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Nurs 368 > Pregnancy Related Complications > Flashcards

Pregnancy Related Complications Flashcards

1
Q

What is the incidence of preterm birth in the US?

A

9.63%

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2
Q

What accounts for 75% of all infant mortality?

A

Prematurity

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3
Q

What are 3 reasons that preterm labor may occur?

A

spontaneous (70-80%), medically indicated (~25%)(preeclampsia, prolonged ROM, diabetes, IUGR, etc.), and non-medically indicated (elective inductions)

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4
Q

What are medically indicated reasons for preterm labor?

A

preeclampsia, prolonged ROM, diabetes, IUGR

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5
Q

What is a non-medically indicated reason for preterm labor?

A

elective inductions

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6
Q

What is the strongest indicator that a mother may go into preterm labor?

A

hx of preterm labor and delivery

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7
Q

What are some psychosocial factors that may increase the risk of preterm labor?

A

stress, substance abuse, domestic violence, lack of social support, age (<16 or >35), low socioeconomic status, or low educational level

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8
Q

What are some pathophysiological reasons that preterm labor may occur?

A

premature activation of the fetal or maternal HPA axis (the stress response), placental abruption, exaggerated inflammatory response/infection, pathological uterine distention

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9
Q

What are examples of exaggerated inflammatory response/infection?

A

UTI, abnormal vaginal flora, periodontal disease, chorioamnionitis

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10
Q

What is a decidual hemmorhage?

A

placental abruption

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11
Q

What are s/s of preterm labor?

A

menstrual-like cramping, pelvic pressure, intestinal cramping/diarrhea, low backache, change in/increase in vaginal discharge, cervical changes, a sense that something is not right

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12
Q

What assessments should be done if a mother is suspected to be in preterm labor?

A

cultures for infection, fetal fibronectin test, vaginal exam to check for cervical changes//ROM, EFM for ctx and FHR, ultrasound for cervical length

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13
Q

What is the normal cervical length?

A

25-35mm

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14
Q

What is the cervical length that is a strong positive predictive value of preterm labor?

A

<20mm

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15
Q

What is the cervical length that reliably excluded PTL?

A

> 30mm

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16
Q

What is a fetal fibronectin test used for?

A

to predict who will/will not deliver preterm

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17
Q

When is fetal fibronectin not found?

A

between 22-34 weeks

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18
Q

What is the fFN negative predictive value?

A

95%

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19
Q

Is a negative or a positive fFN value more predictive?

A

negative

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20
Q

What are newborn problems associated with prematurity?

A

respiratory problems, feeding problems, thermoregulation, necrotizing enterocolitis, hyperbilirubinemia, CNS damage- cerebral palsy, developmental delays, vision/hearing problems, sepsis, patent ductus arteriosus, intracranial bleeding

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21
Q

What is the first step that would be taken if a woman comes in at 30 weeks gestation saying that she is experiencing cramps?

A

SVE

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22
Q

What is a nurse’s role when managing preterm labor (less invasive)?

A

decreased activity/side-lying position, good hydration, I/O, empty bladder, monitor uterine activity and FHR, teaching!, and facilitating consultation with neonatal staff and tour of NICU

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23
Q

What is a nurse’s role when managing preterm labor (more invasive)?

A

IV fluids, antibiotics for women who are GBS positive or other infection, steroids, tocolytics, MgSO4, progesterone, low dose aspirin

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24
Q

What are the steroids that are commonly administered for preterm labor?

A

betamethasone/dexamethasone

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25
Q

What do steroids do when administered for PTL?

A

stimulates surfactant production in fetus to speed lung maturity

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26
Q

What are some examples of tocolytics used in PTL?

A

terbutaline (Brethine), Calcium channel blockers (Nifedipine), NSAIDS/Prostaglandin inhibitors (Indomethacin, Naproxen)

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27
Q

Why is MgSO4 given during PTL?

A

fetal neuroprotection as well as some tocolytic actions

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28
Q

Why would progesterone be given to a mom that is high risk for PTL?

A

preventative measure for PTL

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29
Q

Why would low dose aspirin be administered for a pregnant woman?

A

prevention for nulliparous women

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30
Q

What is the most common administration of terbutaline?

A

.25mg SQ Q4hours

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31
Q

What does terbutaline do? (MOA)

A

beta adrenergic agonist- causes relaxation of uterine smooth muscle

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32
Q

How can terbutaline be administered?

A

SQ, PO, or IV

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33
Q

What are the major side effects of terbutaline?

A

tachycardia, palpitations, nervousness, tremors, pulmonary edema (strict I/O)

34
Q

Has terbutaline been approved for tocolytic use by the FDA?

A

no

35
Q

What are actions that nurses should take when administering terbutaline?

A

check pulse before administration, check lung sounds (for fluid), monitor FHR, UCs, use infusion pump if giving IV, monitor I&Os!!

36
Q

What is a common dosing of nifedipine (procardia)?

A

10-20mg PO Q3-6H

37
Q

What is the MOA of Nifedipine?

A

Calcium channel blocker which leads to myometrial relaxation. Peripheral vasodilator

38
Q

What are the side effects of Nifedipine?

A

Hypotension, palpitations, flushing, HA, N/V

39
Q

What is the MOA of Magnesium Sulfate?

A

calcium antagonist that decreases uterine contractility

40
Q

What can magnesium sulfate be used for?

A

neuroprotective for fetal brain (can also be used in preeclampsia to prevent seizures and can be used to decrease uterine contractility)

41
Q

Can magnesium sulfate aid in bringing blood pressure down?

A

no

42
Q

How can MgSO4 be administered?

A

Typically given IV, but can be given IM

43
Q

What are a few common side effects of MgSO4?

A

respiratory depression, lethargy, weakness, N/V, DTR depression

44
Q

What is a common dosing of MgSO4?

A

loading dose of 4-6 grams (over 30 minutes), then continuous infusion (~2g/hr)

45
Q

When should MgSO4 be continued for 24 hours post-delivery?

A

when it is administered for PIH

46
Q

How long is MgSO4 given for PTL?

A

~48 hours

47
Q

What is the antidote/antagonist of MgSO4?

A

calcium gluconate

48
Q

Which drug should the nurse make sure is ordered and is at the bedside if MgSO4 has been ordered?

A

calcium gluconate

49
Q

How should magnesium sulfate always be administered?

A

an infusion pump

50
Q

What are important nursing actions when MgSO4 is adminstered?

A

check DTF, monitor VS, esp respiratory rate Q1-2hours, monitor Mg levels Q6H, monitor for s/s of toxicity, I&Os, fetal monitoring, breath sounds

51
Q

What should be assessed for toxicity of MgSO4?

A

resp depression, loss of DTRs, oliguria, SOB

52
Q

What are ways in which PTL can be prevented?

A

teach patients s/s of PTL, health behavior education, social services, identify community resources, identify risks, recognize limitations to risk screening

53
Q

When can the rubella vaccine be administered for a pregnant woman?

A

postpartum

54
Q

When is ROM considered a prolonged ROM?

A

ruptured for >24 hours before delivery

55
Q

What is considered Preterm ROM?

A

Occurring before 37 weeks gestation

56
Q

When is it considered premature rupture of membranes?

A

greater than or equal to 37 weeks gestation, but before the onset of labor at term

57
Q

What are predisposing factors for PROM?

A

multiple gestation, infection, Hx of PROM, polyhydramnios, abruption, insufficient cervix/short cervical length, trauma

58
Q

What are maternal risks related to infection of the amnion?

A

maternal/fetal tachycardia, maternal fever >100.4 degrees Fahrenheit, uterine tenderness, foul smelling vaginal discharge/leaking

59
Q

Neonatal risks associated with PROM

A

infection/sepsis, prematurity, RDS, Hypoxia (umbilical cord compression), prolapsed cord

60
Q

S/S of PROM

A

gush or slow steady leaking of fluid from the vagina

61
Q

What are three ways that PROM can be confirmed?

A

check pH of vaginal fluid with nitrazine paper, check ferning, or amnisure (most accurate)

62
Q

What can an ultrasound be used for if PROM is suspected?

A

Looking for decreased amniotic fluid

63
Q

What is the management for PROM and PPROM?

A

PROM- generally induction or C-section
PPROM- more complex depending on gestational age

64
Q

What can happen with dilation/effacement of the cervical os when there is an insufficient/incompetent cervix?

A

painless dilation/effacement without uterine contractions

65
Q

When does insufficient/incompetent cervix occur?

A

commonly in the second trimester

66
Q

What are predisposing factors for an incompetent cervix?

A

Hx of previous traumatic delivery, Multiple D&Cs, DES exposure, genetic factors or congenitally short cervix

67
Q

How many weeks is considered the soonest, ideally, for a delivery when there is a PROM?

A

34 weeks

68
Q

How can an incompetent cervix be managed in the least invasive/intensive manner?

A

emotional support, education, ultrasound to evaluate cervical length

69
Q

What are invasive ways in which an incompetent cervix can be managed?

A

prepare for cerclage and prepare for birth if ROM is present

70
Q

What are 4 categories of hypertension during pregnancy?

A

chronic/preexisting HTN, chronic/preexisting HTN with superimposed preeclampsia, gestational HTN, Preeclampsia

71
Q

What is HELLP syndrome?

A

hemolysis, elevated liver enzymes, low platelets

72
Q

What percentage of women with preeclampsia will progress to HELLP syndrome?

A

4-12%

73
Q

What happens in stage 1 of preeclampsia?

A

abnormal development of the placental vasculature early in pregnancy

74
Q

What happens in stage 2 of preeclampsia?

A

impaired placental perfusion/hypoxia/underperfusion of fetus, altered maternal systemic endothelial function causing HTN and other multisystem manifestations of the disease

75
Q

Why is preeclampsia so concerning?

A

it is a major cause of maternal/fetal/infant mortality and morbidity

76
Q

When would maternal spiral arteries develop abnormally and fetal trophoblast cell invasion occur?

A

stage 1 of preeclampsia

77
Q

What type of headaches will women with preeclampsia have?

A

headaches that are severe and do not go away with medicine

78
Q

What are the critical maternal organs that are affected by preeclampsia?

A

vasculature, brain, liver, and kidney

79
Q

S/S of severe preeclampsia

A

BP>160/110, proteinuria 2+ or greater, headache, visual disturbances, upper abdominal pain, oliguria, increased serum creatinine (>1.2), thrombocytopenia, elevated liver enzymes, fetal growth restriction, eclampsia

80
Q

What is eclampsia?

A

seizure activity in the presence of preeclampsia. Can occur during pregnancy, intrapartum, postpartum

81
Q

What is the first thing that a nurse should be doing if there is eclampsia?

A

call provider/get help!

Nurs 368 (20 decks)

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