion
A
pregnancy loss before the fetus is viable or capable of living outside the uterus
before 20 weeks or <500 g
2
Q
when does spontaneous abortion occur most
A
1st trimester
3
Q
parental age and spontaneous abortion
A
incidence increases
4
Q
most common cause of spontaneous abortions
A
chromosomal abnormalities
5
Q
threatened abortion
A
vaginal bleeding and pregnancy threatened
6
Q
inevitable abortion
A
cannot be stopped
7
Q
incomplete abortion
A
not all products are expelled - placenta is usually retained
8
Q
complete abortion
A
all products of conception are expelled
9
Q
missed abortion
A
when fetus dies but is retained in uterus
10
Q
recurrent spontaneous abortion
A
defined as 3+ spontaneous abortions
11
Q
what is required in incomplete abortions and missed abortions
A
D&C/D&E
12
Q
clinical manifestations of spontaneous abortions X3
A
uterine cramping and vaginal bleeding
persistent backache and feelings of pelvic pressure
passing of products of conception
13
Q
abortion mgmt
A
watch for excessive bleeding or signs of infection
D&C/D&E or induction
14
Q
major complication for missed abortion
A
infection and DIC
15
Q
D&C
A
dilation and cutterage
16
Q
D&E
A
dilation and evacuation
17
Q
missed abortion treatment under 13 weeks
A
D&C
18
Q
missed abortion treatment over 13 weeks
A
D&E
19
Q
abortion psych impact X4
A
frightening
sense of loss, grief, anger and disappointment
grief can last for 18 months
may feel guilt/speculate she could have saved it
20
Q
cervical incompetence/insufficiency
A
mechanical defect that causes preemie cervical ripening
21
Q
cervical incompetence associated with X2
A
previous cervical ripening
congenital structural defects of uterus/cervix
22
Q
tcervical incompetence treatment
A
cervical cerclage
23
Q
cerclage
A
purse string suture placed around the cervix between 12-16 weeks
24
Q
what is given during a cerclage
A
antibiotics and tocolytics, RhoD immune globulin
25
cerclage post op monitoring/home care
monitor for bleeding, cramping, infection, fluid leakage, pelvic rest for a week
26
ectopic pregnancy
implantation of fertilized ovum in site other than endometrial lining of uterus (usually fallopian tube)
27
ectopic pregnancy risk factors X2
anything that compromises tubal patency
| previous ectopic pregnancy
28
adnexal pain
R/LUQ ovluation pains that mimic appendicitis
29
when do ectopic pregnancy symptoms occur
6-8 week time period
30
ectopic pregnancy assessment X4
LMP
pelvic and abdominal exam
masses
adnexal tenderness
31
ruptured ectopic pregnancy s/s
referred shoulder pain or mid-scapular pain
32
how do you test for ectopic prgnancy
low hCG and transvaginal ultrasound shows no fetus
33
ectopic pregnancy treatment
stable: methotrexate
ruptured: surgical treatment w/ attempt to preserve tubef
34
methotrexate
chemo agent used to undce aboritons
35
pt education for methotrexate
urine is considered toxic for 72 hours - flush twice with closed lid
do not drink
no folic acid
no NSAID's
avoid sunlight
36
gestational trophoblastic disease aka
hydatidiform mole
37
molar pregnancy
trophoblasts that attach the fertilized ovum to the uterine wall develop abnormally
38
molar pregnancy is more common in
asian woman and older women
more likely to have multiple
39
what happens if fetus is present in a molar pregnancy
fatal chromosomal defect
40
clinical manifestations of molar pregnancy X
```
higher levels of hCG than expected
snowstorm pattern
enlarged uterus for gestational age
vaginal bleeding
preeclampsia before 24 weeks
```
41
snowstorm pattern
vesicles and absence of a fetal sac or fetal heartbeat on ultrasound
42
what do high hCG levels do to the woman
excessive nausea and vomiting
43
choriocarcinoma
common SE of molar pregnancy
mets to the lung liver stomach and brain and vagina
easily treated
44
molar pregnancy dx X2
measurement of hCG and ultrasound
45
molar pregnancy mgmt X2
evacuaiton of trophoblastic tissue
treat for other issues
labs for coag studies
46
uterine stimulation and molar pregnancies
avoid any and all stimulation including oxytocin
47
F/U care for molar pregnancy
hCG monthly for 6 months
| avoid pregnancy
48
what happens if hCG levels rise after molar pregnancy evacuation
malignancy tx w methotrexate
49
when can you get pregnant after a molar pregnancy
when levels are at 0
50
placenta previa
implantation of the placenta in lower uterus
51
marginal or low-lying placenta previa
implanted in lower uterus but more than 3 cm from internal cervical os
52
delivery w/ marginal placenta previa
potentially vaginal
53
partial placenta previa
lower border of placenta is within 3 cm of internal cervical os but does not completely cover it
54
partial placenta previa delivery
c section
55
total or complete placenta previa
placenta completely covers the internal os
56
total placenta previa delivery
c section
57
placenta previa s/s X3
sudden onset of painless vaginal bleeding
uterus soft relaxed and non-tender
occurs at the end of 2nd trimester or during the 3rd
58
how is placenta previa assessed
VAGINAL EXAM IS CONTRAINDICATED
ultrasound is used to determine placement
59
placenta previa tx if mom is stable and no fetal compromise
delay birth to increase maturity and birth weight
admin corticosteroids
60
why are fetuses given corticosteroids
speed fetal lung maturity
61
when can placenta previa be managed at home X8
no active bleeding
strict BRWBRP
home is close to hospital
EMS is available
woman can verbalize risk understanding
develop a procedure to follow if heavy bleeding occurs
daily kick counts
assessing uterine activity
62
placenta previa tx if mom or baby arent stable
in patient care for weeks to months until delivery
63
abruptio placentae
separation of normally implanted placenta before fetus is born causes bleeding and hematoma formation to mom
64
abruptio placentae RF X7
```
illegal drug use
maternal HTN
multigravida
short cord
abdominal trauma
PROM
previous hx
```
65
how long do women need to be monitored after abdominal trauma
up to 24 hours
66
abruptio placentae s/s X8
```
bleeding
uterine tenderness/pain
uterine irritability
abd/low back pain
high IUPC tone
board like abdomen
port wine colored amniotic fluid
non reassuring FHR patterns
```
67
s/s of hypovolemic shock X5
```
tachycardia
hypotension
pale color
cold skin
trendelenburg****
```
68
abruptio placentae conservative mgmt
only if mild condition with fetus <34 weeks old
bed rest
tocolytic admin
corticosteroids
RhoD
69
abruptio placentae mgmt for fetal compromise or maternal deteriorartion
immediate delivery
blood should be available
X2 18 g IV
70
dissmeinated intravascular coagulation
life threatening defect in coag that may occur in several pregnancy complications
71
diseases that cause DIC
severe preeclampsia
HELLP syndrome
dead fetus syndrome
72
DIC dx X3
activated PTT
d-dimer
fibrin degredation product levels
73
DIC tx
```
correct underlying issue
blood replacement
O2 at 10 L/min
VS
quantify blood loss by weight
```
74
hyperemesis gravidarum
persistent uncontrollable vomiting that begins in first weeks of pregnancy and may continue throughout pregnancy
75
hyperemesis mgmt
usually treated at home
in patient includes IV F/E replacement and TPN as a last step
76
nursing interventions for hyperemesis
```
dehydration teaching
daily weight
small portions with low fat
soups/liquids between meals
use ginger
sit upright after meals
```
77
gestational HTN
begins after 20th week
140/90 on 2 different occasions at least 4 hours apart
no proteinuria***
BP returns to baseline by 6 weeks
78
preeclampsia
GH with >1+ proteinuria
79
severe preeclampsia
BP 160/110 with proteinuria of 3+ and oliguria
80
s/s of severe preeclampsia
```
cerebral/visual disturbances
extensive peripheral edema
impaired liver function
hyperreflexia
thrombocytopenia
epigastric and RUQ pain
```
81
ankle clonus in severe preeclampsia
seizure imminent
82
HELLP syndrome
hemolysis, elevated liver enzymes, low platelets
83
HELLP syndrome s/s
pain in RUQ, low right chest or mid epigastric area
84
Eclampsia
preeclampsia + seizure 48-72 hours postpartum
85
mgmt of preeclampsia
do not restrict salt in diet - stay on pregnancy diet
only cure is delivery of baby and placenta
86
severe preeclampsia mgmt
bed rest and fetal monitoring
87
antiHTn meds
labatelol
hydralazine
nifedipine
88
magnesium sulfate
CNS depressant irritability and relaxes smooth muscle to prevent seizures
89
s/s of magnesium toxicity
```
Respiratory depression
chest pain
mental confusion
depressed DTR
flushing, sweating, lethargy
hypotension
```
90
magnesium sulfate antidote
calcium gluconate
91
interventions for mag sulfate
assess the woman for respiratory <12
assess for DTR
assess for urine output <30 mL/hr
92
chronic HTN
if HTn precedes pregnancy or is ID before 20 weeks or postpartum week 12
93
maternal/fetal blood incompatibility
mom attacks baby RBC leading to hyperbilirubinemia and anemia
94
how much does a standard RhoD dose cover
15 mL fetal RBC or 30 mL whole blood
95
alloimmunized pts and RhoD
not given since mom is already sensitized
96
ABO incompatability
common with rare significant hemolysis
97
gestational diabetes dx
1 hour glucose test
<140 - testing stops
>140 - oral glucose tolerance test
98
3 hour oral glucose test
godl standard
| fasting from midnight on
99
insulin requirements during pregnancy
1st - decreased need
2nd - increased need, glucose use increases
3rd - increased need d/t placental maturation and human placental lactogen
100
breastfeeding and insulin
decreases the amount of insulin needed
101
fetal effects form maternal hyperglycemia X9
```
fetal death/abortion
LGA
IGUR if T1 w/ vascular changes
RDS
hyperbilirubinemia
hypoglycemia
preemie
cardiomyopathy
congenital defects
```
102
maternal complications from diabetes X6
```
infections
preeclampsia
hydramnios
ketoacidosis
hypoglycemia
hyperglycemia
```
103
class I or II cardiac disease
limit physical activity
| avoid excessive weight gain
104
class III or IV cardiac disease
primary goal is to prevent cardiac decompensation and development of CHF
105
pregnancy after bariatric surgery
postpone pregnancy for 12-24 months
assess for vitamin and nutritional deficiency
monitor for signs of intestinal obstruction
106
sources of iron rich foods X6
meat, fish, chicken, liver, green leafy veggies
107
anemia maternal effects X6
```
physiologic anemia
pyelonephritis
bone infection
heart disease
preeclampsia
preterm
```
108
sickle cell and fetus
fetus usually fairs well if no sickle cell crisis occurs
109
most serious complication of SLE
congenital haert block
110
antiphospholipid syndrome med
lovenox throughout pregnancy
111
hashimoto's thyroiditis and pregnancy
increased risk of miscarriage and preemie birth/preeclampsia
112
major concern for epilepsy in pregnancy
teratogenic effects of anticonvusant
113
bells palsy and pregnancy
3x more common in pregnancy and usually occurs third trimester
114
HIV and pregnancy
vaginal delivery contraindicated - c section before ROM
115
what is given to infants of HIV mothers immediately after delivert
ART prophylaxis (zidovudine)
116
toxoplasmosis comes from
cat poop and uncooked meats
117
labor dystocia
dysfunctional labor or labor that doesnt progress as expected
118
macrosomic infant
weight more than 8 lbs 13 oz or 4000 g - head might be too big
119
shoulder dystocia
OB emergency where shoulder becomes impacted above the maternal symphysis pubis
120
mcroberts maneuver
used in shoulder dystocia
121
precipitous labor complications and definition
birth occurs within 3 hours of labor
associated with genitcal tract damage, infantile trauma, promotion of fetal oxygenation
122
intrauterine infection aka
chorioamnionitis
123
baby and chorioamnionitis
baby is more likely to die
124
mom and chorioamnionitis
uterine rupture and infection
125
chorioamnionitis interventions X5
temp q 2 after ROM or hourly with fever
keep under pads dry and limit vaginal exams
inform staff if s/s of infection seen
abx therapy initiated before/after birth when infection ID
assess maternal VS hoursly if fever present
126
conditions associated with PPROm X5
```
infection
weak amniotic sac
previous preterm birth
fetal abnormalities
incompetent or short cervix
```
127
therapeutic mgmt for PROM if fetus is <36 weeks
short term tocolytics
corticosteroids
128
mgmt for PROm if gestation is near term
if labor does not spontaneously begin - induction of labor begins
129
mgmt for PROM if gestation is preemie
pro vs con weighing
130
what is considered a short cervix
<25 mm
131
fFN tests
negative = <1% chance of delivering in 2 weeks
positive = 12-17% chance delivering within 2 weeks
132
tocolytics and preemie birth
dont decrease the rate of preemie births - delay them instead for medical mgmt
133
mag sulfate action
depresses myometrium contractility - CNS depressant
134
MgSO4 maternal effects
pulmonary edema
135
MgSO4 fetal effects
may reduce risk of cerebral palsy in neonate
136
MgSO4 mgmt
respirations <12**
137
prostaglnadin synthesis inhibitors action
effective in delaying delivery 48+ hours and used in pregnancies <32 weeks
138
prostaglandin synthesis inhibitors should not be used more than
48 hours
139
Prostaglandin synthesis inhibitor maternal effects
pulmonary edema
140
prostaglandin synthesis inhibiotr fetal effects
constriction of ductus arteriosus
141
indomethacin class
prostaglandin synthesis inhibitor
142
naproxen class
prostaglandin synthesis inhibitor
143
fenoprofen class
prostaglandin synthesis inhibitor
144
nifedapine should not be used with X2
mag sulfate or terbutaline
145
nifedapine MOA
blocks Ca available for muscle contraction
146
nifedapine maternal effects
pulmonary edema
caution in renal and hypotension
147
nifedapine fetal effects
N/A
148
nifedapine nursing mgmt
hold dose for BP <90/50 or HR >120
149
terbutaline action
suppresses uterine activity for up to 3 days
150
terbutaline maternal effects
pulmonary edema, maternal glucose elevation
151
terbutaline mgmt
auscultate lungs for pulmonary edema
monitor blood glucose
152
placenta accreta
invasion of trophoblast is beyond normal boundary
153
placenta increta
invasion of trophoblast extends into uterine myometrium
154
placenta percreta
invasion of trophoblast extends into uterine muscle and can adhere to other pelvic organs
155
how fast can a mom bleed to death in uncontrolled bleeding
8-10 minutes
