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NUR 102 OB Assessment #2 > Pregnancy-Related Complications > Flashcards

Pregnancy-Related Complications Flashcards

1
Q

___ ___

  • Leading cause of pregnancy loss
  • Most commonly due to chromosomal abnormalities incompatible with life
  • Rate increases with age (over 35)
A

Spontaneous abortion

  • Common term we hear = miscarriage
  • 1 in 4 experience this loss
  • Textbook notes as “unexpected”
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2
Q

Collaborative Management

  • Prevent hypovolemic shock and infection; a PPH can happen with a spontaneous abortion
  • Provide emotional support for those grieving
  • Spontaneous abortions can happen as early as 5 weeks
A

Types of Spontaneous Abortions (can overlap, be interrelated)

* Threatened

* Inevitable

* Incomplete

* Complete

* Missed

* Recurrent

* Habitual Abortion

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3
Q

?

Occurs when the membranes have ruptured

* Cervical dilation can occur

* Can’t reverse these events

* D&C is done under IV sedation or general anesthesia

A

Inevitable abortion

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4
Q

?

Occurs when there is any vaginal bleeding in the 1st half of pregnancy

  • Provider will order US to determine viability
  • Look for HR
  • Assess beta hCG level
  • Consider cessation of intercourse, going on bedrest
  • Still at risk for a preterm birth or low birth weight infant
A

Threatened abortion

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5
Q

?

When all products of conception are expelled from the uterus and the cervix closes after the products pass

A

Complete abortion

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6
Q

?

When some but not all products of conception are expelled from the uterus

  • Is active bleeding occurring, severe abdominal cramping, cervix open; fetal and placental tissue has passed but something may be remaining
  • Necessitates D&C or D&E (evacuation)
A

Incomplete abortion

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7
Q
  • Curettage can’t be performed > 14 weeks gestation
  • These women would get oxytocin or prostaglandins to stimulate uterine contractions until all products of conception are expelled
A
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8
Q

?

  • These go hand-in-hand
  • Where someone is having 3 or more consecutive spontaneous abortions
  • Can be triggered by chromosomal or genetic abnormalities as well as anomalies in the reproductive tract of the woman
    e. g. a bicornuate uterus (2 uterine bodies);

an incompetent cervix (when the cervix dilates before it’s supposed to) (⇒ cerclage: stitching the cervix shut)

A

Recurrent and habitual abortions

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9
Q

?

Occurs when the fetus dies during the 1st half of pregnancy but is retained in the uterus

  • Risk for infection and D&C
A

Missed abortion

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10
Q

___ abortion

Some products of conception have been expelled, but some remain

A

Incomplete

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11
Q

___ abortion

Vaginal bleeding occurs

A

Threatened

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12
Q

___ abortion

Membranes rupture, and cervix dilates

A

Inevitable

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13
Q

?

Is a life-threatening complication of a missed abortion, abruptio placentae, and preeclampisa

  • Pro-coagulation and anti-coagulation factors are simultaneously activated

* Activates widespread clotting in vessels throughout body; can see bleeding from any area

  • Priority treatment is delivery of the fetus and placenta
  • Blood replacement products (e.g. plasma, platelets, packed RBC’s) and cryoprecipitate are administered to maintain circulating volume
A

Disseminated Intravascular Coagulation (DIC)

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14
Q

?

Implantation of the fertilized ovum in an area outside of the uterine cavity (most in fallopian tube)

  • Incidence is increasing as a result of ___

⇒ From infections

Risk increased from IUD’s, those with endometriosis, smokers, vaginal douching

A

Ectopic pregnancy

pelvic inflammation

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15
Q

Ectopic Pregnancy

(+) hCG

Abdomen and pelvic pain in 1 side

Risk of tubal rupture

Intra-abdominal hemorrhage, pain in diaphragm

⇒ hypovolemic shock

A transvaginal US can diagnose at ~ 7 weeks

Can occur with twins

A
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16
Q

Ectopic Pregnancy - Collaborative Care

  • Prevent severe hemorrhage and hypovolemic shock

___ prevents cellular reproduction from happening and baby doesn’t grow; it passes on its own

  • Done as a multi-dose therapy

Surgical treatments include ___ (a cut in the fallopian tube) and ___ (removal of the fallopian tube, typically after rupture has occurred) [can still get pregnant again if 1 tube has been removed]

  • Provide emotional support
A

Methotrexate

salpingostomy

salpingectomy

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17
Q

Which one?

The isthmic, ampular, interstitial, or fimbrial part of the fallopian tube is where there is most risk; the ovum is in a narrow spot and NOT the uterine lining

* Higher risk of tubal rupture

A

interstitial

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18
Q

Risk Factors for Ectopic Pregnancy

* History of STIs (because this leads to pelvic inflammation)

* History of pelvic inflammatory disease [PID] (issue with ovum being able to travel to uterus)

* History of previous ectopic pregnancy

* Failed tubal ligation

A

* Intrauterine device (IUD)

* Multiple induced abortions (therapeutic abortion, scar tissue formation)

* Maternal age > 35

* Use of assisted reproductive technologies

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19
Q

Gestational Trophoblastic Disease - Hydatidiform Mole

* As a result of abnormal cellular growth, the placenta develops but not the fetus

* Must be evacuated (via D&C)

  • Regular follow-ups are needed for one year to assess for malignant changes (choriocarcinoma - malignant changes of the residual trophoblastic tissue)
A
  • Provide emotional support
  • Surveillance for cancer
  • Can spread rapidly
  • Watch hCG level
  • Patient may need chemotherapy
20
Q

Also known as a “molar” pregnancy

Uterus can advance to the size of a pregnancy and produce hCG if untreated

Occurs in younger and older reproductive ages

Believed to be caused by sperm duplicating its own chromosomes; XXX or XXY

A
  • Fetus will not be compatible with life; anomalies present
  • Vaginal bleeding that is spotting to full on hemorrhage experienced
  • Uterus larger than expected
  • Excessive nausea and vomiting due to increased level of hCG
  • Early development of preeclampsia
21
Q

?

Implantation of the placenta into the lower uterus

  • Marginal
  • Partial
  • Complete/Total

* More common in older women, multiparas, women who have had cesarean births, and women who have had suction curettage for induced or spontaneous abortion

A

Placenta Previa

22
Q

Placenta Previa

  • Manifested by an onset of sudden, painless uterine bleeding in 2nd half of pregnancy

* Risk from cervical exams - confirm location of placenta

  • At risk of this in future pregnancies
A
23
Q

___ Placenta Previa

As cervical dilation occurs, begin to detach placenta

Can lead to hemorrhage from mother and baby

  • Lower border of placenta is within 3 cm of internal cervical os but does not fully cover it
A

Partial

24
Q

___ Placenta Previa

Placenta completely covers internal cervical os

Hemorrhage from mother and baby

A

Total

25
Q

___ Placenta Previa

Diagnosed at ~ 20 weeks with transvaginal US/anatomy scan

! Can go on to have a normal pregnancy and delivery

A

Marginal

26
Q

?

Separation of the normally implanted placenta before the fetus is born

Bleeding and/or the formation of a hematoma on the maternal side of the placenta

Accompanied by pain, uterine tenderness, and uterine hyperactivity

A

Abruptio Placentae

27
Q

Risk factors include: abdominal trauma (is why there is direction against going on rides if pregnant at parks); domestic violence, and autoimmune conditions

Symptoms - Abruptio Placentae

  • Vaginal bleeding
  • Abdominal and lower back pain
  • Firmness to the abdomen, a “hardboard”
  • Uterine irritability and tenderness
  • High uterine resting tone (only detected if an IUPC is in place)
  • A nonreassuring fetal HR
A
  • a Category III tracing
  • Mom at risk of developing symptoms of hypovolemic shock because of hemorrhage occurring and fetal death (clotting abnormalities like DIC)
  • Accounts for 10-15% of perinatal deaths
  • Occurs in less than 1% of pregnancies
28
Q
A
29
Q

During a marginal abruption with external bleeding, mother and baby’s blood is lost

During a complete abruption with concealed bleeding, no oxygen exchange is occurring

A

During a partial abruption with concealed bleeding, we don’t see bleeding out of the vagina

  • A hardboard abdomen, painful discomfort, and notice compromise on fetal HR monitors
30
Q

Signs & Symptoms of a Concealed Hemorrhage

* Increased fundal height (due to uterus filling with blood)

* Hard, board-like abdomen

* High uterine baseline tone on EFM ⇒ IUPC

* Persistent abdominal pain

A

* Tachycardia, falling BP, restlessness (also symptoms of hypovolemic shock)

* Persistent late decelerations in the fetal HR (could see a sinusoidal pattern)

* Vaginal bleeding can be slight or absent

31
Q

Signs & Symptoms of Impending Hypovolemic Shock

  • Increased pulse rate, falling BP, increased RR
  • Weak, diminished, or thready peripheral pulses
  • Cool, moist skin or pallor
  • Decreased urinary output [oliguria] (less than 30 mL/hour)
  • Decreased hemoglobin and hematocrit levels
  • Changes in mental status and level of consciousness
A
32
Q

___ ___

Persistent, uncontrollable vomiting that begins in the first weeks of pregnancy and may continue throughout

Common and worsens in each pregnancy

Give Zofran (ondansetron)

A

Hyperemesis Gravidarum (HG)

33
Q

Hyperemesis Gravidarum (HG) - Collaborative Management

  • Encourage good oral care
  • Ginger teas/ginger ale
  • Have saltine crackers before getting out of bed

* Maintain nutrition and fluid volume

  • IV fluids may be given; TPN in severe cases
  • Provide emotional support
  • Phenergan (promethazine) can cause drowsiness
A
34
Q

Hypertension During Pregnancy

* Gestational Hypertension

* Preeclampsia

* Eclampsia

* Chronic hypertension (preexisting)

A
35
Q

?

Blood pressure elevation after 20 weeks of pregnancy

NOT accompanied by proteinuria

May progress to preeclampsia or stay as is

If it persists more than 6 weeks after birth, chronic hypertension is diagnosed

* We should see that this resolves after delivery of the placenta

A

Gestational Hypertension

≥ 140 (systolic) or ≥ 90 (diastolic) over 2 readings

36
Q

Risk Factors for Pregnancy-Related Hypertension

* First pregnancy for both the mother and father (consider if woman has a new partner)

* Men who have fathered a prior preeclamptic pregnancy

* Age greater than 35 years

* Anemia

* Family or personal history of preeclampsia

* Chronic hypertension

A

* Chronic renal disease

* Obesity

* Diabetes

* Multifetal pregnancy

* Pregnancy from assisted reproductive technology

37
Q

?

Generalized vasospasm decreases circulation to all organs of the body, including the placenta

Manifestation

> Hypertension (___/___ or greater) WITH ___ ?

Management

> Activity restrictions, fetal monitoring, BP monitoring, weight measurements, urinalysis, sodium-free diet

A

Preeclampsia

140/90

proteinuria (in a 24 hour urine sample [most accurate] ratio > 0.3; in a single dipstick urine = 0.1)

38
Q

Preeclampsia

  • Occurs in 5-8% of US pregnancies annually
  • 1 of the major causes of perinatal death
  • Black Americans at a greater risk of and complications from due to systemic racism within the healthcare system
  • Black women are at a 3-4x higher rate of maternal death than white women
A

Preeclampsia - Risk Factors

  • Have chronic hypertension
  • Are overweight, obese, or have a history of diabetes
  • Most likely to occur in the 1st pregnancy
  • With a new partner
  • Happened in a prior pregnancy
  • Very young or older
  • In multifetal pregnancies
39
Q

Preeclampsia - Symptoms

  • Hyperreflexia
  • Alterations in bloodwork (liver, renal)
  • Headaches, vision changes, epigastric pain (under the right breast) [distended hepatic capsule]

> a sign that seizures may be imminent

  • Could have edema (hard to tell)

! Facial edema as a tell-tale sign (a “pig nose”)

A

Preeclampsia - Management cont’d

* Give magnesium sulfate

Can give rx’s like hydralazine, also nifedipine and labetalol

40
Q

?

Progression of preeclampsia to generalized seizures

Magnesium sulfate [a smooth muscle relaxer] is used to prevent seizures in preeclampsia

! Watch for respiratory depression

  • Monitor O2 sats, lung sounds, frequently check DTRs

> We could see hyporeflexia or absent reflexes

→ Indicates that a woman could experience respiratory depression

A

Eclampsia

41
Q

Interventions & Care for Seizures

  • Initiate preventative measures
    > Padding on side rails; low and locked bed position; place side-lying until seizure ends
  • Monitor for signs of impending seizure activity - note timing
  • Prevent seizure-related injury
  • Protect the woman during a seizure
  • Support the family
  • Monitor for S/S of magnesium toxicity (hyporeflexia or absent DTRs as well as S/S of respiratory depression)
A
42
Q

HELLP Syndrome

___, ___ ___ ___, and ___ ___

  • Presentation with severe pain in RUQ (at liver)

! Delivery helps treat this

  • Likely BP issues in the setting of preeclampsia and eclampsia
  • Bedrest (continuous monitoring of mom and baby)
  • Blood transfusions (treats anemia)
  • Corticosteroids (for fetal lung development) if only at PRETERM to help surfactant production
A

Hemolysis

Elevated Liver Enzymes

Low Platelets

43
Q

Hemolysis occurs as a result of the fragmentation and distortion of the erythrocytes during the passage through damaged blood vessels

A

Liver enzymes increase because hepatic blood flow gets obstructed by the fibrin deposits and low platelets are caused by vascular damage resulting from vasospasm

44
Q

?

Hypertension that precedes the pregnancy or developed at less than 20 weeks gestation

Increased risk for ___

Monitor closely for ___

Antihypertensive medications should be initiated if diastolic BP is higher than 100 mmHg

A

Chronic Hypertension

preeclampsia

proteinuria

45
Q

Incompatability Between Maternal and Fetal Blood

Rh Incompatability

Rh-negative woman conceives an Rh-positive baby (due to father being Rh+)

Maternal antibodies develop after exposure to fetal Rh-positive blood

Administration of ?

A

Rh<span>o</span>(D) Immunoglobulin (RhoGAM)

46
Q

ABO Incompatability

___ blood type woman with naturally occurring anti-A and anti-B antibodies

May result in ___ in the infant

A

O

hyperbilirubinemia

NUR 102 OB Assessment #2 (8 decks)

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