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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
Iron Deficiency Anemia: Implications for Pregnant Person & Fetus
Increase risk of preeclampsia and postpartum hemorrhage Low birth weight, preterm birth, fetal hypoxia during labor
26
Pregnant persons who use substances frequently have the following additional issues:
Poor nutrition Higher risk of infection Safety concerns Non-adherence to prenatal care schedule
27
Pregnancy, Fetal/Neonatal Affects of Caffeine
High intake associated w/ slight decrease birth weight Increase risk of miscarriage
28
Pregnancy, Fetal/Neonatal Affects of Tobacco
Spontaneous abortion FGR (fetal growth restriction) Low birth wt Preterm birth Perinatal mortality Placenta previa, Abruptio Placenta SIDS (sudden infant death syndrome)
29
Pregnancy, Fetal/Neonatal Affects of Alcohol
Fetal alcohol spectrum disorder (FASD) Intellectual disabilities Midfacial hypoplasia
30
Pregnancy, Fetal/Neonatal Affects of Cocaine, Crack, & Methamphetamines
Vasoconstriction Tachycardia, HTN Abruptio Placentae Preterm birth FGR Neurobehavioral abnormalities Congenital anomalies
31
Pregnancy, Fetal/Neonatal Affects of Opioid Use Disorder
Increased incidence of preeclampsia Preterm birth FGR Withdrawal for baby (irritability, seizures, diarrhea, feeding difficulty)
32
Pregnancy, Fetal/Neonatal Affects of Marijuana
Increase use frequency associated w/ cannabinoid hyperemesis syndrome Birth wt < 5.5 lbs
33
Caffeine Goals & Intervention
< 200 mg/day Education - limit yourself
34
Tobacco Goals & Interventions
Discontinuation & reduction Education on effects on baby Nicotine patch
35
Alcohol Goals & Interventions
Abstinence *NO ACUTE DETOX Education Behavioral Intervention Cautious use of meds
36
Cocaine/Crack Goals & Interventions
Discontinuation & abstinence Cognitive behavioral therapy Social support
37
Amphetamines & Methamphetamine Goals & Interventions
Discontinuation & abstinence Cognitive behavioral therapy Social support
38
Opioids Goals & Interventions
Multidisciplinary support Medication Assisted Treatment (MAT) w/ opioid agonists
39
Marijuana Goals & Interventions
Discontinuation & reduction Education on effects on baby
40
Medication Assisted Treatment (MAT) for Opioid Use Disorder
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
41
Types of Hypertension in Pregnancy
Chronic HTN Chronic HTN w/ superimposed pre-eclampsia Gestational HTN Pre-eclampsia/eclampsia/HELLP
42
Chronic Hypertension
Diagnosed when the patient's SBP ≥ 140 mmHg or DBP ≥ 90 mmHg before pregnancy or before the 20th week of pregnancy
43
Chronic Hypertension Management
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
44
What antihypertensive meds are safe for pregnant woman?
Labetalol (IV) Nifedipine (PO) Hydralazine (IV)
45
Chronic Hypertension w/ Superimposed Preeclampsia
Diagnosed when, after 20 weeks gestation, hypertension worsens, and proteinuria occurs
46
Gestational Hypertension
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
Gestational HTN Diagnosis
SBP ≥ 140 mmHg or DBP ≥ 90 mmHg, or both, on two occasion at least 4 hr apart
48
When is gestational hypertension considered chronic HTN?
If HTN persists after 12 weeks postpartum
49
Preeclampsia & Eclampsia
Defined as an increase in BP after 20 weeks of pregnancy, accompanied by proteinuria Categorized as mild (pre) or w/ severe features (eclampsia)
50
Preeclampsia & Eclampsia "Cure"
Birth of newborn and removal of the placenta
51
When is preeclampsia and eclampsia seen?
Most often in the last 10 weeks of pregnancy, during labor, or in the first 48 hours after birth
52
Pathophysiology of Preeclampsia
Fibrosed placental arteries = poorly perfused placenta = placenta releases pro-inflammatory proteins
53
Signs of Preeclampsia
Can be asymptomatic Severe H/A Visual disturbances (blurry, halos) Proteinuria High BP Swollen hands, legs/feet Epigastric pain
54
HELLP Syndrome
Dangerous subtype of preeclampsia w/ specific criteria H = Hemolysis EL = Elevated Liver Enzymes LP = Low Platelets
55
HELLP Syndrome Platelets
Vascular damage to blood vessels causes platelet aggregation = platelets are used up (low platelets)
56
HELLP Syndrome Hemodialysis
As RBCs try to pass by, they break apart
57
HELLP Syndrome Elevated Liver Enzymes
Liver damage can be so severe jaundice occurs, or liver swells and may rupture
58
What can HELLP Syndrome lead to?
Disseminated Intravascular Coagulation (DIC) due to thrombocytopenia
59
What's the difference between preeclampsia and eclampsia?
The difference is eclampsia has seizures
60
What happens with future pregnancies if a mom already had preeclampsia for a pregnancy?
Increased risk for preeclampsia so mom should be started on aspirin 81 mg
61
Treatment for Gestational Hypertension & Mild Preeclampsia
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
Treatment for Preeclampsia w/ Severe Features
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
Magnesium Sulfate for Preeclampsia w/ Severe Features
To relax CNS and prevent seizures 4-6 gm IV loading dose, then continuous 1-2 gm/hr
64
Betamethasone for Preeclampsia w/ Severe Features
To mature fetal lungs before delivery
65
Magnesium Sulfate Nursing Actions
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
Additional Nursing Assessments for Magnesium Sulfate
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
Therapeutic Level for Magnesium
4-8 mg/dl
68
Magnesium Sulfate Toxicity Signs
BURP B = BP decrease U = urine output decrease R = respiratory rate decrease P = patellar reflex absent
69
Magnesium Sulfate Toxicity
STOP infusion and administer antidote Antidote = calcium gluconate (10 mL of 10% solution IV slowly over 10 min)
70
Magnesium Sulfate Side Effects
Feeling hot Flushing Sweating Weakness
71
Preterm Labor
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
Preterm Labor Symptoms
Pressure in pelvis Menstrual-like cramping Persistent low backache
73
Preterm Labor Signs
Bloody show Dilation Regular ctx Sometimes spontaneous rupture of membranes (SROM)
74
Fetal Fibronectin-fFN
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
Preterm Labor Complications on Pregnant Patient
Psychological stress r/t - baby's condition - long admission - bedrest Physiologic stress r/t medical treatment
76
Preterm Labor Complications on Baby
Increased morbidity and mortality d/t organ immaturity Potential lifelong disability
77
Nursing Care for Preterm Labor
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
How should you prepare for preterm delivery?
Interventions for fetal lung maturity and neuro protection
79
Preterm Labor If Discharged Home Teaching
Monitor ctx No sexual intercourse (pelvic rest) Take meds as directed
80
Tocolysis
Use meds to stop or delay labor to give time for fetal lung maturity and fetal neuroprotection Nifedipine (Procardia) Terbutaline
81
Nifedipine (Procardia)
Calcium channel blocker Least side effects Uterine smooth muscle relaxant
82
Nifedipine Side Effects
Flushing HA Hypotension r/t arterial vasodilation
83
Terbutaline
B-adrenergic agonist Short-term use in emergency situation to stop ctx Relaxes smooth muscle S/E: tachycardia, jittery
84
Contraindications in Terbutaline
Heart disease Tachycardia
85
Fetal Neuroprotection and Lung Maturity Meds
Magnesium Sulfate Betamethasone
86
Magnesium Sulfate
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
Betamethasone
Corticosteroid Causes release of surfactant in fetus Decrease in death and long-term disabilities Monitor glucose levels d/t increase in blood sugar
88
Betamethasone Dose
2 IM, 24 hrs apart Need 24 hrs to fully reach effect
89
Betamethasone Indications
24-33 6/7 weeks gestation who are at risk for delivery within 7 days
90
Nifedipine for HTN in Pregnant Patients
Relaxes smooth muscles of arteries to address HTN Relaxes smooth muscles of uterus to address preterm labor contractions
91
SROM
Spontaneous Rupture Of Membranes while laboring
92
AROM
Artificial Rupture of Membranes by a provider
93
PROM
Prelabor Rupture of Membranes before onset of labor at full term
94
PPROM
Preterm Prelabor Rupture of Membranes - before 37 weeks gestation
95
PROM & PPROM Hx
Pt reports a gush of clear or green
96
Risk Factors for PPROM
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
PROM & PPROM DX
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
Associated Risks After PROM/PPROM
Prolapsed cord Infection Premature birth Malpresentation Neonatal issues associated w/ prematurity, increased mortality/morbidity
99
If term, labor is induced to facilitate delivery within what time?
Within 24 hours after ROM
100
Pre-Term Nursing Care
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
Placental Issues
Placenta Previa Placental Abruption
102
When is bleeding normal in pregnancy?
ONLY normal w/ bloody show at term (spotty)
103
Placenta Previa
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
Placenta Previa Types
Low lying placenta Marginal placenta Partial pervia Complete previa
105
Placenta Previa Signs
Bright red & PAINLESS vaginal bleeding during 2nd or 3rd trimester w/ uterus soft and non-tender
106
Placenta Previa Risk Factors
Previous placenta previa Uterine scarring (previous c/s, curettage, endometritis) Advanced age >35 Multifetal gestation Grand multips-5 or more births Smoking
107
Nursing Care of Patient w/ Placenta Previa
Provide bedrest Monitor blood loss, pain, uterine ctx, and V/S Evaluate FHR w/ EFM NO VAGINAL EXAMS
108
Anticipated Orders for Placenta Previa
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
Placental Abruption/ Abruptio Placentae
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
Revealed Placental Abruption
Blood travels btw the membranes and uterine wall (myometrium) and comes out the vagina
111
Concealed Placental Abruption
Blood collects behind the placenta so there is no vaginal bleeding
112
Placental Abruption Assessment Findings
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
Placental Abruption Risk Factors
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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