Test 3 Flashcards
1
Q
Preeclampsia
A
- hypertensive disorder
- characterized by HTN and proteinuria
- usually diagnosed after 20 weeks in a normal pregnancy
- >140/90
- generalized edema (esp face & hands)
- cure=birth
- vasospasm-vasoconstriction-reduced renal perfusion, endothelial damage, PVR increases
- Risk to newborn=IUGR, SGA (r/t placental insufficiency), reduced amniotic fluid, hypoxemia and acidosis, fetal death
- risk: obesity, pre-PG diabetes, 1st PG, >35yo and teenagers, African Americans, family Hx, chronic HTN and renal disease, lupus, clotting disorders, low SEC, sickle cell trait
- hyperactive DTRs, hyper-reflexia +4 (normal is +2), clonus-can precede seizure
- H/A, drowsiness, mental confusion, visual disturbances (spots), numbness, tingling of hands/feet (nerves compressed by retained fluid), epigastric pain (bad!!–liver distension)
- restrict activity, lateral position for 1.5+ hours/day, monitor BP, daily wts, urinalysis, fetal assessment-reduced movement, growth, amniotic fluid decrease, low salt diet
- severe = systolic > 160/110, or if multisystem involvement is present
- complications=seizures, stroke, abruptio placenta, DIC, thrombocytopenia, renal failure (decreased renal perusion-uric acid levels rise), liver failure
- meds=hydralazine (Apresoline)-vasodilator, increases CO, blood flow to the placenta, also nifedipine, labetalol; anticonvulsant = MgSO4-relaxes smooth muscle and reduces vasoconstriction (IV infusion)-may cause decreased FHR variability
- therapeutic MgSO4 is 4-8 mg/dL SE: CNS depression including respiratory depression, excreted by kidneys
- most seizures occur during labor or first 24 hours post partum, keep mother lateral
- oxytocin is OK
- no epidural if there are coagulation issues
- hypovolemia is caused by preeclampsia-fluid shift to interstitial space
- hypomagnesium (inverse relationship bt calcium intake and preeclampsia)
2
Q
Rh Incompatability
A
- erthyrobastosis fetalis=agglutination and hemolysis of fetal erythrocytes resulting from incompatiability between maternal and fetal blood.
- affects fetus, causes no harm to mother
- Mother has indirect Coombs test to determine if she is sensitized (developed antibodies) as a result of previous exposure to Rh-positive blood; if negative Coombs is repeated at 28 weeks
- RhoGAM at 28 weeks to prevent sensitization from small leaks of fetal blood across the placenta; prevents formation of active antibodies
- RhoGAM again after birth if baby is Rh +
- direct Coombs tests baby’s blood for antibody titer
- if mom’s blood has + indirect coombs, monitor baby’s HCT-transfuse for HCT <30
- causes hemolysis and hyperbilirubinemia; erythroblastosis fetalis
3
Q
Abortion
A
- Loss of pregnancy before the fetus is viable (<20 weeks or <500g)
- spontaneous or induced
- spontaneous abortions increase with parental age
- most spontaneous abortions occur within the first 12 weeks: severe congenital abnormalities incompatible with life; chormosomal abnormalities=50-60%, also-infection
- cramping
- Threatened abortion-first sign in vaginal bleeding (50% end in spont abortion)
- Missed abortion-fetus dies but is retained-absorption/maceration of the fetus; complications=DIC, infection
4
Q
DIC
A
- abruptio placentae, intrauterine fetal death, endothelial damage (severe preeclampsia and HELLP syndrome), maternal sepsis, amniotic fluid embolism
- hypertension
- consumption of plasma factors: platelets, fibrinogen, prothrombin, factors 5 and 8
- placenta is a rich source of thromboplastin
- PT, PTT, d-dimer will be +
- watch for bleeding, bruising
- no epidural due to possible bleeding into the spinal canal
- potential vascular occlusion of organs from thromboemboli formation
- monitor VS, watch fro shock, administer O2, blood products, heparin to prevent clot formation and increase available fibrinogen, coagulation factors, and platelets
5
Q
Ectopic Pregnancy
A
- implantation of fertilized ovum in an area outside of the uterine cavity (98% are in fallopian tubes)
- significant cause of maternal death from hemorrhage
- reduces woman’s chance of subsequent pregnancies due to damage/destruction of fallopian tube
- At risk-scarred fallopian tubes (PID, inflm, surgery-Chlamydia/gonorrhoeae, previous ectopic, IUDs, low dose progesterone agents, multiple induced abortions, age)
- pain/bleeding-pain may radiate to scapula
- hypovolemic shock
- if tube is unruptured - Methotrexate (folic acid antagonist), surgical management (salpingectomy=removal of the tube)
6
Q
Gestational Trophoblastic Disease
(Hydatidiform Mole)
A
- trophoblasts (peripheral cells that attach to fertilized ovum to the uterine wall) develop abnormally
- grow rapidly
- complete=no fetus present, or partial in which some fetal tissue/membranes are present
- age, Asian women, prior molar pregnancy
- may become malignant=choriocarcinoma
- higher levels of hCG, HEG, early preeclampsia
- contraception for at least 1 year
7
Q
Hypovolemic Shock
A
- vital signs and urine output indicate cardiovasculr status
- rising pulse rate and respiratory rate
- falling urine output, O2 sats
- BP falls later in hypovolemic shock
- pale color skin and mucous membranes
- cold, clammy skin
- weak peripheral pulses
- falling H&H, BP
- restlessness, tachy, agitation, change in LOC
- 16 to 18 guage catheters for blood and fluid replacement
8
Q
Placenta Previa
A
- hemorrhagic condition of late pregnancy
- implantation of the placenta in the lower uterus
- total, partial, marginal (placenta is >3cm from internal cervical os)
- placentas tend to move up during course of PG
- Risk factors: age, multipara, previous c-section, previous suction and currettage, previous placenta previa, African, Asian, smoking, cocaine, male fetus
- S/S=painless uterine bleeding in last half of PG, bright red blood
- no manual examinations or stimulation of contractions, stool softeners, type and cross, tocolytics PRN
- presentation of baby is often transverse
9
Q
Abruptio Placentae
A
- Separation of a normally implanted placenta before the fetus is born
- hemorrhage may be apparent or concealed
- maternal complications=hemorrhage, hypovolemic shock, DIC
- fetal complications=asphyxia, excessive blood loss, prematurity
- Risk factors: cocaine use (vasoconstriction), maternal HTN, smoking, multigravida status, short umbilical cord, abd trauma, PROM, previous history, age, autoimmune coagulopathies
- S/S=bleeding, uterine tenderness, uterine irritability with frequent, low intensity contractions, poor relaxation between contractions, abd and low back pain, high uterine resting tone, non-reassuring fetal HR, signs of hypovolemic shock, fetal death, increased fundal height, boardlike abd (tetanic), persistent late decels, decreasing variability, absence of accels
- Marginal-separates at edges
- Partial-separates at center (may not bleed)
- Complete-total separation
- Maternal VS q15 min
- faster onset than placenta previa
10
Q
Hyperemesis Gravidarum
(HEG)
A
- persistent, uncontrollable vomiting that may continue throughout the PG, not diagnosed until 2nd trimester
- wt loss of >5% of pre-PG
- dehydration-low grade fever
- fatigue
- furrowed tongue
- sp. gravity urine > 10.25
- hypotension, tachy
- tachypnea
- acidosis from starvation
- elevated blood & urine ketones
- alkalosis from loss of HCl in gastric fluid
- hypokalemia, hyponatremia, hypochloremia
- elevated liver enzymes
- deficient vit K
- deficient thiamine (may cause encephalapathy)
- Meds: Phenergan (antiemetic), compazine (anti-emetic/anti-schizo), benadryl, Zantac/Pepcid, esomeprazole, Reglan (antiemetic), ondansetron (Zofran)
- daily weights, I&O, skin turgor
- hypoglycemia can cause nausea
- LOC changes
- causes: unknown, increased hCG, allergy to fetal proteins, thyroid dysfunction, assoc with H.pylori, psychological factors
11
Q
Eclampsia
A
- progression of preeclampsia to generalized (grand mal) seizures.
- provide low-sensory environment
- seizure precautions=padded side rails, O2 and suction equipment
- seizures start with facial twitching…rigidity of the body…tonic-clonic movements…last about 1 minute
- breathing stops during generalized seizures–fetal brady, loss of variability, late decels followed by fetal tachy
- MgSO4 is drug of choice
- blood volume is severly reduced-risk for poor placental perfusion
- pulmonary edema due to fluid shift
- HF due to impeded forward blood flow
- renal blood flow is reduced-oliguria
- cerebral hemorrhage due to HTN and coagulation defecits
- Lasix for pulmonary edema
- O2 by face mask 8-10 L/min
- Digoxin
- kept side lying-prevent aspiration, improve placental circulation
- aspiration of gastric contents=leading cause of morbidity
- causes uterine irritability-monitor for ROM, signs of labor and abruptio placentae
12
Q
HELLP Syndrome
A
- hemolysis, elevated levels of liver enzymes and low platelet levels
- syndrome associated with preeclampsia
- Risk for: hemorrhage, pulmonary edema, hepatic rupture
- S/S-RUQ pain, N/V, severe edema
- ICU mgt req’d, seizure prevention, BP mgt, pulmonary edema, ascites
- induction NOT c-section
13
Q
Hemorrhagic Complications
A
- abortion
- ectopic pregnancy
- DIC
- Placenta Previa
- Abruptio Placenta
14
Q
Hypertensive Disorders
of PG
A
- Chronic-dx prior to PG, or first diagnosed in PG that persists beyond 6 wk post-partum
- Gestational-develops after 20 wks, no proteinuria; BP returns to normal within 6 wks post-partum
- Tx-low Na diet, methyldopa, hydralazine (apresoline)=arterial vasodilator, nifedipine (not with MgSO4), labetalol
- If not taking meds-at risk for clots/stroke
- Superimposed Pre-eclampsia-worse prognosis for mother & fetus, seizure activity or coma elevates disese to superimposed eclampsia; increased risk for: placental abruption, acute renal failure, IUGR, fetal demise, maternal death
15
Q
Infections that Affect PG
A
- cytomegalovirus
- rubella
- varicella-zoster
- herpes simplex
- parvovirus
- Hep B
- HIV
- toxoplasmosis (protozoan)
- group B strep
- TB
