T4: High Risk Perinatal Care: Gestational Cond. Flashcards
gestational hypertension
mom is 20 weeks of gestation OR MORE and her blood pressure is elevated (140/90), NO PROTEIN IN URINE
chronic hypertension
elevated BP BEFORE 20 weeks, NO PROTEIN IN URINE
preeclampsia
BP is elevated WITH PROTEIN IN URINE
s/s of preeclampsia
o Generalized edema, rapid weight gain (>5lbs in one week), vasoconstriction of cerebral vessels
o S/S; HA, blurred vison, abdominal pain, excessive weight gain, protein in urine
what can happen if preeclampsia is left untreated
eclampsia or HELLP syndrome
HELLP syndrome
- HEMOLYSIS (Burr cells on peripheral smear)
- ELEVATED LIVER ENZYMES (AST, ALT)
- LOW PLATELETS
what do we need to diagnose HELLP
LAB RESULTS/TESTS
What is the cure of preeclampsia?
delivery
eclampsia
when preeclampsia progresses, and they HAVE A SEIZURE( If mom has seizure, baby will not be well oxygenated)
preeclampsia or eclampsia superimposed on chronic hypertension
patient had chronic HTN before getting pregnant but now with pregnancy they have getting PROTEIN IN THE URINE or SEIZURES (depending on if its preeclampsia or eclampsia)
physical exam of preeclampsia
Edema, reflexes (monitor DTR for the presence of hyper reflexia or clonus because it indicated increased CNS irritability), proteinuria
s/s of eclampsia
o Headache
o Hyperreflexia
o Proteinuria
o Edema
o Clonus (indicated cerebral edema and patient can have a seizure)
o Visual changes (blurred vision)
o Epigastric pain (because liver enzymes are elevated and liver is swollen)
o Excessive weight gain (>5lbs in one week)
immediate care for ecclampsia
o Maintain patient airway and safety during seizure
- Seizure precautions
o Stabilize mother after seizure
o Magnesium sulfate
o Fetal status
education for eclampsia
EDUCATE about HA, blurred vision, and epigastric because mom can still have a seizure up to 6 weeks after delivery
Labetalol IV
an antihypertensive is needed to lower the blood pressure (slows HR and reduced BP)
other preeclampsia BP medications
Hydralazine IV
Nifedipine PO
Mag sulfate is used for
an anticonvulsant to prevent seizures, preterm labor (slows uterine ctx), & neural protection (decrease preterm brain bleeds)
administration of mag sulfate
MAG ALWAYS GOES ON A PUMP, administered as a secondary IV fluid
In a mom with a premature baby and preeclampsia what steroid is given
betamethasone
How is betamethasone administered?
2 injections (12mg IM, then 24 hours first dose it is repeated), now mother is in her steroid window
dosage for mag sulfate
o 4-6 gram loading dose
o 2-3 grams per hour maintenance infusion
Goal serum magnesium level
4-7 mEq/L
Antidote for magnesium sulfate toxicity
CALCIUM GLUCONATE
what do we monitor for when a patient is on mag sulfate
Respitatory rate!
intervention if RR is low with mag sulfate
TURN THE MAG OFF THEN ADMINSTER CALCIUM GLUCONATE
hyperemesis gravidarum
excessive vomiting during pregnancy
clincal manifestation of hyperemesis gravidarum
o Excessive vomiting
o Weight loss
o Dehydration
fluid and electrolyte imbalabces
intervention for hyperemesis gravidarum
zofran
first trimester
1-13 weeks
third trimester
27-40 weeks
first trimester hemorrhagic disorders
Miscarriage or ectopic pregnancy
third trimester hemorrhagic disorders
Placenta previa and abruptio placentae
miscarriage (spontaneous abortion)
: pregnancy ended before 20 weeks, < 500 gm, not viable
When do most miscarriages occur?
before 8 weeks gestation
threatened abortion
mom will present with slight spotting (bleeding), mild uterine contractions (cramping), and NO CERVICAL DILATION
Inevitable abortion
they do not know why, but there is moderate to heavy bleeding and the CERVIX IS DILATED/OPEN so mom WILL abort (lose the baby)
incomplete abortion
bleeding is moderate to heavy; the cervix is DILATED and the baby could be delivered but the placenta is retained
complete abortion
BOTH placenta and fetus are completely expelled, may have slight bleeding and the cervix after the placenta and fetus are expelled, the cervix will start to close
missed abortion
bleeding, then stops, and mom can go on to have a normal pregnancy, CERVIX is closed
bicornuate uterus
women that have one uterus but has a septum in between (can be pregnant on one side but not the other)
recurrent abortion
when mom gets to a certain week at each pregnancy, she aborts the baby
Cervix insufficiency
- Painless cervical dilation
- Cervical shortening
cerclage
suture around the cervix and close it, the suture stays in until 36 weeks
when is the recommended time for a cerclage placement
16 weeks or before
ectopic pregnancy
fertilized ovum (egg) implants outside the uterine cavity (can get stuck in fallopian tube)
Management of ectopic pregnancy
Stable (not ruptured): Methotrexate (baby will be aborted)
Unstable (ruptured): Surgery
hydatidiform mole
ONLY the placenta is developed without a fetus
- No embryo, fetus, or amniotic sac
management for hydatidiform mole
o Methotrexate will be used to expel placenta
o Avoid pregnancy for 1 year
s/s of hydatidiform mole
Vaginal blessing (prune juice color)
Increase in hCG
Rapid uterine growth
Failure to detect fetal heart activity
A distinct snowstorm pattern on ultrasound with no evidence of developing fetus
diagnosis for hydatidiform mole
o Elevated hCG levels, no heartbeat and no growth, snow storm pattern on US
placenta previa
occurs when placenta is before the baby (Usually, placenta is at the top of the fundus, but here it is in the lower uterine segment)
marginal placenta previa
implanted in lower uterus but its lower border is >3cm from internal cervical os
complete placenta previa
placenta completely covers internal cervical os
partial (low lying) placenta previa
lower border of placenta is within 3dm of internal cervical os but does not fully cover it
clinical manifestations for placenta prevus
BRIGHT RED BLOOD AND PAINLESS in the third trimester
when a patient comes in with suspected placenta previa, what is done
o NEVER DO A VAGINAL EXAM, DO AN ULTRASOUND (level 2)
- Want to know exactly where placenta is placed
Maternal and fetal outcomes for placenta previa
MUST DO A C-SECTION
-bed rest for as long as possible
abruptio placentae
premature separation of placenta from lining of the uterus after 20 weeks’ gestation OBSTECTRICAL EMERGENCY MUST DO A C-SECTION
goal of abruptio placentae
deliver baby as soon as possible
Types of abruptio placenta
o Grade I Mild separation: 10-20%
o Grade II Moderate separation: 20-50%
o Grade III Severe separation: > 50%
clinical manifestations of abruptio placenta
o DARK RED BLEEDING AND PAINFUL
o Bleeding can be seen vaginally or concealed (abdomen feels board-like)
maternal/fetal outcome for abruptio placenta
o No O2 or blood supply to baby, must do a C SECTION
Cholelithiasis and Cholecystitis
o Causes generalized itching, induction may be suggested so that a surgeon can take over to take out the gallbladder
