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Maternity & OB > Pregnancy complications > Flashcards

Pregnancy complications Flashcards

1
Q

What defines chronic hypertension in pregnancy?

A
  • Systolic BP >140mmHg or diastolic BP >90mmHg prior to conception on 2 different occasions before 20 wks or after 12 wks.
  • Persists after pregnancy/birth
  • No proteinuria
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2
Q

What are the 4 medications to give for hypertension

A

“New Mothers Hate Labor”
* N: nifedipine
* M: methyldopa
* H: hydralazine
* L: labetalol

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3
Q

What antihypertensives to avoid during pregnancy

A
  • Avoid Ace inhibitors (“pril): lisinopril, enalapril
  • ARBs (“sartan”): losartan, valsartan
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4
Q

what is the drug of choice for anticonvulsions during pregnancy

A

Magnesium sulfate

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5
Q

what is the therapeutic range of magnesium sulfate

A

4 - 7 mEq/L

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6
Q

what are signs of toxicity with magnesium sulfate

A
  • low deep tendon reflexes (early sign)
  • low VS: respiratory depression
  • decreased mental status
  • low urine output: <30mL
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7
Q

What is chronic HTN with superimposed preeclampsia

A
  • preexisting HTN + signs of preeclampsia
  • increased BP that was previously controlled
  • with new onset of proteinuria

this is previous HTN w/ new preeclampsia s/s, preeclampsia is just new HTN

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8
Q

what are s/s of chronic HTN with superimposed preeclampsia

A
  • proteinuria
  • increased liver enzymes
  • thrombocytopenia (low platelets)
  • RUQ pain
  • headaches, blurred vision, scotoma (blind spot)
  • pulmonary edema or congestion
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9
Q

What is gestational hypertension?

A

High blood pressure for the first time after 20 weeks.

can progress to preeclampsia

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10
Q

What characterizes preeclampsia?

A

Hypertension during pregnancy accompanied by proteinuria after 20 weeks gestation.

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11
Q

What are the risk factors for preeclampsia?

A
  • first time pregnant
  • Maternal age >35 years
  • Prepregnancy obesity (BMI >30)
  • Multiple gestation
  • Family history
  • Chronic hypertension, kidney disease, systemic lupus, thrombophilia, antiphospholipid syndrome, diabetes
  • Assisted reproduction
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12
Q

What are suspected cause of preeclampsia

A
  • remodeling of vessels are abnormal and doesn’t accomodate increased blood flow
  • around 20wks, the fetus develops quickly, requiring more nutrients and O2
  • the abnormality leads to ischemia -> inflammation -> endothelial dysfunction & thrombosis
  • or just genetics
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13
Q

What are the diagnostic criteria for preeclampsia?

A
  • SBP >160; DBP >110
  • proteinuria
  • serum creatinine 1.1mg/dL +
  • liver enzymes elevated x2
  • platelets <100,000/uL
  • new onset cerebral or visual disturbances
  • persistent epigastric pain
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14
Q

why does proteinuria, edema, and hemoconcentration change due to preeclampsia

A

increased permeability and capillary leakage

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15
Q

What are the criterions for proteinuria

how is the test done

A
  • > = 300mg in 24 hr collection
  • protein/creatinine >=0.3
  • > =2+ on dipstick
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16
Q

why are platelets & RBC decreased in preeclampsia

A

intravascular coagulation leads to:
* hemolysis or RBC
* increased factor VIII antigen
* platelet adhesion

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17
Q

As a result of vasospasm, explain the cause of:
* IUGR: intrauterine growth restriction
* decreased GFR, oliguria
* headache, hyperreflexia, seizure
* blurred vision, scotoma
* N/V, Epigastric RUQ pain

A
  • IUGR: decreased uteroplacental perfusion
  • decreased GRR, oliguria: Glomerular damage
  • headache, hyperreflexia, seizure: Cortical brain spasms
  • blurred vision, scotoma: Retinal arteriolar spasm
  • N/V, epigastric pain: Liver ischemia
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18
Q

Complications for the mother after getting preeclampsia

A
  • lower extremity edema -> pulmonary edema, cerebral edema, CVA
  • hemorrhage
  • disseminated intravascular coagulation
  • congestive HF
  • HELLP, eclampsia

long term damage
* liver/kidney damage
* abruptio placenta

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19
Q

Complications for fetus after preeclampsia

A
  • Fetal growth restriction (FGR)
  • Fetal intolerance to labor
  • Stillbirth
  • Spontaneous or preterm delivery
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20
Q

Nursing care for preeclampsia

A
  • seizure precautions
  • decrease environmental stimuli
  • ensure adequate protein intake
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21
Q

What does HELLP syndrome include

A
  • Hemolysis
  • Elevated Liver enzymes
  • Low platelets
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22
Q

Complications for women with HELLP

A
  • abruptio placenta
  • renal failure
  • liver hematoma
  • rupture of blood vessels -> internal bleeding
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23
Q

Complications for the fetus with HELLP

A
  • PTB
  • death
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24
Q

treatment for HELLP

A
  • magnesium sulfate drip
  • IV push antihypertensives
  • fluids
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25
Q

what is eclampsia

A
  • seizures or coma in pt w/ preeclampsia
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26
Q

Labs for eclampsia

A
  • Urinalysis
  • Serum creatinine >1.1mg/dL
  • hematocrit >35
  • increased AST >40, ALT >56
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27
Q

S/S of eclampsia besides seizures

A
  • loss of consciousness
  • agitation
  • headaches/muscle pain
  • URQ pain
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28
Q

medical interventions for eclampsia
* Meds

A
  • magnesium sulfate prophylactically & after
  • antihypertensives
  • corticosteroids if induced birth is necessary (enhance lung maturity)
  • epidural if platelets >100,000
  • platelet transfusion <50,000
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29
Q

medical interventions for eclampsia
* what to assess

A
  • Lung sounds, RR, SpO2
  • CNS: headache, vision changes, deep tendon reflexes
  • Epigastric pain
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30
Q

Why is a quiet environment and bedrest in the lateral recumbent position recommended for women with preeclampsia, eclampsia, HELLP

A
  • Reduce stress to prevent seizures
  • lateral recumbent position promotes blood flow to the uterus and organs -> reduce maternal BP
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31
Q

What is gestational diabetes mellitus (GDM)?

A
  • glucose intolerance
  • insulin resistance
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32
Q

Etiology for gestational diabetes mellitus

A

Hormonal changes (hPL, insulinase, P&E, etc.) from the placenta -> insulin resistance and hyperglycemia

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33
Q

S/S of gestational diabetes

A
  • polyuria, polyphagia, polydipsia
  • blurred vision
  • frequent UTIs, vaginal candidiasis
  • excessive fatigue
  • sudden wt loss
  • hypoglycemic episodes
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34
Q

antepartum care for GDM

A
  • Diet and exercise
  • insulin therapy
  • NO oral hypoglycemic agents
  • self-monitoring BG
  • fetal kick counts/monitoring
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35
Q

diet education for antepartum with gestational diabetes

A
  • switch to complex carbs, fruits and veggies
  • eat small low-carb snacks throughout the day instead of 3 large meals
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36
Q

glucose monitoring education for antepartum with gestational diabetes

A
  • test 1 fasting glucose + 3 postprandial checks per day
  • fasting glucose <95, 1hr after meals <140, 2hrs after meals <120
  • monitor fasting ketonuria levels prn
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37
Q

Risk factors for getting gestational diabetes mellitus

A
  • Hx of fetal macrosomia (large baby)
  • family hx
  • obesity
  • polycystic ovarian syndrome
  • HTN
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38
Q

what are complications for the mother with gestational diabetes

A
  • Hypoglycemia and DKA
  • Preeclampsia or Hypertensive disorders
  • C-section
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39
Q

what are the complications for the baby w/ gestational diabetes

A
  • macrosomia (large baby>4000g) -> shoulder dystocia (shoulder trapped in pelvis)
  • IUGR
  • hypoglycemia first few hrs
  • polycythemia (elevated HCT)
  • hyperbilirubinemia
  • resp distress syndrome - immature lungs
  • assisted delivery, birth trauma
  • preterm birth
  • stillbirth
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40
Q

explain the process for glucose fasting tests

A

1hr glucose challenge test (non-fasting):
* drinks 50g glucose
* BG in 1hr: 135-140 mg/dL + is positive

if positive -> 3hr glucose tolerance test
* fasts for 8-12hrs prior
* drinks 100g glucose

positive if 2 or more of the following are elevated:
* fasting >= 95
* 1hr >=180
* 2hrs >=155
* 3hrs >=140

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41
Q

etiology for hyperemesis gravidarum

A

rapid rising serum hormones: hCG

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42
Q

What are the signs and symptoms of hyperemesis gravidarum?

A
  • Prolonged, frequent, or severe vomiting
  • Weight loss >5%
  • Acetonuria/ketonuria
  • Signs of dehydration (lightheadedness, dizziness, tachycardia, dry mucous membranes, hypotension, poor skin turgor)
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43
Q

What distinguishes hyperemesis gravidarum from morning sickness?

A

Hyperemesis gravidarum involves all-day vomiting that doesn’t improve with food, while morning sickness improves after eating.

44
Q

treatment for hyperemesis gravidarum

A
  • vitamin B6 and doxylamine
  • dextrose and thiamine
  • antihistamine H1 receptor blockers, phenothiazines, benzamides
  • enteral tube feeding initially for nutrition support
45
Q

What is a spontaneous abortion?

A

Loss of an intrauterine pregnancy before viability (20 weeks)

46
Q

what are the 4 classifications of abortion

A
  1. induced
  2. elective
  3. therapeutic
  4. spontaneous
47
Q

explain the difference between induced, elective, and therapeutic abortions

A
  • induced: mifepristone-misoprostol regimen
  • elective: termination before viability requested by mother
  • therapeutic: termination r/t maternal-fetal complications
48
Q

what is the treatment for medical abortions

A
  • 800ug of vaginal misoprostol
    dilates the cervix, stimulates contractions
  • surgical evacuation
49
Q

What are the risk factors for early pregnancy loss?

A
  • Prior pregnancy loss
  • Advanced maternal age
  • Endocrine abnormalities
  • Drug use/toxins
  • Immunological factors
  • Infections
  • Systemic disorders
  • Genetic factors
  • Uterine or cervical abnormalities
  • Black women
50
Q

Peri care education for post abortion/miscarriage

A
  • no tampons
  • no douching
  • no sexual intercourse for weeks
51
Q

Dietary teachings for post abortion/miscarriage

A
  • high Fe
  • high protein
52
Q

what type of examinations are done to confirm complete expulsion of fetus during abortion

A

hCG serum testing & U/S

53
Q

what is ectopic pregnancy

A
  • implantation outside the uterine cavity - mostly in fallopian tube
54
Q

what are the risk factors for ectopic pregnancy

A
  • recurrent STIs
  • PID: pelvic inflammatory dx
  • tubal sx, damage/scarring
  • IUDs
55
Q

What are the signs and symptoms of ectopic pregnancy?

A
  • Sudden, severe one sided abdominal or pelvic pain
  • Dizziness or fainting
  • Lower back pain
  • red vaginal spotting
56
Q

what are s/s of ruptured ectopic pregnancy

A

hypovolemic shock
* hypotension
* tachycardia
* dizziness

shoulder pain: severe, sudden, and sharp
* pooling of blood from the abdomin
* can lead to peritonitis: rigid abdomen, tenderness, fever

57
Q

how do you diagnose ectopic pregnancy?

A
  • 6-12 week zygote large enough to rupture fallopian tube
  • serial hCG levels
  • transvaginal U/S
58
Q

what is the treatment for ectopic pregnancy

A
  • early: methotrexate (given until negative hCG titer)
    methotrexate stops cells from dividing
  • salpingectomy: laparoscopy to ligate bleeding vessels and to remove or repair damaged fallopian tube

never viable and can’t be transplanted

59
Q

What is a hydatidiform mole?

A

A benign proliferating growth of the trophoblast, resulting in grape-like clusters without a viable fetus.

60
Q

What is the normal process of trophoblast cell development?

A

Trophoblast cells form the placenta and develop chorionic villi, then implant in the endometrium.

61
Q

What characterizes a hydatidiform mole?

A

Abnormal growth of the placenta and trophoblastic cells leading to fluid accumulation in chorionic villi -> formation of cysts.

62
Q

What is the difference between a complete mole and an incomplete mole?

A
  • Complete mole: no fetal development
  • Incomplete mole: abnormal fetal tissue is present but doesn’t mature.
63
Q

What are some risk factors for developing a molar pregnancy?

A
  • Age under 18 or over 40 years
  • Previous molar pregnancy.
64
Q

What is the relationship between hCG and TSH -> hyperthyroidsm in a pt with molar pregnancy

A

hCG and TSH have similar structures, and elevated hCG can bind to TSH receptors, stimulating thyroid hormone production.

65
Q

What are the clinical manifestations of a molar pregnancy?

A
  • Bleeding -> Anemia
  • Enlarged uterus -> overestimated fundal height
  • Pelvic pain or pressure
  • high hCG -> Hyperemesis gravidarum
  • Hyperthyroidsm
  • Dark brown “prune juice color” uterine bleeding
66
Q

What is the increased risk associated with a molar pregnancy?

A

Increased risk of choriocarcinoma, an aggressive cancer from trophoblastic tissue of the placenta.

67
Q

How is a molar pregnancy diagnosed?

A
  • Transvaginal ultrasound
  • Serum hCG levels - elevated for the first 8-12 wks
68
Q

What is the immediate medical management for a molar pregnancy?

A

Suction curettage for immediate evacuation of the mole.

69
Q

Fill in the blank: In a molar pregnancy, serial hCG levels should be monitored for at least ______ months after removal.

A

6 months

avoid pregnancy until cleared by PCP

70
Q

What is placenta previa?

A

Malposition or implant of the placenta in the lower uterine segment, covering the internal cervical opening partially or completely.

71
Q

List the types of placenta previa.

A
  • Total: completely covers cervix opening
  • Partial
  • Low-lying: lower part of the uterus but does not cover the cervix.
72
Q

What are the 3 main risk factors for placenta previa?

Give examples

A

Endometrial scarring
* Previous C-section
* Abortion
* Multiparity

Impeded endometrial vascularization
* Advanced maternal age
* Diabetes
* Hypertension
* Smoking
* uterine fibroids, endometritis

Increased placental mass
* multiple gestation: twins, triplets
* large placenta

73
Q

Complications of placenta previa for women?

A
  • Hemorrhagic and hypovolemic shock
  • Potential Rh sensitization
  • Septicemia
  • Death.
74
Q

Complications of placenta previa for the baby?

A
  • Intrauterine growth restriction (IUGR)
  • Blood loss -> anemia
  • Hypoxia
  • Preterm birth.
75
Q

What are the signs and symptoms of placenta previa?

A
  • Painless vaginal bleeding during 3rd trimester that is bright red
  • low HgB
76
Q

How is placenta previa diagnosed?

A

Transabdominal ultrasound: 36wks and prior to onset of labor

77
Q

what must you never do for placenta previa

A
  • NO vaginal or rectal exams: can pierce the placenta and lead to hemorrhage
78
Q

What is the management for a patient with placenta previa?

A
  • Anticipate blood transfusion: initiate 2 large bore IVs, blood typing & screening
  • FHR (1st sign)
  • Count pads for blood loss
  • prepare for C-section prior to labor
  • betamethasone given for preterm lung development
  • give O2 8-10L/mins prn
79
Q

What is abruptio placenta?

A

Bleeding at the decidual-placental interface leading to hematoma and partial or complete placental detachment.

80
Q

when are abruptio placenta typically diagnosed

A

after 20wks gestation

81
Q

What are the grades of abruptio placentae?

A
  • Mild: mild to moderate dark vaginal bleeding
  • Moderate to severe: uterine rigidity, severe abdominal pain, dark vaginal bleeding, signs of shock, fetal distress
82
Q

What are the risk factors for abruptio placenta?

A
  • Previous abruption, c-section
  • Hypertension, preeclampsia
  • Maternal age
  • abdominal trauma
  • Drug use: coke, meth
  • thrombophilias
83
Q

complications for women with abruptio placenta?

A
  • Obstetric hemorrhage
  • Blood transfusions
  • Emergency hysterectomy.
  • Renal failure
  • DIC
84
Q

complications for the baby associated with abruptio placenta?

A
  • Low birth weight
  • Preterm delivery
  • Asphyxia
  • Stillbirth.
85
Q

What are the signs and symptoms of abruptio placenta?

A
  • dark red vaginal bleeding
  • Hypovolemic shock:
  • Severe continuous abdominal pain
  • rigid & tender uterus
  • abnormal FHR pattern
  • uterine tachysystole: frequent contractions that can lead to fetal hypoxia
  • Kleihauer-Betke test
86
Q

interventions for abruptio placenta

A
  • anticipate emergency C-section
  • continuous FHR monitoring
  • large IV bore access & blood typing for transfusion
  • monitor for hypovolemic shock
87
Q

What is the Kleihauer-Betke test?

A

A test to detect the presence of fetal red blood cells in maternal blood.

88
Q

What does placenta accreta spectrum (PAS) include?

A
  • Placenta accreta
  • Placenta increta
  • Placenta percreta.
89
Q

Placenta accreta vs. increta vs. percreta

A
  • Accreta (most common): beyond the boundary without invasion of the decidua
  • increta: into uterine myometrium
  • percreta: into uterine musculature and can adhere to other pelvic organs
90
Q

What is the etiology of placenta accreta spectrum?

A

Defect of the endometrial-myometrial interface leading to abnormal deep placental anchoring.

91
Q

What are the risk factors for placenta accreta spectrum?

A
  • Myometrial damage from previous C-section
  • previous placenta previa overlying uterine scar
  • Advanced maternal age
  • In vitro fertilization
  • multiparity
92
Q

complications for women with placenta accreta spectrum?

A
  • Hemorrhagic shock
  • Increased risk of infection, thromboembolism, pyelonephritis, pneumonia, adult resp distress syndrome, renal failure
93
Q

What are the risks for the baby associated with placenta accreta spectrum?

A
  • Preterm birth.
94
Q

What is the medical management for placenta accreta spectrum?

A
  • Preterm cesarean hysterectomy
  • Delivery between 34 and 37 weeks.
95
Q

what should you never do for the placenta accreta spectrum

A

No vaginal exams

96
Q

assessment/management for 2nd and 3rd trimester bleeding

A
  • description of bleed
  • contractions and fetal activity
  • observe for signs of shock
  • NO vaginal exams
  • U/S
97
Q

What does the acronym TORCH stand for in infections during pregnancy?

A
  • T: Toxoplasmosis
  • O: Other (Hep B, syphilis)
  • R: Rubella
  • C: Cytomegalovirus
  • H: Herpes simplex virus.
98
Q

s/s of toxoplasmosis for mothers

A
  • fatigue
  • muscle pains
  • pneumonitis
  • myocarditis
  • lymphadenopathy
99
Q

s/s of toxoplasmosis for the fetus

A
  • premature birth
  • hydrocephalus
  • vision problems
  • hearing loss
100
Q

patient teachings to avoid toxoplasmosis

A
  • no changing cat litter
  • wash soil-contaminated fruits & veggies
  • no raw or undercooked meat
101
Q

treatment for toxoplasmosis

A
  • sulfadiazine or
    pyrimethamine after the first trimester
102
Q

when is group beta strep screening done

A

36-38weeks swab

103
Q

What is the treatment for group beta strep (GBS) during labor?

A

IV antibiotics, typically penicillin during labor

104
Q

what are complications for the fetus when the mother has group beta strep

A
  • pneumonia
  • septicemia
  • meningitis
105
Q

What are the effects of trauma during pregnancy?

A
  • Risk of placental abruption
106
Q

how long are you supposed to monitor the mother after experiencing trauma

A

4 hrs monitoring of:
* pain
* bleeding
* contractions

Maternity & OB (3 decks)

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