pregnancy at risk Flashcards
1st trimester preg disorders
hyperemesis gravidarum
early preg bld’g disorders (spontaneous abortion, ectopic preg, gestational trophoblastic disease)
hyperemesis gravidarum
persistent uncontrollable vomitting usually occurs at the beginning of preg but can last the duration
may be related to increased estrogen/hcg; vit B deficiency; hyperthyroidism; psych fxrs
dx by 5% weight loss, ketonuria, dehydration
mgmt of hyperemesis
B6, anti-emetics
tpn, iv hydration (hospital)
care of hyperemesis
stabilize
hydrate
weight mgmt
spontaneous abortion classified as
loss prior to 20 weeks
most occur within first 12 wks
risk fxr for spontaneous abortion
maternal infection
inadeq. progesterone production
pre-existing cond. (DM, lupus)
fetal abnormalities
characteristics of spontaneous abortion
threatened - spotting, cramping (long duration, high prob)
inevitable - spotting, cramping, ROM, cerv. dilation
incomplete - bld, cramp, dilation - passage of tissue
complete - passage of product of conception, no further trt needed
missed - fetus expired, labor not begun
recurrent - 3+ preg
ectopic preg risk fxrs
ovulation inducing drugs
smoking
hx of ectopic preg
manifest of ectopic preg
abd pain
dark blood
referred shoulder pain
trt of ectopic preg
surgical removal
trt w/methotrexate
Gestational Trophoblastic Disease aka/is
Hydatidiform mole or Molar pregnancy
complete mole = no fetus
partial mole = some fetal parts
resembles cluster of grapes (proliferation of chronic villi)
manifest of GTD
uterine size greater than gestational age
dark red bld’g
n/v & cramping
trt for GTD
immed evac of mole
oxytocin to promote involution
monitor HcG levels
no preg. for 1yr
care for pt. w/GTD
prevent hemorrhage/infection
pain mgmt
emotional status/support
educate
late preg bld’g disorders
placenta previa
placenta abruptio
placenta previa characterized by
complete or partial covering of cervix by the placenta painless bright red bld'g 3 types (low lying or marginal, partial, complete)
placenta previa risk fxrs
smoking/drug use
hx of previa
maternal age
uterine surgery
mgmt of placenta previa
delivery via c-section
abruptio placentae
premature separation of placenta from uterine wall
painful bleeding
manifest of abruptio placentae
board like abdomen abnormal FHR fetal death uterine hyperactivity may be concealed or apparent; marginal, partial or complete
3 grades for abruptio placentae
grade 1 - 10-20% separation
grade 2 - 20-50% separation
grade 3 - >50% separation
risk fxr for abruptio placentae
maternal htn short cord drug use/smoking hx abd. trauma
mgmt of abruptio placentae
condition of fetus
cardiovascular of mom
immed delivery w/fetal compromise/excessive bld’g
late preg bld’g care
status of fetus & mom
educate
immed delivery w/fetal compromise, excessive bld’g or maternal compromise
nursing dx for late preg bld’g
risk for injury/infection
ineffective tissue perfusion
perinatal infections
infections having devastating affect on fetus/min on mom
fxrs governing affects of perinatal infections
gestational age
trt options
specific organism
route of transmission - vertical=across placenta- horizontal=through breast-feeding
perinatal infections maternal risks
premature labor
PROM
UTI
perinatal infections fetal risks
prematurity malformations IUGR(intrauterine growth restriction) IUFD (intrauterine fetal death) sepsis
sexually transmitted infections
chlamydia
gonorrhea
trichomoniasis
chlamydia maternal affects
PROM
chorioamnionitis
chlamydia fetal affects
IUGR
vertical transmission
conjunctivitis
otitis media
chlamydia nurs considerations
presumptively trt for gonorrhea
erythromycin eye oint for newborn
gonorrhea maternal affects
dysuria; freq
chorioamnionitis
PTL; PROM
gonorrhea fetal affects
vertical transmission
rare perm. visual damage or systemic disease
conjunctivitis
gonorrhea nurs considerations
presumptively trt for chlamydia
erythromycin eye trt for newborn
trichomoniasis maternal affects
increased risk for preterm labor/birth
PROM
trichomoniasis fetal effects
vertical transmission at birth
asymptomatic or resp. infection
low birth weight
trichomoniasis nursing considerations
mom & partner must be treated
genitourinary infections
bacterial vaginosis
group b hemolytic strep (GBS)
cystitis & pyelonephritis
bacterial vaginosis maternal affects
imbalance in vaginas normal flora by hormonal chg or antibiotic trt
asymptomatic or white/yellow discharge w/fishy odor
assoc w/preterm labor, PROM, UTI
bacterial vaginosis fetal affects
limited- assoc w/ preterm birth
bacterial vaginosis nurs considerations
prenatal screen
hx of preterm delivery
GBS maternal affects
often asymptomatic (15-40% are colonized)
discharge
uti
preterm labor
GBS fetal affects
most common cause of neonatal infections, morbidity and mortality
acquired by vertical transmission during birth causing sepsis, pneumonia, meningitis
early (within 48hrs) or late onset (after 1wk of life)
GBS nurs considerations
maternal screen 35-37 weeks
cystitis & pyelonephritis maternal affects
cystitis may cause dysuria - freq, hematuria, urgency
premature l&d
progression to pyelonephitis - fever, n/v, chills, cva tenderness
cystitis & pyelonephritis fetal affects
effects related to preterm labor/birth
cystitis & pyelonephritis nurs considerations
teach importance of finishing meds
if turns into pyelonephritis, hospitalization necessary for iv trt w/antibiotics
Torch Infections
toxoplasmosis other (syphilis/Hep B) Rubella Cytomegalovirus Herpes Simplex Virus
toxoplasmosis Maternal/Preg Affects
consuming poorly cooked meat
exposure to cat feces
acutely infected can cause congenitally infected
90% are asymptomatic
general malaise, premature L&D, miscarriage
toxoplasmosis Fetal Affects
transmitted across placenta
may be asymptomatic at birth
long term blindness, mr, impaired vision
IUGR
toxoplasmosis Nursing Considerations
Maternal treatment with pyrimethamine, sulfadiazine and folinic acid (leucovorin) during 2nd & 3rd trimesters
Neonates treated w/leucovorin
other (syphilis/Hep B) Maternal/Preg Affects
HEPATITIS B - Preterm labor &/or delivery, Stillbirth
SYPHILIS - Can cause spontaneous abortion, fetal death, and congenital syphills
other (syphilis/Hep B) Fetal Affects
HEPATITIS B - Vertically transmitted-Infants infected at birth have 90% risk of becoming a carrier, 25% risk of
developing significant liver disease 90-95% of those infected are symptomatic
SYPHILIS- Fetal infection may involve multiple organs and can cause fetal growth restriction, non-immune hydrops, and increases risk of premature birth. May also be asympotmatic at birth; symptomatic in 1st 3 months
other (syphilis/Hep B) Nursing Considerations
HEPATITIS B -Neonatal treatment isHBV vaccine (within 12hrs of birth, at 1-2 months & 6-18 months) •HBV immunoglobulin (HBIG) plus vaccine if mother is a carrier or HbsAG+ •All pregnant women are screened prenatally
SYPHILIS -Infected newborns are treated w/PCN over 10-
14 days•AAP states that no newborn be discharged without knowing mother’s serologic status for syphilis•
Provide support to parents related to their feelings about how infection was transmitted
Rubella Maternal/Preg Affects
transmitted across placenta
infection during 1st trimester can cause spontaneous abort
Rubella Fetal Affects
more severe disease if acquired in 1st trimester
cns/heart defects, stillbirth, jaundice, cataracts
Rubella Nursing Considerations
isolate exposed neonate
vaccine contraindicated during preg., vaccine after delivery, do not become preg within 1st 4 weeks
Cytomegalovirus Maternal/Preg Affects
transmitted across placenta at birth or thru breast-milk
only 1-5% develop symptoms (malaise)
Cytomegalovirus Fetal Affects
no trt for infants
90% unaffected
mr 5-15% w/hearing loss, microcephaly
Cytomegalovirus Nursing Considerations
good hygiene
isolate infected infants
no effective drug therapy
Herpes Simplex Virus Maternal/Preg Affects
Type I: Non genital type, although can infect genital area
Type II: Genital type; more often associated with
neonatal disease. Causes painful vesicle lesions on maternal external genitals, buttocks, cervix
Herpes Simplex Virus Fetal Affects
Greatest risk is from maternal primary infection at birth; 85-90% acquired at time of vaginal birth•Acquired post-natally through oral lesions, breastfeeding,
and from other infected infants• Mortality of 50-60% if neonatal exposure is w/active primary infection• W/congenital transmission: SGA, low birth weight, diffuse
brain damage, microcephaly and intracranial calcification
Herpes Simplex Virus Nursing Considerations
Neonates treated w/acyclovir x2-3weeks; topical ophthalmic drug in addition to IV therapy•
Prevention: if positive lesions or culture at time of
delivery –cesarean section•Avoid routine use of scalp electrodes during labor•Strict hand washing for mothers with active infections•Contact isolation w/infected infants•
Educate parents on precautions to use after discharge
HIV transmission
intravenous drug use #1 route of transmission
perinatal transmission through trans-placental during delivery or breastfeeding
HIV maternal/preg affects
preterm l&d
s/e from arv & haart drugs
HIV fetal affects
perinatal transmission
IUGR
asymptomatic at birth (antibodies 1-18 mos)
HIV nursing considerations
Antepartum•Use of ARV/HAART usually after week 14•
Prevention of opportunistic infection
Intrapartum•ACTG 076 Protocol: (mother) AZT 2mg/kg IV over 1 hour, then 1mg/kg IV continuous infusion until cutting of cord. •Avoid procedures that increase the risk of perinatal transmission, such as amniocentesis, and fetal scalp sampling by minimizing fetus/neonate’s exposure to maternal blood and body fluids.•Trend toward scheduling cesarean birth prior to the onset of labor decreases transmission to 2% (depending on viral load). Women should be counseled and supported in their decision
Postpartum•Monitor mother for signs of infection; restrict breast-feeding•Instruct mother on how to avoid the spread of HIV•Provide supportive care.•Mother will continue her anti-retroviral meds as prescribed.•Administer PO AZT or ZVD to neonate as prescribed.•AZT 2mg/kg P.O. q 6hrs x 6 weeks 8-12 hours after birth•Current guidelines suggest testing newborn within 48 hours of birth, at 1-2 months and 3-6 months of age. •Diagnosis is confirmed with two positive tests on two separate blood draws
Psychosocial support•Disclosure of a woman’s HIV status to family/significant other can put her at risk for domestic violence, rejection•Requires assistance in identifying coping strategies and managing day to day life
nursing considerations for perinatal infections
focus is on screen/prevention
culture at initial appt & 3rd trimester
educate regarding effect of infect on pregnancy
nursing dx for perinatal infections
ineffective coping, health maint.
risk for infection, injury/fetal
