T4: High Risk Pernatal Care: Preexisting Cond.

Question 1

why should moms with diabetes get genetic counseling

Answer 1

Get genetic counseling before getting pregnant because baby is at high risk for fetal anomalies

Question 2

Pregestational diabetes mellitus

Answer 2

HbgA1C is trending upwards

Question 3

Gestational diabetes mellitus (GDM)

Answer 3

diabetes in pregnancy

Question 4

intervention for gestational diabetes

Answer 4

Can be controlled through diet but PO medication may be used (Metformin)

Question 5

diagnosis for gestational diabetes

Answer 5

1 hour glucose test, if it is high (>150), then they will order a 3-hour glucose tolerance test

Question 6

BG needs to be controlled because

Answer 6

· otherwise baby may be LGA (>4200g) and can end up shoulder dystocia

Question 7

Recommendation of induction if gestational diabetes is done at

Answer 7

36 weeks to prevent stillbirth

Question 8

First trimester insulin is

Answer 8

decreased

Question 9

trimester 2 and 3 doses of insulin are

Answer 9

increased

Question 10

Insulin administration

Answer 10

o INSULIN ALWAYS GOES ON A PUMP IN A SEPARATE LINE AND HAS TO BE VERIFIED BY ANOTHER NOSE
o NEVER IVPB

Question 11

insulin resistance begins at

Answer 11

14-16 weeks

Question 12

why does anemia need t be corrected before delivery

Answer 12

it increases the risk for PPH

Question 13

SE of iron

Answer 13

constipation (order colase)

Question 14

Preterm Labor (PTL)

Answer 14

labor prior to 37 weeks (before 20 weeks)

Question 15

Goal of preterm labor

Answer 15

keep mom pregnant for as long as possible

Question 16

ntervention for preterm labor

Answer 16

Place mom on monitor and you will see contractions (contractions can be painful and cause cervical dilation
o BUT WE DO NOT WANT TO DO A STERILE VAGINAL EXAM, USE A SPECULUM INSTEAD, because we do not want to stimulate the cervix

Question 17

Fetal fibronectin (FFN)

Answer 17

a cervical swab that tells us if mom is in PTL

Question 18

what do we need to ask mom before Fetal fibronectin (FFN)

Answer 18

Ask mom if they have been sexually active withing the past 48 hours, if they say yes, you cannot do the test because there will be a false positive

Question 19

positive Fetal fibronectin (FFN) tells us

Answer 19

mom is in preterm labor and tells us mom can deliver within 2 weeks of the test

Question 20

clinical manifestations fo preterm labor

Answer 20

Þ Uterine activity
Þ UC’s-at least every 10 minutes lasting for one or more hours
o Painful CONTRACTIONS
Þ Discomfort
o Low abdomen
o Dull, intermittent
o Painful menstrual cramps
o Suprapubic or pelvic pain or pressure
o Urinary frequency
Þ Vaginal discharge
o ∆ in character or amount of discharge
o Rupture of amniotic membranes

Question 21

Tocolytics

Answer 21

drugs used to stop preterm labor

Question 22

Tocolytics: mag sulfate

Answer 22

smooth muscle relaxant

Question 23

what must be checked before Terbutaline is given

Answer 23

HR, if it is >120 it CANNOT BE ADMINISTERED

Question 24

what needs to be monitored with nifedipine

Answer 24

MUST MONITOR THE BP, AND EDUCATE THE MOM TO TAKE BP BEFORE TAKING IT BECAUSE IT CAN LOWER THE BP

Question 25

fetal lung maturity

Answer 25

Stimulate fetal lung maturity: Glucocorticoid
o Betamethasone 12 mg IM q 24 hours x 2

Question 26

steroid window

Answer 26

achieved 24 hours after last dose of betamethasone

Question 27

if mom doesnt get betamethasone then

Answer 27

e baby will need to be intubated and surfactant will be given

Question 28

PROM

Answer 28

premature rupture of membrane but baby is term (>=37wk), RUPTURED BUT ARE NOT IN LABOR (there are no contractions)

Question 29

PPROM

Answer 29

preterm premature rupture of membrane (baby is not term; <37wk)

Question 30

1 CAUSE OF PPROM

Answer 30

infection

Question 31

chorioamnionitis

Answer 31

bacterial infection of the membranes

Question 32

chorioamnionitis treatment

Answer 32

triple antibiotics