Pregnancy w/ Complications Flashcards
def abortion
-fetus < 20 wks gest
or
-fetus weighing < 500 grams
- that is not viable
what does SAB stand for
spontaneous abortion
when does SAB usually occur
within first 12 weeks
risk of SAB increases w/ _______ ________
paternal age
what is the most common cause of SAB’s
severe congenital anomalies
other causes of SAB’s
low progesterone levels
fibroids
scar tissue
after a woman experiences her first SAB, when can she try getting pregnant again
- wait a couple (3) months
- get back on normal menstrual cycle
- try getting pregnant again within a few months afterward
if a woman experiences more than 2 or 3 SAB’s, what is the protocol?
- fertility testing
- genetic testing
- testing on the tissues of conception
what is the difference bx threatened abortion and inevitable/imminent abortion?
- threatened abortion may have cramps, small amt of fluid/blood leakage
how do HCP’s know if mom is losing the pregnancy?
HCG goes down
if a woman experiences a missed abortion, they are ta high risk for
- DIC with retained POC (products of conception)
def recurrent SAB’s
3 or more consecutive SAB’s
what can cause recurrent SAB’s
- genetic/ chromosomal abnormalities
- anomalies of the female rep tract
- insuff progesterone
- immunologic factors - Rh factor, immunosuppression
- cervical incompetence
what do nurses asses for in the woman who experienced an SAB?
hypovolemia
what do HCP’s ask woman to do after experiencing an SAB?
save all POC’s
def ectopic pregnancy
implantation of fertilized ovum in a site other than the endometrial lining of the uterus
possible causes of ectopic pregnancies
- PID
- STI’s/ STD’s
- build up of scar tissue
- IUD’s
T/F- ectopic pregancy is always an emergency
true
why us an ectopic pregnancy an emergency
high risk of rupture
s/s of ectopic preg
- sharp, one sided pain
- syncope
- referred shoulder pain
- lower abdominal pain
- scant dark/reddish brown vaginal spotting
how is ectopic preg dx’d
- US
- LMP
- low hcg levels
medical mgmt of ectopic preg
- methotrexate
- Salpingostomy via lap
- salpingostomy
under what conditions can methotrexate be used to terminate an ectopic pregancy
- unruptured tube
- embryo < 3.5 cm in size
- stable maternal conditions
- no fetal cardiac motion
how does methotrexate terminate an ectopic pregnancy
- stops the growth of fetal cells
admin of methotrexate
- given IM
- may be given up to 2 times
what is considered a good outcome of termination of ectopic preg
- removal of the embryo without removing the tube
what is considered a bad outcome of termination of ectopic pregnancy
- if you have to remove the tube with the embryo
- loss of tube through rupture
Gestational Trophoblastic Disease is also known as________ __________
Molar Pregnancy
what is Molar preg caused by
abnormal trophoblastic cells
def complete hydatidiform mole
no fetus present
def partial hydatidiform mole
presence of fetal tissue/membranes
Molar pregnancy etiology
- sperm and egg meet and travel down uterus
- cells start growing and multiplying
- uncontrolled multiplication of cells
which molar pregnancy is considered viable?
- none
- both complete and partial are non viable pregnancies
women who have had a Molar pregnancy are at a high risk of developing
choriocarcinoma
dx of Molar pregnancy
- vaginal bleeding: dk brown spotting to perfuse hemorrhaging
- US
- passing of hydropic vessels (grape-like clusters)
- uterine enlargement greater than expected for gest age
- absence of fetal heart sounds
- ELEVATED HCG!!!!!
- excessive N/V
- elevated BP
Molar pregnancies are more common among which women?
- teens
- women over 40
- women who have taken Clomid
Medical tx of Molar pregnancy
- D&C
- possible hysterectomy if invasive
- * Careful Follow Up*
- serial HCG’s for the next year
- chemo for choriocarcinoma
nursing care of woman who experienced a Molar Pregnancy
- monitor VS and vaginal bleeding
- assess abdominal pain
- assess emotional state and coping ability
- convey the importance of adhering to follow up care!!!
def placenta previa
placenta is improperly implanted in the lower uterine segment
classification of placenta previa
marginal
partial
total
marginal placenta previa
placenta just at the edge of the opening
partial placenta previa
placenta partially in the opening
total placenta previa
placenta completely covers entire cervix
what is the hallmark sign of placenta previa
painless bleeding after 20 weeks
s/s of placenta previa
- sudden onset of painless bleeding after 20 weeks of gestation
- scanty or profuse bleeding
placenta previa pts are at high risk for
- bleeding
- infec
how will placenta previa patients be birthed?
c sec
def abruptio placenta
premature separation of a normally implanted placenta from the uterine wall
maternal risk factors a/w abruptio placenta
bleeding
shock
hypovolemia
death
fetal risk factors a/w abruptio placenta
- hypoxia
- neuro deficits- CP
- pre term
what can cause abruptio placenta
* cocaine abuse*
maternal HTN
abdominal trauma- fall, MVA
T/F- women who have had an abruptio placenta are not at an incr risk for a recurrences for their next pregnancies
false- they are at an incr risk
s/s of abruptio placenta
vaginal bleeding pain uterine tenderness, irritability, high resting tone port wine colored amniotic fluid uterine contractions decr fetal activity fetal demise
what is the focus of med mgmt for abruptio placenta
- CV status of the mother
- status of the fetus
nursing care for abruptio placenta
- assess amt and nature of bleeding
- assess and manage pain
- monitor maternal VS
- monitor status of fetus
- assess uterine contractions
- collect OB hx and length of gestation
- obtaining lab data
- assessing and providing psychosocial support
early s/s of hypovolemic shock
low bp
tachycardia
decr urinary output
late s/s of hypovolemic shock
bradycardia
renal failure
low bp
multisystem organ failure
medical mgmt of hypovolemic shock
monitor fetus
promote tissue oxygenation
fluid replacement
def placenta accreta
the chorionic villi attach directly to the myometrium of the uterus
def placenta increta
- the myometrium is invaded
- the placenta is growing into the wall of the uterus
def placenta percreta
- the myometrium is penetrated
- the placenta grows through the wall of the uterus and into the abdominal cavity
primary complications of placenta accreta
maternal hemorrhage
failure of placenta to separate following birth
how is placenta accreta diagnosed and what is the problem with diagnosis
- dx by US
- can easily be missed if slight
def Gest HTN
- syst bp >140
- diast bp >90
- after 20 wks of preg with BO returning to normal within 6 wks post partum
are all hypertensive mothers considered high risk
yes
risk factors for developing GHTN
obese
less than 20 yrs
over than 40 yrs
diabetic mother
def pre-eclampsia
- syst bp >140/ diast bp >90 after 20 wks gestation
- accompanied by proteinuria (>0.3 g in 24 h urine)
if a woman is dx’d w/ pre-eclampsia, what may be the protocol for her care
-mom may be admitted to antepartum for the remainder of her preg
def eclampsia
the progression of pre-eclampsia to generalized seizures
def chronic HTN
- elevated BP before preg or development of HTN before 20 wks of gestation
what lab levels should be monitored closely for women w/ HTN/ pre-eclampsia?
sodium
pre-eclampsia pathophys
- maternal vasospasm affecting every organ
- incr PVR
- decr perfusion to almost all organs
prevention of GHTN
- low dose ASA
- calcium
- magnesium
- fish oil supplements
in-pt mgmt for pre-eclampsia: bed rest
quiet room limit visitors/stressful visitors keep light low strict I/O's & daily weights monitor lungs, inc spir, teds monitor liver enzymes fetal monitor once 2 h or twice per shift
name 2 anticonv meds
mag sulfate
hydralazine (apresoline)
action of mag sulfate
prevents and treats convulsions caused by pre-eclampsia
loading dose of mag sulfate
4-6 grams in 100 cc IVPB
what is the goal of mgmt for pts on mag sulfate?
keep pt on ther level
what is the ther range for mag sulfate
serum level should be bx 4-7.5 meq’s
major adverse rxns to mag sulfate
***CNS Depressant*** decr DTR's nausea/ vomitting weakness dizziness slurred speech
what is the antidote for mag sulfate?
calcium gluconate
how long does mom need to be on mag sulfate after they deliver
24 hrs
what must be closely monitored and how often
- BP and VS
- Q Hr!!!!
what is the med of choice for the tx of HTN during preg?
hydralazine
other meds used to treat GHTN
phenytoin
diazepam
s/s of HELLP
-sudden weight gain
-HTN
-edema in the upper extremilites more than in the lower extremities
- hemolysis—> anemia and jaundice
- elevated Liver enzymes
epigastric pain
NV
-Low platelets
thrombocytopenia
abnormal bleeding and clotting time
petechiae
if mom is dx’d w/ HELLP, what are the delivery options
-mom may have to deliver baby early
def hypertonic labor
-ineffective uterine contractions
when does hypertonic labor occur
in the latent phase of labor
hypertonic labor pathophys
contractions become more frequent
intensity increases—> incr pain and prolonged labor
medical mgmt of hypertonic labor
bed rest
sedation
pitocin
amniotomy
def precipitous labor
labor lasting more than 3 hrs
what are the risks a/w precipitous labor
laceration from rapid descent
accelerated cervical dilation
nursing dx r/t precipitous labor
risk for injury r/t rapid labor and birth
acute pain r/t rapid labor
def prolonged pregnancy
a preg lasting more than 42 weeks
maternal risks a/w prolonged pregnancy
incr risk for induction LGA infant surgical delivery use of forceps/vaccuum psyhological stress infec
infant risks a/w prolonged pregnancy
decr placental perfusion oligohydramnios--> incr risk for: -cord compression - meconium aspiration - low apgar
nursing dx r/t prolonged preg
- fear r/t unknown outcome of baby
- ineffective individual coping r/t anxiety abt status of baby
when there is a mo with a prolonged preg, how often is a biophys done?
q 24-48 hrs
when is external version used
for breech or shoulder presentation
when is external version performed
- at 36 wks following:
- US
- NST
why is US and NST done prior to external version
to eval fetal well being and confirm fetal/placental position
when can an external version not be performed?
if the presenting part is engaged
what med is admin before external version is performed and why
tocolytics
- relax the uterus
regional anesthesia
name an example of a tocolytic
terbutaline
when is an external version abruptly stopped
- fetal decels
- fetal bradycardia
nursing mgmt during an external version
VS NST FHR monitoring IVF comfort post procedure fetal and maternal monitoring
def amniotomy
AROM
when is an amniotomy done
@ 2 cm or >
indications for amniotomy
shorten/augment labor
manipulate hormone release–> stim cxn
apply IUPC and/or fetal scalp electrode
what are the risks a/w amniotomy
cord prolapse
medical mgmt during amniotomy
FHR decr vaginal exams temps q 2 h comfort hygeine
ways to induce labor
-AROM pitocin intercourse nipple stim mechanical dilation- foley herbs enemas castor oil evening primrose @ 36 wks to soften cervix
nursing role during induction of labor
VS EFM NST FHR Pain mgmt
