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N416 > Pregnancy Complications > Flashcards

Pregnancy Complications Flashcards

1
Q

Hyperemesis Gravidarum (HG)

A

Intractable vomiting w/ weight loss of > or = to 5% of pre-pregnancy weight

Can lead to dehydration and ketonuria

Check UA for ketones

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2
Q

Severe Cases of Hyperemesis Gravidarum

A

Enteral nutrition or TPN if severe

Have symptoms of dehydration and starvation:

Hypotension

Tachycardia

Metabolic alkalosis and later to acidosis

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3
Q

Hyperemesis Gravidarum Treatment Goals

A

Control vomiting

Correct dehydration

Restore electrolyte balance

Maintain adequate nutrition

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4
Q

Hyperemesis Gravidarum Treatment

A

IV LR

Vitamins

PO meds:

Pyridoxine (B6)

Doxylamine (unisom)

Combined doxylamine and vitamin B6 (Diclegis)

Metoclopramide (Reglan)

NPO then advance diet

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5
Q

Cervical Insufficiency

A

Inability of the uterine cervix to retain a pregnancy in the 2nd trimester, in the absence of uterine contractions related to a presumed physical weakness of the cervical tissue in an otherwise healthy pregnancy

Cervix has insufficient strength to maintain pregnancy and fetus is born premature and dies

<1% of all pregnancies

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6
Q

Cervical Insufficiency Risk Factors

A

2 consecutive 2nd trimester fetal losses (this is the dx)

Cervical trauma

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7
Q

Cervical Insufficiency Clinical Manifestation

A

Painless dilation w/out noticeable contractions

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8
Q

Cervical Insufficiency Treatment

A

Cerclage, stitching the cervix closed (placed at 12-14 wks)

Placed before baby puts pressure on the cervix

Removed at 36 wks gestation or when spontaneous rupture of membranes or spontaneous labor occurs

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9
Q

Cerclage Nursing Assessment

A

Vaginal discharge

Pt perception of pressure/contractions

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10
Q

Gestational Diabetes Mellitus

A

Placental hormones make insulin less effective, and pancreas is unable to produce enough insulin

Diagnosed in 2nd or 3rd trimester

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11
Q

Early Pregnancy Changes R/T DM

A

Increase insulin production

Increase tissue response to insulin

Increase stores of glycogen in the liver and other tissues

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12
Q

What are a GDM mother’s need for insulin in the first trimester?

A

The pregnancy person’s need for insulin frequently decreases d/t metabolic changes and less food consumption

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13
Q

Second Half of Pregnancy Changes R/T DM

A

Increase resistance to insulin

Decrease glucose tolerance

Fat metabolism

Glucose production and utilization is stressed by fetal demands for glucose

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14
Q

What are a GDM mother’s need for insulin in the 2nd and 3rd trimester?

A

The pregnancy person’s need for insulin are 140% greater

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15
Q

When does GDM develop?

A

Most pregnant persons are able to make enough insulin to maintain normal glucose levels but if they cannot, then GDM develops

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16
Q

Maternal Issues w/ DM & Pregnancy

A

Increase vascular damage r/t diabetes

Decrease placental perfusion

Pre-eclampsia

Polyhydramnios (excess amniotic fluid)

Preterm delivery

Dystocia (difficult birth) secondary fetal macrosomia

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17
Q

Fetal Issues w/ DM & Pregnancy

A

Increase risk congenital malformation

Large for gestational age = increase insulin acting as growth hormone

Fetal growth restriction (FGR) = decrease placental perfusion

Hypoglycemia after birth

Resp distress syndrome = decrease in surfactant production

Polycythemia (extra RBC production) = decrease O2 release from maternal RBC

Hyperbilirubinemia (destruction of RBC = bili released)

Fetal hypoxia and acidosis

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18
Q

What do we want the HbA1C to be in a diabetic person?

A

<6%

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19
Q

GDM & Assessment of Fetal Status

A

More frequent ultrasound (fetal growth)

Non-stress test (fetal well-being)

Fetal biophysical profile (fetal well-being)

Amniocentesis (lung maturity)

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20
Q

GDM Intrapartum

A

Protocol for frequent glucose checks and insulin administration during labor

Insulin needs vary

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21
Q

GDM Postpartum

A

Insulin needs decrease rapidly after delivery

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22
Q

GDM Newborn

A

Hypoglycemia protocol

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23
Q

Iron Deficiency Anemia

A

Most common complication in pregnancy

Causes: hemodilution or inadequate intake of iron

HgB < 11

S/S: fatigue, craving unusual food

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24
Q

Iron Deficiency Anemia Prevention

A

Supplemental iron or folic acid during pregnancy

Iron-rich diet

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25
Q

Iron Deficiency Anemia: Implications for Pregnant Person & Fetus

A

Increase risk of preeclampsia and postpartum hemorrhage

Low birth weight, preterm birth, fetal hypoxia during labor

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26
Q

Pregnant persons who use substances frequently have the following additional issues:

A

Poor nutrition

Higher risk of infection

Safety concerns

Non-adherence to prenatal care schedule

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27
Q

Pregnancy, Fetal/Neonatal Affects of Caffeine

A

High intake associated w/ slight decrease birth weight

Increase risk of miscarriage

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28
Q

Pregnancy, Fetal/Neonatal Affects of Tobacco

A

Spontaneous abortion

FGR (fetal growth restriction)

Low birth wt

Preterm birth

Perinatal mortality

Placenta previa, Abruptio Placenta

SIDS (sudden infant death syndrome)

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29
Q

Pregnancy, Fetal/Neonatal Affects of Alcohol

A

Fetal alcohol spectrum disorder (FASD)

Intellectual disabilities

Midfacial hypoplasia

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30
Q

Pregnancy, Fetal/Neonatal Affects of Cocaine, Crack, & Methamphetamines

A

Vasoconstriction

Tachycardia, HTN

Abruptio Placentae

Preterm birth

FGR

Neurobehavioral abnormalities

Congenital anomalies

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31
Q

Pregnancy, Fetal/Neonatal Affects of Opioid Use Disorder

A

Increased incidence of preeclampsia

Preterm birth

FGR

Withdrawal for baby (irritability, seizures, diarrhea, feeding difficulty)

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32
Q

Pregnancy, Fetal/Neonatal Affects of Marijuana

A

Increase use frequency associated w/ cannabinoid hyperemesis syndrome

Birth wt < 5.5 lbs

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33
Q

Caffeine Goals & Intervention

A

< 200 mg/day

Education - limit yourself

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34
Q

Tobacco Goals & Interventions

A

Discontinuation & reduction

Education on effects on baby

Nicotine patch

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35
Q

Alcohol Goals & Interventions

A

Abstinence *NO ACUTE DETOX

Education

Behavioral Intervention

Cautious use of meds

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36
Q

Cocaine/Crack Goals & Interventions

A

Discontinuation & abstinence

Cognitive behavioral therapy

Social support

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37
Q

Amphetamines & Methamphetamine Goals & Interventions

A

Discontinuation & abstinence

Cognitive behavioral therapy

Social support

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38
Q

Opioids Goals & Interventions

A

Multidisciplinary support

Medication Assisted Treatment (MAT) w/ opioid agonists

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39
Q

Marijuana Goals & Interventions

A

Discontinuation & reduction

Education on effects on baby

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40
Q

Medication Assisted Treatment (MAT) for Opioid Use Disorder

A

Use Methadone or Buprenorphine

Prevent opioid withdrawal symptoms

Reduce relapse risk of nonmedical opioid use

Improve adherence to prenatal care - reduce risk of obstetric complications

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41
Q

Types of Hypertension in Pregnancy

A

Chronic HTN

Chronic HTN w/ superimposed pre-eclampsia

Gestational HTN

Pre-eclampsia/eclampsia/HELLP

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42
Q

Chronic Hypertension

A

Diagnosed when the patient’s SBP ≥ 140 mmHg or DBP ≥ 90 mmHg before pregnancy or before the 20th week of pregnancy

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43
Q

Chronic Hypertension Management

A

More prenatal vists

Aspirin 81 mg daily beginning at 12 wks gestation through delivery

Avoid excessive sodium and caffeine intake

Advise smoking cessation or reduction

Antihypertensive meds

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44
Q

What antihypertensive meds are safe for pregnant woman?

A

Labetalol (IV)

Nifedipine (PO)

Hydralazine (IV)

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45
Q

Chronic Hypertension w/ Superimposed Preeclampsia

A

Diagnosed when, after 20 weeks gestation, hypertension worsens, and proteinuria occurs

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46
Q

Gestational Hypertension

A

Pregnancy-Induced HTN

Elevation of BP occurring after 20 weeks w/ no proteinuria or other signs of preeclampsia

BP returns to normal by 12 weeks postpartum

Can advance to preeclampsia

47
Q

Gestational HTN Diagnosis

A

SBP ≥ 140 mmHg or DBP ≥ 90 mmHg, or both, on two occasion at least 4 hr apart

48
Q

When is gestational hypertension considered chronic HTN?

A

If HTN persists after 12 weeks postpartum

49
Q

Preeclampsia & Eclampsia

A

Defined as an increase in BP after 20 weeks of pregnancy, accompanied by proteinuria

Categorized as mild (pre) or w/ severe features (eclampsia)

50
Q

Preeclampsia & Eclampsia “Cure”

A

Birth of newborn and removal of the placenta

51
Q

When is preeclampsia and eclampsia seen?

A

Most often in the last 10 weeks of pregnancy, during labor, or in the first 48 hours after birth

52
Q

Pathophysiology of Preeclampsia

A

Fibrosed placental arteries = poorly perfused placenta = placenta releases pro-inflammatory proteins

53
Q

Signs of Preeclampsia

A

Can be asymptomatic

Severe H/A

Visual disturbances (blurry, halos)

Proteinuria

High BP

Swollen hands, legs/feet

Epigastric pain

54
Q

HELLP Syndrome

A

Dangerous subtype of preeclampsia w/ specific criteria

H = Hemolysis

EL = Elevated Liver Enzymes

LP = Low Platelets

55
Q

HELLP Syndrome Platelets

A

Vascular damage to blood vessels causes platelet aggregation = platelets are used up (low platelets)

56
Q

HELLP Syndrome Hemodialysis

A

As RBCs try to pass by, they break apart

57
Q

HELLP Syndrome Elevated Liver Enzymes

A

Liver damage can be so severe jaundice occurs, or liver swells and may rupture

58
Q

What can HELLP Syndrome lead to?

A

Disseminated Intravascular Coagulation (DIC) due to thrombocytopenia

59
Q

What’s the difference between preeclampsia and eclampsia?

A

The difference is eclampsia has seizures

60
Q

What happens with future pregnancies if a mom already had preeclampsia for a pregnancy?

A

Increased risk for preeclampsia so mom should be started on aspirin 81 mg

61
Q

Treatment for Gestational Hypertension & Mild Preeclampsia

A

Until 37 0/7 weeks

US for fetal growth and fluid volume

BPP, NST

Weekly labs: CBC w PLT, Cr, liver enzymes

BP monitoring

Hospitalization if unreliable for adherence to frequent monitoring

62
Q

Treatment for Preeclampsia w/ Severe Features

A

Bedrest in darkened room

Magnesium sulfate

Betamethasone

Sometimes antihypertensives, depending on severity of BP

Labor can be induced if cervix is ripe

C/S if s/s severe, pt needs to be delivered, and cervix is not ripe

63
Q

Magnesium Sulfate for Preeclampsia w/ Severe Features

A

To relax CNS and prevent seizures

4-6 gm IV loading dose, then continuous 1-2 gm/hr

64
Q

Betamethasone for Preeclampsia w/ Severe Features

A

To mature fetal lungs before delivery

65
Q

Magnesium Sulfate Nursing Actions

A

Continuous FHR monitoring w/ EFM

Assess Q1-4H, depending on maternal and fetal status:
- VS
- Urine output in foley
- DTR and clonus
- Lung sounds (can develop pulmonary edema)
- LOC
- Presence of H/A, visual disturbances, epigastric pain

66
Q

Additional Nursing Assessments for Magnesium Sulfate

A

Assess edema (pitting? increased?)

Vaginal bleeding (placental abruption?)

Worsening HA and/or epigastric pain

Labs (CBC, BUN, Cr, Clotting studies, Mg level)

Emotional response

67
Q

Therapeutic Level for Magnesium

A

4-8 mg/dl

68
Q

Magnesium Sulfate Toxicity Signs

A

BURP

B = BP decrease

U = urine output decrease

R = respiratory rate decrease

P = patellar reflex absent

69
Q

Magnesium Sulfate Toxicity

A

STOP infusion and administer antidote

Antidote = calcium gluconate (10 mL of 10% solution IV slowly over 10 min)

70
Q

Magnesium Sulfate Side Effects

A

Feeling hot

Flushing

Sweating

Weakness

71
Q

Preterm Labor

A

Contractions and cervical changes occurring between 20 and 36 6/7 weeks of pregnancy

Tests - transvaginal US for cervical length, fetal fibronectin, cervical cultures, CBC, UA

72
Q

Preterm Labor Symptoms

A

Pressure in pelvis

Menstrual-like cramping

Persistent low backache

73
Q

Preterm Labor Signs

A

Bloody show

Dilation

Regular ctx

Sometimes spontaneous rupture of membranes (SROM)

74
Q

Fetal Fibronectin-fFN

A

Swab on cervix

fFN is a protein found in fetal membranes

Should not be present in cervical fluid btw 22-37 weeks

<10 = delivery

75
Q

Preterm Labor Complications on Pregnant Patient

A

Psychological stress r/t
- baby’s condition
- long admission
- bedrest

Physiologic stress r/t medical treatment

76
Q

Preterm Labor Complications on Baby

A

Increased morbidity and mortality d/t organ immaturity

Potential lifelong disability

77
Q

Nursing Care for Preterm Labor

A

Goal is to prevent labor from advancing to point of no return

Ensure good uterine blood flow (lateral position)

EFM - detect uterine ctx

EFM - ensure fetus is stable

78
Q

How should you prepare for preterm delivery?

A

Interventions for fetal lung maturity and neuro protection

79
Q

Preterm Labor If Discharged Home Teaching

A

Monitor ctx

No sexual intercourse (pelvic rest)

Take meds as directed

80
Q

Tocolysis

A

Use meds to stop or delay labor to give time for fetal lung maturity and fetal neuroprotection

Nifedipine (Procardia)

Terbutaline

81
Q

Nifedipine (Procardia)

A

Calcium channel blocker

Least side effects

Uterine smooth muscle relaxant

82
Q

Nifedipine Side Effects

A

Flushing

HA

Hypotension r/t arterial vasodilation

83
Q

Terbutaline

A

B-adrenergic agonist

Short-term use in emergency situation to stop ctx

Relaxes smooth muscle

S/E: tachycardia, jittery

84
Q

Contraindications in Terbutaline

A

Heart disease

Tachycardia

85
Q

Fetal Neuroprotection and Lung Maturity Meds

A

Magnesium Sulfate

Betamethasone

86
Q

Magnesium Sulfate

A

IV bolus and then infusion

Neuroprotective for < 32 weeks (reduction of cerebral palsy)

Administer for 4-24 hrs

D/C if birth has not occurred at 24 hrs

87
Q

Betamethasone

A

Corticosteroid

Causes release of surfactant in fetus

Decrease in death and long-term disabilities

Monitor glucose levels d/t increase in blood sugar

88
Q

Betamethasone Dose

A

2 IM, 24 hrs apart

Need 24 hrs to fully reach effect

89
Q

Betamethasone Indications

A

24-33 6/7 weeks gestation who are at risk for delivery within 7 days

90
Q

Nifedipine for HTN in Pregnant Patients

A

Relaxes smooth muscles of arteries to address HTN

Relaxes smooth muscles of uterus to address preterm labor contractions

91
Q

SROM

A

Spontaneous Rupture Of Membranes while laboring

92
Q

AROM

A

Artificial Rupture of Membranes by a provider

93
Q

PROM

A

Prelabor Rupture of Membranes before onset of labor at full term

94
Q

PPROM

A

Preterm Prelabor Rupture of Membranes - before 37 weeks gestation

95
Q

PROM & PPROM Hx

A

Pt reports a gush of clear or green

96
Q

Risk Factors for PPROM

A

Infection

Placental abruption

Amniocentesis

Bleeding during pregnancy

Cervical insufficiency

Hx of surgery on cervix before pregnancy

Trauma

Polyhydramnios

Low BMI

Multiple pregnancy

Placenta previa

Previous hx of PPROM

Previous preterm birth

Smoking

Genital tract anomalies

97
Q

PROM & PPROM DX

A

Based on:
- visual pool of fluid in vagina during sterile speculum exam (below cervix)
- US assessment of amniotic fluid volume
- Other (Fern test, Commercial immunoassay rupture of membranes test)

98
Q

Associated Risks After PROM/PPROM

A

Prolapsed cord

Infection

Premature birth

Malpresentation

Neonatal issues associated w/ prematurity, increased mortality/morbidity

99
Q

If term, labor is induced to facilitate delivery within what time?

A

Within 24 hours after ROM

100
Q

Pre-Term Nursing Care

A

EFM for FHR and ctx pattern

Nothing in the vagina/No exams unless delivery is imminent

Bedrest w/ BRP

Provide emotional support

Corticosteriods for fetal lung maturity

Watch for s/s of infection - VS Q4H, CBC, foul smelling fluid, abd. tenderness

Administer ABX if needed

101
Q

Placental Issues

A

Placenta Previa

Placental Abruption

102
Q

When is bleeding normal in pregnancy?

A

ONLY normal w/ bloody show at term (spotty)

103
Q

Placenta Previa

A

Placenta implantation in the lower segment

Placenta covers all or part of the cervical os - but may move cervical os during pregnancy

Will be deliver by C/S if placenta does not move from cervical os or 2 events of bleeding

104
Q

Placenta Previa Types

A

Low lying placenta

Marginal placenta

Partial pervia

Complete previa

105
Q

Placenta Previa Signs

A

Bright red & PAINLESS vaginal bleeding during 2nd or 3rd trimester w/ uterus soft and non-tender

106
Q

Placenta Previa Risk Factors

A

Previous placenta previa

Uterine scarring (previous c/s, curettage, endometritis)

Advanced age >35

Multifetal gestation

Grand multips-5 or more births

Smoking

107
Q

Nursing Care of Patient w/ Placenta Previa

A

Provide bedrest

Monitor blood loss, pain, uterine ctx, and V/S

Evaluate FHR w/ EFM

NO VAGINAL EXAMS

108
Q

Anticipated Orders for Placenta Previa

A

Obtain labs: H&H, Rh factor, coagulation profile

Provide LR IV

Have 2 units blood available for transfusion

C/S for hemorrhage

May be discharged if bleeding stops & pt/fetus are stable

109
Q

Placental Abruption/ Abruptio Placentae

A

Premature separation of a normally implanted placenta before the baby is born

Can be a partial or complete detachment w/ either revealed or concealed bleeding

110
Q

Revealed Placental Abruption

A

Blood travels btw the membranes and uterine wall (myometrium) and comes out the vagina

111
Q

Concealed Placental Abruption

A

Blood collects behind the placenta so there is no vaginal bleeding

112
Q

Placental Abruption Assessment Findings

A

Sudden onset of intense localized uterine pain w/ or w/out dark red vaginal bleeding

Area of uterine tenderness can be localized or diffuse over uterus & BOARD-LIKE

Ctx w/ hypertonicity/tachysystole

Fetal distress

May have s/s of hypovolemic shock

113
Q

Placental Abruption Risk Factors

A

HTN (chronic, gestational, or preeclampsia)

Blunt external abdominal trauma

Cocaine or methamphetamine use

Previous hx of placental abruption

Smoking

Premature rupture of membranes (PROM)

Multifetal gestation

N416 (9 decks)

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