Prelabor and Gestational Onset Flashcards
HEG
Hyperemesis Gravidarum
cause: somewhat unclear but more common in
- nulliparous women, adolescents, twins
- individuals w/ increased BMI, prior HEG, fam hx
- GTD
- if there are fetal abnormalities
Preeclampsia
new onset of HTN that is accompanied by proteinuria after 20wks EGA in previously normotensive woman
pregnancy-specific syndrome of reduced organ perfusion d/t vasospasm and endothelial activation and impact various body systems among other thoughts
Assessment findings: BP greater or equal 140/90 AND proteinuria greater than or equal to 1+
Resolve via delivery and mag sulfate to prevent seizures
Severe Preeclampsia
BP > 160/110 on two occasions at least 6 hrs apart AND 3+ proteinuria on tow samples OR symptoms
Eclampsia
seizure activity that occurs in the setting of preeclampsia (with no other cause for seizure)
Magnesium Sulfate
monitor urine output (>30ml/hr)
monitor DTR’s
therapeutic range = 5-7mg/dl
toxicity? give calcium gluconate (5-10meq over 5-10min)
Chronic HTN
BP is 140/90 or higher prior to pregnancy or before 20 wks gestations OR develops during pregnancy and persists for 12+ wks following childbirth
Gestational HTN or Pregnancy Induced HTN (PIH)
BP greater than or equal to 140/90 for the first time noted after 20 wks EGA without proteinuria
50% go on to develop preeclampsia
final dx made during PP period if pt never developed preeclampsia and BP return to normal by 12 wks PP
(doesn’t return to normal = chronic HTN)
PTL
cervical changes and uterine contractions occurring earlier than 37 completed wks in pregnancy
assessment findings: persistent uterine contractions (>6/hr), dilated to 3cm or more OR >80% effaced, positive fFN result
Tocolysis
medication used to stop labor for 24-48 hrs and get steroids on board to develop lungs
meds: terbutaline, mag sulfate, nifedipine, indocin
Miscarriage/SAB
occurs prior to 20wks or a fetus <500g
Ectopic Pregnancy
nonviable pregnancy
rf: prior tubal damage, prior ectopic, bilateral tubal ligation, assisted reproduction, PID, smoking, abdominal adhesions
monitor HCG, does not rise normally
GTD
gestational trophoblastic disease (molar pregnancy)
risk for woman = choriocarcinoma with complete molar pregnancy (often fatal/metastatic)
assessment: vaginal bleeding, markedly elevated HCG (w/ increased HEG because of this), uterine enlargement greater than expected, absence of fetal heart sounds
Incompetent Cervix
painless dilation of cervix w/o contractions b/c of a structural or functional defect of the cervix
Placental Abruption
premature separation of normally implanted placenta
rf: HTN disorder, abdominal trauma, cocaine
assessment findings: severe sudden onset of intense abd pain, Kleihauer Betke test (blook test on mom to evaluate if there is mixing of maternal and fetal blood)
Placenta Accreta
abnormality of implantation defined by degree of invasion into the uterine wall, can be dx antepartally but typically dx after delivery with retained placenta
placenta should separate w/in 30min of delivery
