Risk Conditions Related to Pregnancy

Question 1

Bleeding during pregnancy

Answer 1

Implantation bleeding: occurs 10 to 14 days after conception. Usually lasts 1 to 2 days and is lighter than the typical menstrual period (often confused). No treatment necessary.
Other causes: abortion, malignancy, polyps, trauma, ectopic pregnancy, idiopathic, infection, molar pregnancy, subchorionic hemorrhage, vaginitis, UTI, cervicitis, postcoital bleeding, placenta previa, and abruptio placentae.

Question 2

Abortion: definition, risk factors and assessment

Answer 2

• pregnancy that ends before 20 weeks (spontaneous or elective)
• Risk factors: advanced maternal age, previous miscarriage, previous elective abortion, uterine abnormalities, prolonged time to achieve pregnancy, low serum progesterone, celiac disease, polycystic ovarian syndrome, thyroid dysfunction or Cushing’s, lupus, infection, fever, trauma, low BMI, smoking, alcohol, cocaine use, certain meds, high caffeine intake.
• Assessment: spontaneous vaginal bleeding, low uterine cramping or contractions, blood clots or tissue through the vagina, hemorrhage and shock can result if bleeding is excessive.

Question 3

Abortion: Types and interventions

Answer 3

• Miscarriage: natural causes
• Induced: therapeutic or elective reasons exist for terminating.
• Threatened: spotting and cramping occur without cervical change.
• Inevitable: spotting and cramping occur and cervix begins to dilate and efface.
• Incomplete: loss of some of the products of conception (most often placenta is retained).
• Complete: loss of all products of conception.
• Missed: products are retained in utero after fetal death.
• Habitual: miscarriages occur in 3 or more successive pregnancies.
  Interventions: bed rest as prescribed, monitor vital signs, cramping and bleeding. Count perineal pads to evaluate blood loss and save expelled tissues and clots. IV fluids as prescribed. Prepare client for dilation and curettage. Adm RH0 immune globulin as prescribed for Rh-neg woman. Provide psychological support.

Question 4

Cardiac Disease: description, assessment and interventions

Answer 4

A pregnant client with cardiac disease may be unable physiologically to cope with the added plasma volume and increased cardiac output (blood volume peakes at weeks 32-34)

• Assessment: cough and respiratory congestion, dyspnea and fatigue, palpitations and tachycardia, peripheral edema, chest pain.
• Interventions: monitor vital signs, FHR and condition, cardiac stress and decompensation. Limit physical activities, encourage adequate nutrition (to prevent anemia) and low-sodium diet may be prescribed to prevent fluid retention and heart failure. Avoid excessive weight gain.
• During labor: monitor client and fetal, maintain bed rest, with client lying on her side with her head and shoulders elevated. Adm oxygen as prescribed, manage pain early, and use controlled push efforts.

Question 5

Chorioamnionitis: description, assessment, and intervention.

Answer 5

• Bacterial infection, of the amniotic cavity, can result from premature or prolonged rupture of the membranes, vaginitis, amniocentesis, or intrauterine procedures. May result in the development of postpartum endometritis and neonatal sepsis.
• Assessment: uterine tenderness and contractions, elevated temperature, maternal or fetal tachycardia, foul odor to amniotic fluid, leucocytosis.
• Interventions: Monitor maternal VS and FHR, results of blood cultures, adm antibiotics and oxytocic meds as prescribed. Prepare to obtain neonatal cultures after birth.

Question 6

Diabetes Mellitus

Answer 6

• Pregnancy places demands for carbohydrates metabolism and causes insulin requirements to change.
• Insulin resistance and hyperinsulinemia may predispose some women to diabetes.
• Maternal glucose crosses the placenta, but insulin does not. The fetus produces its own and pulls glucose from the mother, which predisposes the mother to hypoglycemic reactions.
• Newborn of a diabetic mother may be large in size and is at risk for hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, hypocalcemia, and congenital anomalies.
• During the first trimester, maternal insulin needs decrease. During second and third trimester, increases in placental hormones cause an insulin-resistant state, requiring an increase in the client’s insulin dose.

Question 7

Gestational Diabetes Mellitus

Answer 7

• occurs during the second or third trimester when the pancreas cannot respond to the demand for more insulin.
• should be screened between 24 and 28 weeks.
• frequently can be treated by diet alone, however some clients may need insulin.
• most women return to a euglycemic state after birth, but there is a increased risk for developing DM in their lifetimes.
• the need for a cesarean section is more likely, and neonatal hypoglycemia and macrosomia may be evident.
• Overt diabetes occurs in the first trimester.

Question 8

Gestational Diabetes Mellitus: Risk Factors

Answer 8

• older than 35, obesity (BMI > 30), nonwhite race, previous unexplained perinatal loss, previous child born with congenital anomalies, polycystic ovarian syndrome, multiple gestation, first degree relative with DM or GDM, previous delivery of a fetur weighing greater than 9lb, maternal birth weight less than 6lb or greater than 9lb, previous pregnancy with GDM, glycosuria, essential or pregnancy-related hypertension, use of glucocorticoids.

Question 9

Gestational Diabetes Mellitus: Assessment

Answer 9

• Excessive thirst, hunger, weight loss, frequent urination, blurred vision, recurrent urinary tract infections and vaginal yeast infections, glycosuria and ketonuria, signs of gestational hypertension and preeclampsia, polyhydramnios, large for gestational age fetus.

Question 10

Gestational Diabetes Mellitus: Interventions

Answer 10

• Employ diet, meds, exercise, and blood glucose determination 4 times daily to maintain <95 (fasting), <130-140 (1h post-prandial), < 120 (2h post-prandial)
• Observe for signs of infection, hyperglycemia, glycosuria, ketonuria and hypoglycemia.
• Monitor weight and calorie intake.
• Assess for complications such as preeclampsia, fetal status.
• Schedule visits every 2 weeks until 36 weeks and then every week from 36 weeks and up.
• During birth: monitor for signs of fetal distress and prepare for c-section. Regulate insulin and provide glucose IV as prescribed because labor depletes glycogen.
• After birth: Observe for hypoglycemic reaction of the mother because a decline in insulin normally occurs. Reregulate insulin needs as prescribed. Assess dietary needs based on blood glucose. Monitor for signs of infection or postpartum hemorrhage.

Question 11

Disseminated intravascular Coagulation (DIC)

Answer 11

• A maternal condition in which the clotting cascade is activated, resulting in the formation of clots in the microcirculation.
• Predisposing conditions: abruptio placentae, amniotic fluid embolism, gestational hypertension, HELLP syndrome, intrauterine fetal death, liver disease, sepsis, severe postpartum hemorrhage and blood loss.
• Assessment: uncontrolled bleeding, bruising, purpura, petechiae, and ecchymosis, presence of occult blood in excretions, hematuria, hematemesis, signs of shock, decreased fibrinogen level, platelet count, and hematocrit level. Increased prothrombin time, clotting time, and fibrin degradation products.
• Interventions: remove underlying cause, monitor VS, assess for bleeding and shock. Prepare for oxygen therapy, volume replacement, and possibly heparin therapy. Monitor for complications, urine output (maintain at least 30ml/h).

Question 12

Ectopic Pregnancy

Answer 12

• Implantation of the fertilized ovum outside of the uterine cavity.
• Sites: Ampullar, Fimbrial, Isthmic, Intertitial
• Assessment: missed menstrual period, abdominal pain, vaginal spotting to bleeding that is dark red or brown. If rupture > increased pain, referred shoulder pain, signs of shock.
• Intervention: obtain assessment data and VS, monitor bleeding and initiate measures to prevent rupture and shock. Methotrexate, a folic acid antagonist, may be prescribed to inhibit cell division in the developing embryo. Prepare for laparotomy. Adm Rh0 if Rh- women.

Question 13

Fetal death in utero

Answer 13

• refers to the death of a fetus after the 20th week and before birth.
• Can develop DIC if the fetus is retained for more than 3 weeks.
• Assessment: absence of fetal movement, heart tones, maternal weight loss, lack of fetal growth, decrease in fundal height.
• Interventions: prepare for birth of fetus, provide support, accept behaviors, refer to support group.

Question 14

Hepatitis B

Answer 14

• Risk of prematurity, low birth weight, and neonatal death. Transmitted through blood, saliva, vaginal secretions, semen, breast milk, and across the placental barrier.
• Interventions: limit the number of vaginal examinations, suction fluids and remove maternal blood immediately after birth. Bathe before any invasive procedure, clean and dry the face before instilling eye prophylaxis. Adm HepB immune globulin and vaccine soon after birth, after bath.

Question 15

Hematoma

Answer 15

• Occurs following the escape of blood into the maternal tissue after birth. Predisposing condition include operative delivery with forceps or injury to a blood vessel.
• Assessment: abnormal, severe pain. Pressure in the perineal area, palpable sensitive swelling with discolored skin. Inability to void, decreased hemoglobin and hematocrit levels. Signs of shock.
• Interventions: Monitor VS, apply ice, adm analgesics, monitor intake and output, encourage fluids and voiding (prepare for catheterization if necessary). Adm blood and antibiotics as prescribed, monitor for signs of infection. Prepare for incision and evacuation of the hematoma.

Question 16

HIV and AIDS

Answer 16

• Women infected with HIV may first show signs and symptoms at the time of pregnancy or possibly develop life-threatening infections because normal pregnancy involves some suppression of the maternal immune system.
• 3-drug combination HAART treatment is recommended to reduce mother-to-child transmission. Zidovudine is recommended and adm based on the following:
  = antepartum: orally beginning after 12 weeks of gestation, maternal HAART is given to reduce the viral load to undetectable.
  = intrapartum: IV during labor, zidovudine is given 1h before vaginal birth and 3h before c-section if the HIV RNA is greater than 400 copies/ml or unknown, if less may not be required. Vaginal birth is acceptable if less than 1000 copies/ml.
  = postpartum: in the form of syrup to the newborn 2h after birth and every 12h for 6 weeks. May be placed in ICU. Avoid adm of oxytocin and place pads under the hips to absorb blood and fluids. Minimize neonate’s exposure.
• Prenatal exposure of an infant to infected secretions through birth or breast feeding is a form of transmission.
• A mother with HIV is considered high risk because she is vulnerable to infections.

Question 17

Hydatidiform Mole: Description

Answer 17

• is a form of gestational trophoblastic disease that occurs when the trophoblasts, which are the peripheral cells that attach the fertilized ovum to the uterine wall, develop abnormally.
• the mole manifests as an edematous grape-like cluster that may be nonmalignant or may develop into choriocarcinoma.

Question 18

Hydatidiform Mole: Assessment

Answer 18

• fetal heart rate not detectable.
• vaginal bleeding, which may occur by the fourth week or not until the second trimester; may be bright red or dark brown and may be slight, profuse, or intermittent.
• signs of preeclampsia before the 20th week.
• fundal height greater than expected.
• elevated human chorionic gonadotropin levels.
• characteristic snowstorm pattern shown on US.

Question 19

Hydatidiform Mole: Interventions

Answer 19

• diagnostic tests are done to detect metastatic disease.
• prepare the client for uterine evacuation, which is done by vacuum aspiration and oxytocin may be adm after to contract the uterus.
• monitor for post-procedure hemorrhage and infection.
• tissue is sent to lab for evaluation.
• human chorionic gonadotropin levels are monitored every 1 to 2 weeks until normal levels are attained. Levels are checked every 1 to 2 months for 1 year.
• Instruct client and partner to prevent pregnancy during 1 year.

Question 20

Hyperemesis Gravidarum

Answer 20

• Intractable nausea and vomiting during the first trimester that causes disturbances in nutrition and fluid and electrolyte balance.
• assessment: nausea, persistent vomiting, weight loss, signs of dehydration, fluid and electrolyte imbalances.
• interventions: medication therapy and if unsuccessful, IV adm fluid and electrolyte imbalances or parental nutrition. Monitor VS, intake and output, weight, calorie count, lab data, urine for ketones, FHR, activity, and growth. Encourage intake of small portions, liquids between meals, and sit upright after meals.

Question 21

Hypertensive Disorders of Pregnancy: Description

Answer 21

• Four major categories: preeclampsia, chronic/preexisting hypertension, chronic hypertension with superimposed preeclampsia, and gestational hypertension.
• BP elevations can lead to preeclampsia and eclampsia (seizures).
• Women who have had preeclampsia, speacially those who delivered preterm, have an increased risk later in life of cardiovascular disease and kidney disease, including heart attack, stroke, and high blood pressure.

Question 22

Gestational Hypertensive Disorders: Types

Answer 22

• Chronic hypertension: present before pregnancy or that occurs in the first half (before 20 weeks).
• Gestational hypertension: BP elevation that first occurs in the second half (after 20 weeks). Usually resolves after childbirth, but it may increase the risk of developing hypertension in the future.
• Preeclampsia: usually occurs after 20 weeks, typically third trimester. When before 32 weeks (called early-onset). It can also occur in the postpartum period.
• Eclampsia: Seizures occurring in pregnancy and linked to high blood pressure.

Question 23

Hypertensive Disorders of Pregnancy: Assessment

Answer 23

=! Proteinuria is not a reliable indicator of preeclampsia. Evidence demonstrates that kidney or liver dysfunctions can occur without signs of protein, and that the amount of protein in the urine does not predict how severely the disease will progress.
- persistent hypertension, swelling of the face and hands, headache, changes in eyesight, pain the upper abdomen or shoulder, nausea and vomiting (in the second half), sudden weight gain, difficulty breathing.

Question 24

Hypertensive Disorders of Pregnancy: Risk factors

Answer 24

• previous preeclampsia or gestational hypertension, previous placental abruption, or fetal demise. Primigravida, family history of first-degree relative with preeclampsia, woman who are 40 years or older. African american, woman who are carrying more than one fetus. History of chronic hypertension, kidney disease or both. Medical conditions such as connective tissue disease, DM, thrombophilia, or lupus erythematosus. BMI greater than 26. Metabolic syndrome, muiltifetal pregnancy, hydatidiform mole, hydrops fetalis, unexplained intrauterine growth retardation. Women who had in vitro fertilization.

Question 25

Hypertensive Disorders of Pregnancy: Complications of hypertension and gestational hypertension disorders

Answer 25

• abruptio placentae, disseminated intravascular coagulopathy, fetal growth restriction, preeclampsia and eclampsia, intracranial hemorrhage, maternal cerebral hemorrhage or infarction. Subcapsular hapatic hematoma, HELLP syndrome, oligohydramnios, placental insufficiency, the need for preterm delivery or c-section, maternal and/or fetal death.

Question 26

Hypertensive Disorders of Pregnancy: Interventions

Answer 26

• BP and weight monitoring
• weekly or twice weekly health care visits, and delivery may be recommended at 37 weeks.
• monitor fetal activity and growth
• encourage frequent rest periods (in lateral position)
• adm meds to reduce BP as prescribed
• provide adequate fluids, monitor intake and output (30ml/h) and evaluate renal function with blood urea nitrogen and creatinine, and 24h urine levels for creatinine clearance and protein.
• monitor neurological status, deep tendon reflexes (presence of hyperreflexia or clonus indicates CNS irritability)
• monitor for HELLP syndrome.
• Mg sulfate may be prescribed to prevent seizures and may be continued for 24-48h postpartum (monitor for toxicity and keep antidote calcium gluconate available).
• corticosteroids may be prescribed to promote fetal lung maturity.

Question 27

HELLP syndrome

Answer 27

• Stands for: Hemolysis, Elevated Liver enzymes, Low Platelet count.
• In this condition, red blood cells are damaged or destroyed, blood clotting is impaired, and the liver can bleed internally, causing chest or abdominal pain.
• Is a medical emergency, woman can die or have lifelong problems as a result.

Question 28

Preeclampsia Assessment

Answer 28

• BP >= 140mmHg or >= 90mmHg on 2 occasions at least 4hrs apart after 20 weeks of gestation.
• Proteinuria <= to 0.3g in 24h, <= to 1+ on dipstick, may be normal.
• Reflexes: may be normal
• Changes in mentation: transient or absent
• Placental perfusion: somewhat reduced
• Creatinine: may be normal
• protein/creatinine ratio: 0.3mg/dl (>22.89mcmol/L)
• Platelets: may be decreased.
• Liver enzymes: normal or minimal increase levels
• Uric acid: may be normal
• Urine output: normal
• Visual disturbances: absent to minimal
• pulmonary edema, heart failure, cyanosis: absent
• normal growth.

Question 29

Preeclampsia with Severe Features: Assessment

Answer 29

• Persistent elevation >= 160 or >= 110 on 2 occasions at least 4h apart while on bedrest.
• Proteinuria <= to 5g in 24h, <= to 3+ on dipstick 2 times.
• Reflexes: hyperreflexia
• Changes in mentation: may be present
• Placental perfusion: decreased with possible abnormal FHR.
• Creatinine: elevated (>1.0mg/dl [>76.3mcmol/L])
• protein/creatinine ratio: > 0.3mg/dl (>22.89mcmol/L)
• Platelets: decreased (<100,000 mm3)
• Liver enzymes: elevated levels (double or greater)
• Uric acid: >5.5mg/dl (330mcmol/L)
• Urine output: Oliguria common, often <500ml/day.
• Severe headache, mental confusion: often present, persistent.
• Visual disturbances: common
• pulmonary edema, heart failure, cyanosis: may be present.
• Fetal growth restriction; reduced amniotic fluid volume.

Question 30

Eclampsia: Assessment and Interventions

Answer 30

• Characterized by generalized seizures.
• Remain with the client and call for help
• ensure an open airway, turn the client on her side, and adm oxygen by face mask at 8-10L/min.
• monitor FHR patterns
• Adm medications to control the seizures as prescribed
• after the seizure, insert an oral airway and suction the client’s mouth as needed.
• prepare for delivery of the fetus after stabilization of the client
• document occurrence, client’s response, and outcome.

Question 31

Incompetent Cervix: Description, Assessment, and Intervention

Answer 31

• Refers to a premature dilation of the cervix, which occurs most often in the fourth or fifth month of pregnancy and is associated with structural or functional defects of the cervix.
• Assessment: vaginal bleeding and fetal membranes visible through the cervix.
• Interventions: provide bed rest, hydration, and tocolysis (as prescribed), to inhibit contractions. Prepare for cervical cerclage (at 10-14 weeks as prescribed), in which a band of fascia or nonabsorbable ribbon is placed around the cervix beneath the mucosa to constrict the internal os. After, client is told to refrain from intercourse and to avoid prolonged standing and heavy lifting. The cerclage is removed at 37 weeks or left in place for c-section. (if removed, needs to be done for every pregnancy after). After placement, monitor for contractions, rupture of the membranes and signs of infection. Instruct client to report postprocedure bleeding or contractions.

Question 32

Infections (TORCH complex acronym)

Answer 32

Toxoplasmosis
Other infections (HIV, Syphilis, Parvovirus, HepB, West Nile, etc.)
Rubella (german measles)
Cytomegalovirus
Herpes simplex virus

Question 33

Toxoplasmosis

Answer 33

• infection with the intracellular protozoan parasite Toxoplasma gondii.
• produces a rash and symptoms of acute, flu-like infection.
• transmitted through ingestion of raw meat or handling of cat litter of infected cats.
• transmitted across the placenta.
• can cause miscarriage in the first trimester.

Question 34

Rubella

Answer 34

• teratogenic in the first trimester.
• transmitted to the fetus across the placenta
• causes congenital defects of the eyes, heart, ears, and brain.
• blood titer studies will be done and if not immune (<1:8), client should be vaccinated postpartum (wait 3 months to get pregnant).

Question 35

Cytomegalovirus

Answer 35

• transmitted through close personal contact, it crosses the placenta, and also may be infected in the birth canal.
• mother may be asymptomatic and most infants are too at birth.
• causes low birth weight, intrauterine growth restriction, enlarged liver and spleen, jaundice, blindness, hearing loss, and seizures.
• antiviral meds may need to be prescribed for severe infections in the mother (meds are toxic).
• maintain contact precautions.

Question 36

Herpes Simplex Virus

Answer 36

• affects external genitalia, vagina, and cervix.
• causes draining, painful vesicles.
• Acyclovir may be prescribed during pregnancy or used as suppressive therapy late in pregnancy to prevent an outbreak during labor and birth.
• usually transmitted during birth through infected vagina.
• no examinations are done in the presence of active lesions.
• can cause death or severe neurological impairment in the newborn.
• usually done by cesarean section if lesions present in the vagina.
• maintain contact precautions.

Question 37

Group B Streptococcus (GBS) - may be included as an “O”

Answer 37

• is a leading cause of life-threatening perinatal infections.
• gram-positive bacterium colonizes the rectum, vagina, cervix, and urethra of pregnant and nonpregnant women.
• meningitis, fasciitis, and intraabdominal abscess can occur in the pregnant client if she is infected at the time of birth.
• transmission occurs through vaginal delivery.
• early onset newborn GBS occurs within the first week after birth, usually within 48h, and can include infections such as sepsis, pneumonia, or meningitis (permanent neurological disability can result).
• diagnosis of the mother is done via vaginal and rectal cultures at 35 to 37 weeks.
• antibiotics may be prescribed for the mother during labor and birth; IV ATB may be prescribed for infected infants.
• maintain contact precautions.

Question 38

Multiple gestation

Answer 38

• results from fertilization of 2 ova (fraternal or dizygotic) or a spliting of 1 fertilized ovum (identical or monozygotic).
• complications include: miscarriage, anemia, congenital anomalies, hyperemesis, intrauterine growth restriction, gestational hypertension, polyhydramnios, postpartum hemorrhage, premature rupture of membranes, and preterm labor and delivery.
• assessment: excessive large activity, uterus large for gestational age, palpation of 3 or 4 large parts, auscultation of more than 1 FHR, excessive weight gain.
• Interventions: monitor anemia, preterm labor, prepare for c-section if abnormal presentation, and adm oxytocin as prescribed to prevent postpartum hemorrhage from uterine overdistension.

Question 39

Placental abnormalities: accreta, increta, and percreta

Answer 39

• accreta: an abnormally adherent placenta.
• increta: occurs when the placenta penetrates the uterine muscle iself.
• percreta: occurs when the placenta goes all the way through the uterus.
• May cause hemorrhage immediately after birth because the placenta does not separate easily.
• Monitor for hemorrhage and shock.
• Prepare the client for hysterectomy if a large portion of the placenta is abnormally adherent.

Question 40

Placenta Previa

Answer 40

• is an improperly implanted placenta in the lower uterine segment near or over the internal cervical os.
• total (complete): internal os is covered by the placenta when the cervix is dilated fully.
• partial: the lower boder of the placenta is within 3 cm of the internal cervical os.
• marginal: placenta is implanted in the lower uterus, but its lower border is more than 3 cm from the internal os.
• Assessment: sudden onset of painless, bright red vaginal bleeding occurs in the last half of pregnancy. uterus is soft, relaxed, and nontender. Fundal height may be more than expected for age.
• Interventions: vaginal examinations are avoided, maintain bedrest in side lying position, monitor amount of bleeding, adm IV fluids blood products, or tocolytic meds as prescribed. Of bleeding is heavy, c-section may be performed.

Question 41

Abruptio Placentae

Answer 41

• premature separation of the placenta from the uterine wall after the 20th week and before fetus delivery.
• assessment: dark red vaginal bleeding, or absence, uterine pain or tenderness, uterine rigidity, severe abdominal pain, signs of fetal distress, signs of maternal shock if bleeding is excessive.
• interventions: monitor, maintain bed rest, adm oxygen, IV fluids and blood products as prescribed. place in trendelenburg’s to decrease pressure of fetus on the placenta or place in lateral with the head flat. Monitor and report any uterine activity, prepare for delivery. Monitor for signs of DIC in postpartum.

Question 42

Urinary Tract Infection: Cystitis and Pyelonephritis

Answer 42

• results from bacterial infections that extends upward from the bladder through the blood vessels and lymphatics.
• frequently follows untreated UTI and is associated with increased incidence of anemia, low birth weight, gestational hypertension, premature labor and delivery, and premature rupture of the membranes.
• Pregnancy is a predisposing factor for UTI.
• lower urinary infection is called cystitis.
• predisposing conditions: history of UTI, anomalies, low socioeconomic status, sexual activity, young age, sickle cell trait, poor hygiene, anemia, DM, obesity, catheterization.
• screening is done at the first prenatal visit or at 12-16 weeks.
• if pyelonephritis, hospitalization may be required for ATB and possible tocolysis.
• women may also experience asymptomatic bact.

Question 43

Chlamydia

Answer 43

• sexually transmitted
• associated with increased risk for premature birth, stillbirth, neonatal conjunctivitis, and newborn chlamydial pneumonia.
• can cause salpingitis, pelvic abscesses, ectopic pregnancy, chronic pelvic pain, and infertility.
• usually asymptomatic but may cause dysuria or dyspareunia. Bleeding between periods or after coitus. Mucoid or purulent cervical discharge.
• screening is indicated for high-risk women. Partner should be treated and treatment for both gonorrhea and chlamydia should be done, which includes ATB.
• pregnancy complications: septic spontaneous abortion or miscarriage, preterm delivery, premature rupture of the membranes, chorioamnionitis, disseminated gonococcal infection, ophthalmia neonatorum, postpartum metritis.

Question 44

Syphilis

Answer 44

• chronic infectious disease transmitted by physical contact with lesions.
• infection may cause abortion or premature labor and is passed to the fetus after the 4th month as congenital.
• a serum test is done on the first prenatal visit, and repeat at 36 weeks.
• if positive, treatment with ATB may be necessary (treatment of partner too).
• complications: transmission to fetus (100% in primary and secondary stages), congenital anomalies, deafness, neurological impairment (mortality rate is 50%).

Question 45

Gonorrhea

Answer 45

• cause inflammation of the mucuos membranes of the genital and urinary tracts.
• transmission is by sexual intercourse and may be transmitted to the newborn’s eyes during delivery, causing blindness.
• usually asymptomatic, vaginal discharge, urinary frequency, and lower abdominal pain possible.
• testing is done in the initial prenatal and repeated in the third trimester for high-risk clients.
• instruct that treatment of partner is necessary.
• complications are similar to chlamydia.

Question 46

Condyloma acuminatum (human papillomavirus)

Answer 46

• infection affects the cervix, urethra, anus, penis, and scrotum.
• transmitted sexually.
• produces small to large wart-like growths on the genitals.
• cervical cell changes and is associated with malignancies.
• lesions can be removed by the use of cytotoxic agents, cryotherapy, electrocautery, and laser, but is usually delayed until birth.
• encourage annual papanicolaou test.
• sexual contact should be avoided until lesions are healed.
• c-section is indicated only if genital warts are obstructing the pelvic outlet.

Question 47

Trichomoniasis

Answer 47

• transmitted sexualy and is associated with premature rupture of the membranes and postpartum endometritis.
• yellowish to greenish, frothy, mucopurulent copious, malodorous vaginal discharge.
• inflammation of vulva, vagina, or both.
• metronidazole may be prescribed and partner should be treated.

Question 48

Bacterial vaginoses

Answer 48

• caused by haemophilus vaginalis and transmitted sexually.
• associated with premature labor and birth.
• client complains of fishy odor and increased odor after intercourse.
• metronidazole may be prescribed (treat partner too).

Question 49

Vaginal Candidiasis

Answer 49

• most common causative organism
• predisposing factors: ATB, DM, and obesity.
• vulval and vaginal pruritis.
• white, lumpy, cottage cheese-like discharge.
• antifungal may be prescribed. Fluconazole should be avoided due to risk of miscarriage.
• sitz baths may be helpful.
• sexual partner should be treated.

Question 50

Tuberculosis

Answer 50

• transmitted by airborne route.
• transplacental transmission is rare, usually occurs during birth through aspiration of infected amniotic fluid.
• active disease during pregnancy has been associated with an increase in hypertensive disorders.
• chest RX only after 20 weeks with lead shield.
• tuberculin skin test is safe during pregnancy.
• newborn assess: fever, lethargy, poor feeding, failure to thrive, respiratory distress, hepatosplenomegaly, meningitis, may spread to all major organs.
• adm of isoniazid, pyrazinamide and rifampin daily for 9 months (ethambutol is added if resistence).
• pyridoxine should be adm with isoniazid to prevent fetal neurotoxicity.
• promote breast-feeding only if client is noninfectious.
• skin testing is done on the newborn, and may be placed on isoniazid therapy , test is pepeated in 3-4 months, ans med can be stopped if negative, if positive at least 6 more months.
• if mother’s sputum is free of organisms, newborn does not need to be isolated from the mother.

Question 51

Obesity in pregnancy

Answer 51

• places the client at risk for several complications including: gestational diabetes, gestational hypertension, preeclampsia, venous thromboembolism, and increased need for cesarean birth.
• delivery complications can result from difficulty obtaining IV access, epidural access, intubation, and decreased oxygen consumption with associated increased cardiac output, stressing the heart.
• can also have negative effects on newborn: stillbirth, premature birth, congenital anomalies, future obesity, heart disease, and difficulty with breast feeding.
• obese women have lower prolactin response to suckling in the first week postpartum.
• potencial postdelivery complications: thromboembolism, postpartum hemorrhage, endometritis.