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Module 6 > Unit 3-HIGH RISK PREGNANCY AND/OR DELIVERY > Flashcards

Unit 3-HIGH RISK PREGNANCY AND/OR DELIVERY Flashcards

1
Q

What is an abortion?

A
  1. Pregnancy loss before fetus is viable or capable of living outside the uterus (before 20 weeks or <500g)
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2
Q

What is the most common cause of a spontaneous abortions?

A

chromosomal abnormality

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3
Q

What are clinical manifestation of a spontaneous abortion?

list 3

A
  1. uterine cramping, backache, and peliv pressure
  2. Passing of products of conception
  3. bright red vaginal bleeding
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4
Q

What is a threatened abortion?

A

Spotting without cervical changes- pregnancy threatened

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5
Q

What is an inevitable abortion?

A
  1. Cannot stop, open cervical os, moderate to heavy bleeding, passing tissue
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6
Q

What is an incomplete abortion?

A

Not all products of conception are expelled
requires D&C to prevent infection

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7
Q

What is a complete abortion?

A

All products of conception are expelled- no treatment required.

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8
Q

What are s/s of sepsis from an abortion?

A
  1. fever, abdominal pain, tenderness (over uterus), foul-smelling vaginal discharge, scant to heavy bleeding
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9
Q

What is a missed abortion?

A
  1. Fetus dies but remains in uterus; can cause dead fetus syndrome and may develope DIC (D&C Required)
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10
Q

What is a recurrent/habital spontanous abortion?

A
  1. defined as 3 or more spontanous abortions
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11
Q

What is abortion management for a missed or incomplete abortion?

A
  1. D&C (<13 weeks) or D&E (>13weeks) may be required
  2. Prostaglandin E3 or cytotec- induce contractions to expel the fetus
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12
Q

What are major complications for a missed abortion?

A
  1. Infection
  2. DIC- disseminated intravascular coagulation
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13
Q

If we have a mom experiencing recurrent spontaneous abortions what might we do for them?

A
  1. Examination of reporductive organs as indicated
  2. Refer for genetic counseling
  3. Identify hormone/endocrine problems
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14
Q

True or false: Giving Rho (D) immune globulin is important to be given even with abortions for moms that are RH-

A

True

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15
Q

What is the psychological impact of abortions?

A
  1. Frightening; waiting and watching is difficult
  2. Feel acute sense of loss and grief, anger, disappointment, and sadness
  3. Grief can last up to 18 months- they grieve for fantasies of unseen, unborn child
  4. may feel guilt and speculation they could have prevented the loss
  5. Nurses shold convey acceptance of feeligs expressed and provide information and simple brief explanations of what has occured
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16
Q

Abortions can be….what kind of choice

A

therapeutic or elective

caution asking about previous abortions infront of others

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17
Q

What is cervical incompetence or cervical insufficiency?

A
  1. Mechanical defect in the cervix which causes premature cervical ripening
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18
Q

What are risk factors of cervical incompetence or cerivical insufficiency?

A
  1. Previous cervical trauma such as cervical dialation and curettage (D&C) or cauterization
  2. Congential structural defecs of uterus or cervix
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19
Q

How is cervical incompetence or cervical insufficiency managed?

A

Cevical cerlage (cervical stitch)

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20
Q

What do we need to know about cervical cerclage (cervical stitch)

A
  1. Sutures reinforce the cervix- removed near term in preperation of labor (around 36 weeks)
  2. Prophylactic- 12-16 weeks if history of loss/cervical insufficiency
  3. Rho(D) immune globulin given to RH neg. patients
  4. Post op monitoring and home instructions
  5. Antibiotics or tocolytics- to rela the uterus and stop contractions
  6. Montior for uterine activity, leaking fluid, or infection
  7. Modify activity- for about 1-2 weeks and after follow up with MD then maybe back to normal
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21
Q

What is an ectopic pregnancy?

A
  1. Implantation of fertilized ovum in sites other than endometrial lining of uterus (usually fallopian tube)
  2. Medical emergency
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22
Q

What should our assessment for an ectopic pregnancy include?

A
  1. Normal symptoms of pregnancy may or may not be present
  2. Full feeling in lower abdomen, lower quadrant tenderness
  3. Postive pregnancy test

Usually happens around 6-8 weeks along

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23
Q

What is a common place for a fetilized ovum to implant to cause an ectopic pregnancy?

A

Fallopian tubes

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24
Q

When we have a patient with s/s of an ectopic pregnancy what are our inital actions as the nurse?

A
  1. Assess vital signs STAT– looking for bp drop and hr increase– hemorrage
  2. check for vaginal bleedig
  3. start large bore IV (18g) to start fluids
  4. Notify provider immediately
  5. Assess for abdominal masses or adnexal tenderness
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25
Q

How do we treat ectopic pregnancies?

A
  1. Prepare patient for abdominal ultrasound
  2. Rapid surgical treatment for rupture ectopic
    • Explain procedure and sign consents-give pre and post op instructions
    • Type and cross for two untis of PRBCs
    • Future pregnancy is desired and tube is not ruptured- will attempt to preserve the tube
    • Observe for shock
    • Rho (D) immune globulin if the patient is Rh (-)
  3. Medical management with methotrexate can e done only if stable
  4. if rupture occurs… likely to lose tube
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26
Q

What do we need to know about methotrexate?

A
  1. Appropriate personal protective equipment (double glove)
  2. Verify patient name, medication and dosage with another nurse
  3. Air should NOT be expelled from syringe so as not to aerosol the drug
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27
Q

What is our patient teaching for methotrexate?

A
  1. Urine is considered toxic for 72 hours
    • Avoid getting urine on toliet seat; flush toliet twice with lid closed after voiding

2.Refrain from drinking alcohol, taking vitamins with folic acid, using NSAIDS, and avoid sundlight

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28
Q

What are adverse effects of Methotrexate?

A
  1. N/V and transiet abdominal pain
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29
Q

What is gestational trophoblastic disease (hydatidiform mole)

A

AKA Molar pregnancy
1. Trophoblasts that attach the fertilized ovum to uterine wall develop abnormally

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30
Q

What might our assessment of a patient with a molar pregnancy show?

A
  1. Higher levels of beta hCG than expected for getation
  2. Hyperemesis-excessive n/v
  3. Uterus larger than expected for gestational age
  4. Vaginal bleeding (first trimester) that varies from brown discarge to profuse hemorrhage
  5. Early development of preeclampsia before 24 weeks gestation
  6. Characteristic “snowstorm” pattern shows vesicles, absence of a fetal sac or heartbeat on ultrasound
  7. Malignant change is choriocarcinoma and mets to lung, vagina, liver and brain.
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31
Q

What should we know about a molor pregnancy?

A
  1. Placenta does NOT develop normally
  2. Embryo rarely present
  3. Characterized by proliferation and edema of chorionic vili into a bunch of clear vesicles in grape like clusters
  4. Can grow large enoguht to fill the uterus to the size of an advanced pregnancy
  5. Can predispose patient to choriocarcinoma
  6. Hydatidiform (mole) molar pregnancy is a developmental anomaly patient will be monitored for 1 year after
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32
Q

What is our therapeutic managment of molar pregnancy?

A
  1. evacuation of trophoblastic tissue (D&C)
    • Before evacuation
    • chest x-ray, ct scan or MRI to detect metastasis
    • Avoid uterine stimulation- includes manual or chemical (oxytocin)

2.Treat any hyperemesis and preeclampsia
3.CBC, type and screen, and coagulation status

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33
Q

What is our discharge teaching for a patient that had a molar pregnancy?

A
  1. Prevent pregnancy for atleast 1 year– birth control will be important
  2. Obtain serum hCG levels monthly for 6 months then every 2 months for 6 months
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34
Q

If hCG levels rise what does this indicate in patient who had a previous molar pregnancy?

A

Indicates malignancy
1. Malignancy is treated with methotrexate
2. Same precautions and teaching apply as with the ectopic pregnancy with the usage of methotrexate

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35
Q

For a patient who had a previous molar pregnancy what signs and symptoms should we teach them to report immediately?

A
  1. Bright red vaginal bleeding
  2. temp sike over 100.4
  3. Foul smelling vaginal discharge
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36
Q

What is placenta previa?

A
  1. Implantation of the placenta in the lower uterus
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37
Q

What are the classifications of placenta previa?

A
  1. Marginal or low-lying- placenta implanted in lower uterus, but MORE than 3cm from internal cervial os
  2. Partial- lower placenta border with WITHIN 3cm of the internal cervical os but does not completely cover the os
  3. Total or complete- placenta COMPLETELY covers the internal os
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38
Q

What are the clinical manifestations of placenta previa?

A
  1. Sudden onset of PAINLESS vaginal bleeding- bleeding is usually bright red
  2. Uterus is soft, relaced and non tender
  3. inital episode of bleeding usually occurs end of 2nd trimester or 3rd trimester and is rarely life-threatening. Not usually seen in early pregnancy
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39
Q
A
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40
Q

What is our assessment of placenta previa going to show and how is it diagnosed?

A
  1. Vaginal exam is ALWAYS contraindicated with placenta previa ALWAYS
  2. Can cause placental seperation or tear placenta causing severe hemorrhage and death of fetus
  3. ultrasound to determine placental placement
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41
Q

What determines the managment of placenta previa?

A

Based on the condition of mother and fetus
1. Determine amount of hemorrhage
2. evaluate fetus using electronic fetal monitoring
3. gestational age of fetus is considered

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42
Q

If a mother with placenta previa is stable with no fetal compromise how will her care be managed?

A
  1. Delay birth to increase maturity and birth weight
  2. Corticosteriods given to speed up lung maturity of fetus
  3. Conservative management may take place in the hospial or home
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43
Q

If the doctor says the mothers placenta previa can be managed from home the following criteria must be achieved

A
  1. No evidence of active bleeding is present
  2. Patient can maintain strict bedrest at home except for toileting/shower
  3. Patient can veralize understanding of risks of how to manage care
  4. home is a short distance from the hospital
  5. Emergency systems are available for immediate transport to the hospital
  6. Patient can perform daily kick counts and recognize uterine activity
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44
Q

If a mother with placenta previa or the fetus is NOT stable how will there care be managed?

A

Inpatient care on antepartum unit until delivery
1. Mother/fetus are monitored closely for compromise-immediate delivery may be necessary
2. c/s (cseaction) for total or partial previa, for heavy bleeding or deterioration of mother/fetus
- additional personnel may be needed
- large bore IV (18g) and consider second line for fluid esp. if she bleeding
- Blood on standby or immediately available
- NICU team for baby.

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45
Q

What is abruptio placentae?

A
  1. Partial or complete premature detatchement of placenta from its implantation in uterus
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46
Q

What should we know about abruptio placentae

Dont ask

A
  1. Occurs in 1 in 200 pregnancies usually in the 3rd trimester esp. if overstimulated
  2. Cause of 15% of maternal deaths
  3. Considered an obstetric emergency
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47
Q

Abruptio placentae is related to what conditions?

A
  1. Hypertensive disorders
  2. high gravidity
  3. abdominal trauma-car accidents, falls, abuse
  4. Cocaine, meth, weed, or tobacco use (vasocontricts similar to HTN disease)
  5. short umbilical cord
  6. premature rupture of membranes
  7. previous abruptio placentae
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48
Q

What will our nursing assessment of abruptio placentae show?

A
  1. Bleeding concealed or overt (if overt, is dark red)
    • r/t blood staying behind the placenta
  2. Uterine tenderness/pain that can be localized over the site of abruption
  3. perisistent abdominal pain
  4. rigid,board-like abdomen
  5. FHR abnormalities (Dcels)
  6. signs of shock- bp down, hr up
  7. IUPC will reveal high resting tone.
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49
Q

Often times with abruptio placentae you will see what as far as bleeding goes?

A

No bleeding

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50
Q

What are our nursing interventions for abruptio placentae?

A
  1. Best rest- no vaginal or rectal manipulation
  2. Notify provider immediately
  3. Place patient on side-lying position
  4. apply external fetal monitors- montior contractions and FHR
  5. IV infusion with large bore cath
  6. stat CBC, clotting studies, RH factor, and type/crossmatch
  7. Prepare for immediate cesarean section
  8. Provide constant surveillance-monitor for signs of DIC
  9. Assessfor IPV (intimate partner violence) done anytime someone has an abruption. ask privately
  10. quantify blood loss
  11. provide emotional support, teach regarding managment and expected outcomes
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51
Q

What would our conservative managment for abruptio placentae if mild and fetus is <34 weeks with no signs of distress?

A
  1. Bed rest
  2. possible admin of tocolytic to reduce uterine activity
  3. Corticosteriods to accelerate fetal lung maturity
  4. Rho(D) immune glbulin admin to rh - moms
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52
Q

What is our managment of abruptio placentae if there is maternal or fetal compromise/deterioration in status?

A

1.Immediate delivery
2.NICU team at delivery

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53
Q

What is disseminated intravascular coagulation (DIC)

A

DIC is also called cosumptive coagulopathy this is a life-threatening defect in coagulation that can occur with several complications of pregnancy.
1. Anticoagulation occurs, and concurrently inappropriate coagulation takes place in micro-circulation
- Formation of tiny clots in tiny blood vessels that block blood flow to organs causing ischemia
- excessive bleeding

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54
Q

What diseases cause DIC?

A
  1. Placental abruption or prolonged retnantion of dead fetus
  2. Conditions characterised by endothelial damage- severe preeclampsia and HELLP syndrome
  3. nonspecific effects of some diseases- maternal sepsis or amniotic fluid embolism.
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55
Q

What is anemia?

A

A decrease in the o2 carrying capcity of the blood
1. Related to iron deficiency and reduced dietary intake

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56
Q

Anemia is associated with what in pregnancy?

A
  1. Increased miscarriage
  2. preterm labor
  3. preeclampsia
  4. infection
  5. PPH
  6. IUGR
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57
Q

What should we know about Iron-deficiency anemia?

A
  1. Total iron requirement for single fetus pregnancy is 1000/day
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58
Q

what is our primary sources of iron in our diet?

A
  1. Meat
  2. fish
  3. chicken
  4. liver
  5. green leafy veggies
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59
Q

What are s/s of iron-deficiency anemia?

A
  1. pallor
  2. fatigue
  3. lethargy
  4. headache
  5. inflammation of lips and tongue
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60
Q

UTI if left untreated can result in?

A

Pyelonephritis

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61
Q

UTI in pregnancy increase the risk of?

A
  1. preterm labor
  2. premature delivery
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62
Q

Maternal complications of a UTI include?

A
  1. High fever
  2. flank pain
  3. septic shock
  4. ARDS
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63
Q

True or false: Pregnant women with UTIs often require hospitalizations?

A

True

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64
Q

What are 2 types of vaginal infections we might encourger in pregnancy and what might cause?

A
  1. Candidiasis- thrush may develope in newborns
  2. Bacterial vaginosis- PROM, preterm labor and birth, intraamniotic infection and postpartum endometritis, neonatal sepsis and death
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65
Q

What should we know about Rubella infections in pregnancy?

A
  1. Prevention is the only effective protection for the fetus; can result in fetal congential heart defects, IUGR, congenital cataracts, hearing or vision problems
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66
Q

What should we know about covid infections during pregnancy?

A
  1. Research is ongoing but preliminary studies show increased risk of preeclampsia, stillbirth and maternal death if infected in pregnancy
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67
Q

What should we know about hepatitis in pregnancy?

A
  1. Risk for prematurity, low birth weight and neonatal death
  2. If mother is hep b postive
    • newborn recieves hep b immune globulin FOLLOWED by hep b vaccine
    • Newborn should be carefully bathed before any injections
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68
Q

What should we know about cytomegalovirus?

A

No treatment for mother or infant
1. Still born, congenital CMV (this virus), microcephaly, IUGR, cerebral palsy, mental retardtion, rash, jaundice, heptosplenomegly

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69
Q

What should we know about the varicella-zoster virus in pregnancy?

A
  1. mom/infant-highly contagious, placed in airborne/contact isolation
  2. Only immune staff should come into contact with these patients
  3. Can include preterm labor, encephalitis and varicella penumonia
  4. Fetal effects depend on time of infection
    • 13-20 weeks- limb hypoplasia, cutaneous scars, choriorentintis, cataracts, microcephaly, ad IUGR
    • 5-2 days before birth-life threatening varicella infection congenital varicella syndrome
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70
Q

What should we know about the non-viral toxoplasmosis infections in pregnancy?

A
  1. Caused by a protozoan- raw undercooked meat, cat feces (litter boxes)
  2. Congenital toxoplasmosis, stillbirth, microcephaly, hydrocephalus, blindness, deafness
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71
Q

What should we know about group b streptococcus infection?

A
  1. Leading cause of life-threatening perinatal infections
  2. women will have vaginal and rectal cultures between 35-37 weeks
  3. If postive, the patient will recieve penicillin, cephazolin, clindamycin
    • Two doses min. before delivery is desired
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72
Q

What are different types of STIs we might encounter in pregnant women?

A
  1. syphillis
  2. conorrhea
  3. chlamydia
  4. trichomoniasis
  5. HPV
  6. herpes
  7. HIV
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73
Q

What do we need to know about Chorioamnionitis in pregnancy?

A
  1. Infection of the amnion/chorion or amniotic fluid
  2. maternal fever-fetal tachycardia- baseline >160 for atleast 10 mins
  3. Maternal WBC count greater than 15000 (without corticosteriods)
  4. Purulent fluid emanating from the cerical os
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74
Q

What are our interventions for chorioamnionitis?

A
  1. wash hands before/after contact with patients; temp q2 after ROM- hourly for fever
  2. Keep under pads dry and limit vaginal exams- maintain aseptic technique
  3. Inform newbor staff if signs of infection are noted
  4. Antibiotic therapy initated before or after birth when infection is indentified
  5. Assess maternal pulse, respirations, and B/P hourly if fever present
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75
Q

What is PROM?

A

Prematrue rupture of membranes before the onset of tru labor regarless of festational age

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76
Q

What is PPROM?

A

Preterm premature rupture of membranes rupture of membranes before 37 weeks gestation
1. Associated with preterm labor and birth
2. The greatest risk to newborn is birth before 32-34 weeks
3. Infection risk increases if not delived within 24 hours of rupture

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77
Q

What conditions are associated with PPROM?

A
  1. infection of the vagina or cervix
  2. weak structure of the amniotic sac
  3. Previous preterm birth, especially if preceded by PPROM
  4. Fetal abnormalities or malpresentation
  5. Incompetent or short cervix
  6. Over distension of the uterus
  7. Maternal hormonal changes
  8. Maternal stress or low socioeconomic status
  9. Maternal nutritonal deficiencies and diabetes.
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78
Q

How is the managment of PROM decided?

A

Managment depends on gestational age
1. 1st- verify ruptured membranes
2. 2nd- if gestation is near term
- Labor does not begin spontaneously-induction of labor is initated
3. 3rd- if gestation is preterm- less than 36 weeks
- provider weights risks for maternal-fetal infection
- newborn’s risk for complication for prematurity

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79
Q

How do we therapeutically manage PROM?

A
  1. Short-term tocolytics to delay delivery and administer corticosteriods
  2. Consider- fetal age, lung maturity, amount of amniotic, and signs of fetal compromise
  3. No evidence of infection or fetal lung immaturity- admit and observed for infection or labor
    • Daily non-stress tests are performed
    • biophysical profiles
    • Fetal lung maturity testing
    • Maternal antibiotics- 7days course of antibiotics
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80
Q

What is our patient teaching for PROM?

A

Very important to verify patient understanding
1. Aboid sexual intercourse, orgasm or inserting anything into the vagina
2. Avoid breast stimulation with preterm gestation
3. Take temperature at least 4 times per day, reporting anything over >37.8c (100F)
4. Maintain activity restrictions
5. Note and report uterine contractions or a foul odor to vaginal drainage.

Patient hospitalized (in this region) until birth, some may be managed at home

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81
Q

What is preterm labor?

A

Labor that begins after 20th gestational week but before the 37th weeks

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82
Q

Infants born not equipped for extrauterine life are at risk for of developing what complications?

A
  1. Cerebral palsy, develppmental delays, vision and or hearing impairments
  2. significant emotional and financial burdens for the families.
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83
Q

True or false: They are racial disparity that exists in preterm birth rates?

A

True- african americans are at highest risk

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84
Q

What are risks factors for preterm labor?

A
  1. Uterine over distention
  2. Decidual (endometrium) activation
  3. Prematrue activations for normal physiological inition of labor
  4. Inflammation and infection in decidua, fetal membranes and amniotic fluid.
85
Q

What are inidcations that can help us predict preterm labor?

A
  1. cevical length- if its shortening
  2. Infections
  3. preterm premature rupture of membranes in previous births
  4. Fetal fibronectic (fFN) test- high negative predictive and low postive predictive value.

Goal is to identify preterm labor- delay birth and promote futher fetal maturation

86
Q

What are our inital measures to stop preterm labor?

A
  1. identify and treat infections or other causes
  2. limit activity- encourage a side-lying or semi-setting position
  3. hydration
    • Oral fluids may reduce uterine irritability and the risk of UTIs
    • Iv fluids are ordered on outpatient basis
    • High IV infustion volumes- maternal respiratory distress-pulmonary edema
87
Q

What do we need to know about tocolytics with preterm labor?

A
  1. have not demonstrated a decrease in the rate of preterm birth
  2. Can successfully delay birth to provide time for the following:
    • Maternal corticosteriods
    • antibiotics to prevent neonatal infection with GBS
    • transfer to a tertiary facility
    • give magnesium sulfate for neuroprotection.
88
Q

What is the action of MgSO4 Magnesium Sulfate in perterm labor?

A

Depresses myometrium contractility; CNS depressant

89
Q

What is the dosage for Mag sulfate when used in preterm labor?

A

Load: 4g in 20-30min
theb
IV: 2g/hr via pump

Therapeutic level 5-8mg/dl’

90
Q

What is the antidote for magnesium sulfate used in preterm labor ?

A

Calcium gluconate

91
Q

What is the maternal effectsof mag sulfate used in preterm labor?

A
  1. flushing
  2. dry mouth
  3. lethargy
  4. headache
  5. muscle weakeness
  6. pulmonary edema
  7. Cardiac arrest
92
Q

What are the fetal effects of mag sulfate used in preterm labor

A
  1. lethargy
  2. hypotonia
  3. resp depression
  4. may reduce risk of cerebral palsy in neonate; shown to offer neuro-protection in preterm infant
93
Q

What is our nursing managment for mag sulfate?

A
  1. Monitor FHR
  2. Contractions
  3. MgS04 levels
  4. Monitor for s/s of maternal toxicity
    • absent DTRs
    • Resp <12
    • Severe hypotension
    • decreased LOC
    • Pulmonary edema
    • Chest pain
    • Urine output <30ml/hour
94
Q

What is the action of Prostaglandin Synthesis Inhibitors
(Indomethacin sodium; naproxen sodium; fenoprofen) used in preterm labor

A
  1. Depresses synthesis of prostaglandins efffective in delaying deliver 48+ hours generally used short term due to fetal side effects
  2. Used in pregnancies less than 32 weeks
  3. NSAID
95
Q

What is the dosage for prostaglandin syntheis inhibitors for preterm labor?

A
  1. indomethacin sodium 50mg orally loading dose, the 25-50mg orally q 6 hours

Should not be used longer than 48 hours

96
Q

What are the maternal effects prostaglandin used in preterm labor?

A
  1. nausea
  2. heartburn
  3. GI upset
  4. Pulmonary edema
  5. blurred vision
  6. headache
  7. PPH
97
Q

What should we know about fetal effects of prostaglandin in preterm labor?

A
  1. Contriction of ducturs arteriosus
  2. Pulmonary hypetertension
  3. reversible decrease in renal function with oligohydramnios
  4. intra-ventricular hemorrhage
  5. hyperbilirubiemia
  6. NEC
98
Q

What is our nursing managment for prostaglandin syntheisis used in preterm labor?

A
  1. Monitor FHR and uterine contractions
  2. Treat nausea and heartburn
  3. MOnitor for manifestions of pulmonary edema
  4. monitor for PPH
99
Q

What is the action of Nifedapine Nicardipine (procardia, adalat) used in preterm labor

A
  1. Blocks calcium availiablity for muscle contractions
  2. effective in delaying delivery 48-72 hours
100
Q

What should nifedaoien Nicardipine (procardia, adalat) not be administed with?

A
  1. Should not be admin concurrent with mag sulfate
  2. Do not use with Terbutaline
101
Q

What is the dosage for Nifedapine Nicardipine (procardia, adalat) used in preterm labor?

A
  1. 10-20mg PO q4-6 hours
102
Q

What are the maternal effects of nifedapine nicardipine (procardia, adalat)? in preterm labor

A
  1. flushing
  2. headache
  3. dizziness
  4. nausea
  5. transient hypotenson
  6. pulm edema

caution should be used in patients with renal disease and hypotension

103
Q

What are the fetal effects of nifedapine nicardipine (procardia, Adalat) in preterm labor

A
  1. None noted yet
  2. May decrease utero-placenta blood flow
104
Q

What is our nursing managment for nifedapine nicardipine (procardia, adalat) in preterm labor

A
  1. Monitor FHR and UC’s
  2. Monitor maternal blood pressure and heart rate
  3. hold dose for blood pressure less than 90/50 or heart rate >120
105
Q

What is the action for terbutaline & ritordine in preterm labor?

A
  1. Suppress uterine activity
  2. Can delay delivery for 3 days
  3. IV or sq
106
Q

What is the dosage for Terbutaline and ritodrine for preterm labor?

A

Terbualine
1. IV max dose 0.08mg/min
2. SQ; 0.25mg q3-4 hours

Ritodine IV
1. Max dose 0.350mg/min

107
Q

What are the maternal effects of terbutaline & ritodrine used for preterm labor

A
  1. Cardiac or cardiopulmonary arrhythmias
  2. pulmonary edema
  3. myocardial ischemia
  4. hypotension
  5. tachycardia
  6. elevation in maternal glucose
  7. hypokalemia
108
Q

What are the fetal effects of terbutaline & ritodrine used in preterm labor?

A
  1. Fetal tachycardia
  2. hypersulinemia
  3. hyper-glycemia
  4. myocardial and septal hypertrophy
  5. myocardial ischemia
109
Q

What is our nursing managment for terbutaline and ritaodrine which is used in preterm labor

A
  1. monitor fhr and UC
  2. Monitor I&O for overload
  3. Ausculate lungs for pulmonary edema
  4. Monitor maternal hr and may hold dose for heart rate >120
  5. Monitor blood glucose
110
Q

What do we need to know about atenatol corticosteriods- bethamethasone or dexamethasone

A
  1. Recommened administration between 24-34 weeks- risk for preterm birth within 7 days
  2. Reduces incidence/severity of RDS and intraventricular hemorrhage in preterm infant
  3. Active infection is a relative contraindication
  4. Precaustion should be used with pregnancies complicated by diabetes
  5. Infants born sooner than 24 hours after administration may still have some benefit– takes about 2 days to deliver the dose
111
Q

What is postterm Pregnancy?

A
  1. Pregnany that lasts longer than 42 weeks
112
Q

What is a common cause of postterm pregnancy?

A

Some cases of prolonged pregnancy-miscalculation of EDD

113
Q

What are the risks to the fetus if pregnancy is >42 weeks?

A
  1. placenta insufficiency- increasesthe risk for stillbirth the longer the pregnancy lasts
  2. Meconium aspiration syndrome
  3. Fetus may continue to grow-complications dysfunction labor, lacerations or infections
114
Q

How do we manage a posterm pregnancy?

A
  1. Accurate determination of due date- EDC confirmation.. ultrasound early pregnancy to get femor lengths and gestational age
  2. Induction of labor– induction is usually done at 39 weeks anytime before that is usually due to secondary complication
115
Q

What is labor dystocia?

A
  1. Difficult birth resulting from any cause
  2. Can result from any one or all of the p’s
    • Powers- ineffective uterine contractions and secondary bearing down effects
    • Passage-maternal pelvis, uterus, cervix, vagina, perineum
    • Passenger-fetal size, fetal position, placenta
    • Position of the laboring women- (TURN)
    • Psyche- response to labor-anxiety
116
Q

What is shoulder dytocia?

A

Obstetrical emergency- shoulder becomes impacted above the maternal symphysis pubis- usually a large infant (IDM)

117
Q

What is a complication of shoulder dystocia?

A
  1. Cord can be compressed between the fetal body and maternal pelvis
118
Q

What is an inital sign of shoulder dystocia?

A

Turtle sign

119
Q

What is our managment of shoulder dystocia?

A
  1. Team prepares for STAT sugrical delivery, as urgent steps for vaginal deliver are taken
  2. call for help
  3. Priority Nursing action- McRoberts Maneuver
  4. one staff member keeps time
  5. Suprapubic pressure may be appled to move the impacted shoulder past symphysis
  6. After delivery, infant clavicals should be checked
120
Q

What is an inital signs of persistent OP?

A

Low back pain– counterpressure may help

121
Q

What are some maternal position changes to promote fetal head rotation?

A
  1. Hands and knees
  2. side-lying especially far side-lying with the use of peanut ball
  3. Squatting (for second stage)
  4. Sitting, kneeling, or standing while leaning forward
  5. Physcian may assist rotation using forcepts
122
Q

What might be required for a baby that is presenting brow, military or face?

A

Csection

123
Q

What should we know about breech presentation in delivery?

A

greatest fetal risk is that head is last be born
1. Umbilical cord may be compressed
2. Head can become entrapped if cervix lamps around neck— late decels on fetal monitor may be present

124
Q

What do we need know about prolonged labor

A
  1. Maternal and neonatal infections are more likely with prolonged ruptured membranes
  2. New research is changing what we believed about the “normal” length of labor
    • nuli and mulipara- 6 hours to progress from 4-5 and 3hrs to progress from 5-6c,
    • After 6cm multipara progresses faster than nuliparas
    • Nuliparas 2nd stage labor without epidural 2.8hrs vs. with labor 3.6hrs.
125
Q

What is a precipitous labor?

A

Birth occurs within 3 hours of onset

126
Q

What should we know about precipitious labor?

A
  1. Can cause trauma to genital tract of mother or babies head
  2. Can cause trauma to infant such as bruising, intracranial hemorrage or nerve damage-hyperbilirubinemia
  3. Women should be supported, and staff should be alert to rapid labor progress and be prepared for delivery of the fetus?
127
Q

What are our nursing care priorities with a preciptious labor?

A
  1. FHR
  2. fetal oxygenation
  3. maternal comfort
    4.
128
Q

What is associated with precipitous labor?

A
  1. Placental abruption
  2. Fetal meconium
  3. Infection
  4. Maternal cocaine use
  5. PPH
  6. Low APGAR scores
129
Q

HTN disorders- Pregnancy-specific syndrome is what?

A

Leading cause of maternal morbidity and mortality
1. Divided into clinical subsets
2. Progressive disease- can be managed but the ONLY CURE is delivery of the fetus
3. The underlying mechanism is vasospasm which leads to poor tissure perfusion
4. Can occur simultaneously with chornic hypertension

130
Q

HTN disorders in pregnancy are associated with…

A
  1. Placental abruption
  2. kidney failure
  3. Hepatic rupture
  4. Preterm birth
  5. fetal and maternal dealth
131
Q

What do we need to know aobut gestational htn (GH)

A

1.Begins after 20th week gestation- anything before the 20th week we should be thinking molar pregnancy unless she has hx or HTN prior to pregnancy
2.Elevated B/P of equal to or >140/90 recorded on two different occasions at least 4 hours apart
3.No proteinuria

132
Q

What should we know about Preeclampsia?

A
  1. GH with the addition of equal to or >1+ protienuria
  2. Possible transient headaches along with epiodes of irritability
  3. Edema may be present- ankles and feet are normal but if we start to see swelling in fingers, nose, face we are probably progressing to preeclampsia esp. if she has protien in urine and 2 HTN reading
133
Q

What should we know about severe preeclampsia?

A
  1. B/P equal to or >160/110
  2. protienuria >2+ or 3+
  3. Oliguria (<100ml in 4 hours)
  4. CNS symptoms; severe headache, visual distrubances (blurred, statoma which is blacks spots could be indicitive of a incoming seizure
  5. Extensive peripheral edema; pulmonary edema or cyanosis
  6. Impaired liver function
  7. Hyperreflexia (3+) with possible ankle clonus
  8. Thrombocytopenia, elevated serum creatine, marked liver enzyme elvations
  9. epigastric and right quadrant pain- often time mistake for indigestion when really its referred pain from liver
134
Q

What is HELLP syndrome?

A

H: Hemolysis RBC cant carry oxygen and iron
E: Elevated: AST & LFT
L: Liver Enzymes: Edema- not filtering well. This is whaat causes the pain
L:Low
P: Platelets: Clotting helper helper increased risk PPH

135
Q

What are the symptoms of HELLP?

A

Epigastric or RUQ pain, malaise, lower right chest or mid-epigastric area, nausea and vomiting

135
Q

What is HELLP syndrome?

A
  1. Many patients are normotensive and do not have proteinuria- still need mgSO4
  2. Hepatic rupture, renal failure, ane preterm birth can lead to fetal and maternal dealth
  3. Should be managed in a setting with ICU facilities

They die from not being able to clot and bleeding… literally bleed from everywhere

136
Q

When does preeclampsia turn into eclampsia?

A
  1. New onset grand mal seizure in pregnant women with preeclampsia or new onset seizure 48-72 hours postpartum (or longer)
137
Q

What are the warning signs of impending eclamptic seizure?

A
  1. Severe headache, drowsiness or mental confusion
  2. Severe epigastric pain is particulary omnious
  3. Hyperreflexia or clonus
  4. n/v
  5. decreased urinary output indicates poor renal perfusion
  6. Visual distrubances such as blurred, double vision, or seeing spots
  7. Hemoconcentration
138
Q

What is our seizure managment for eclampsia?

A
  1. Priority is prevention of injury and stabilization of the mertnal airway
  2. Monitor fetal heart rate and for contractions
  3. keep patient on her side
  4. suction equipment readily available
  5. Side rails padded and up

priority during seizure is too keep patient safe and keep them from hurting themselves– secure airway after seizure is done

fetal heart rate might show dcels

139
Q

How is preeclampsia managed?

A
  1. Do NOT restrict salt in the diet- stay on pregnancy diet
  2. ONLY CURE IS DELIVERY of baby and placenta
    • decision is based on severity of disease and degree of fetal maturity
    • Delivery indicated at 3\ weeks gestation even without severe features
  3. If <34 weeks gestation and delivery can be delayed 48 hours
    • admin corticosteriods to mature fetal lungs
140
Q

How is severe preeclampsia managed?

A
  1. Requires hospitalization-antepartum, OBICU,L&D
  2. bed rest and fetal monitoring
141
Q

What should we know about homecare and HTN disorder?

A

May be possible if the women does not have severe preeclampsia and no evidence of worsening fetal or maternal status

142
Q

What should we teach patients when care for HTN disorders are done at home?

A
  1. Reduce activity (sedentary most of the day)
  2. Home blood pressure monitoring
  3. Follow-up with provider every 3-4 days
  4. Fetal activity checks (kick counts)
  5. Left lateral position as much as possible
143
Q

What should we know about intrapartum care for htn disorder?

A
  1. 1/2 of eclamptic seizures occur during labor or for the 1st 48 hours after birth
  2. Fetus and mother should be monitored continously
  3. Mother should be kept in lateral position
  4. Decrease stimulation/agitation-limit visitors and control pain
  5. Large bore IV access
  6. Urine protien every hour
  7. Hourly I&O
  8. B/Ps q 15-30min- until stablized then MD may adjust frequency
144
Q

What should we know about postpartum care with HTN disorders in pregnancy?

A

1.Careful assessment of blood loss and signs of shock are essential
- Vs q 4 hours
2. Monitor for visual distrubances
3. Adminstration of magnesium for 24 hours after delivery or last seizure

145
Q

What are signs of recovery with a patient with HTN disorders during pregnancy?

A
  1. Diuresis
  2. decreased protien in urine
  3. Return of b/p to normal
  4. Resolution of abnormal labs
146
Q

What is our 1st line antihypertensives that help perserve uteroplacental blood flow?

A
  1. Labetalol- Less maternal tachycardia and fewer adverse effects
  2. Hydralazine- Headaches, maternal hypotension, fetal distress
  3. Nifedine- Reflex tachycardia, headaches, and synergistic effect with magnesium sulfate may cause hypotension and neuromuscluar blockade
147
Q

What should we know about Mag Sulfate and its use in htn disorders of pregnancy

A
  1. Used to prevent seizures
  2. CNS depressant- depresses CNS irritability relaxes smooth muscle
    • prevents and controls seizures in severe preeclampsia
    • Prevents contractions in preterm labor
    • Offers neuroprotection of the preterm fetus
148
Q

What is the dosage and route of mag sulfate used in htn disorders of pregnancy

A
  1. IV loading dose of 4-6g administered over 15-20min
  2. Mag sulfate drip is piggybacked into the most proximal port of the mainline IV infusion
  3. Contionous infusion of 1-2g/hr. should be administered by infusion pump
149
Q

What are signs of mag toxicity?

A
  1. Respiratory difficulty/depression
  2. Chest pain
  3. mental confusion; slurred speech
  4. depressed deep tendon reflexes
  5. flushing,sweating, lethagy– initally okay but should not continue
  6. hypotension
150
Q

What should our repspone be to signs and symptoms of mag sul tox

A
  1. STOP THE MAG
  2. notify provider
  3. be prepared to admin calcium gluconate
  4. resucitation equipment at bed side
151
Q

Monitor for mag tox by oberserving for what
important

A
  1. R/R less that 12- STOP the mag
  2. Absent DTR- STOP the mag
  3. Hourly urine output less than 30ml/hr- STOP the mag
  4. Mag serum level about 8mg/dl- STOP the magnesium (theraputic is 5-8mg/dl)
152
Q

What should we ensure is ready when administering mag sulfate?

A

1.Ensure that calcium gluconate (antidote) is readily available
2.If toxcity occurs- STOP the mag, call provider and give calcium gluconate
3.Calcium gluconate can cause fatal arrthymia-cardica monitoring advised

Both mag and and calcium gluconate are 2 nurse check drugs. Give 1ml per min of the calcium gluconate– 7-10mins total

153
Q

What should we know about obesity in pregnancy

A
  1. Obesity has become a public health epidemic in the USA
  2. Pregnancy can exacerbate obesity related comorbitidies- HTN & diabetes
  3. Obesitiy significally increases risk to mother fetus and neonate
154
Q

What are the maternal risks of obesity?

A

1.gestational diabetes
2.PReeclampsia
3.thromboembolism
4.csection
5.preterm birth
6.birth trauma
7.PPH
8.postpartum anemai

155
Q

What are fetal/neonatal risk factors of obsesity in pregnancy?

A
  1. Stillborn
  2. NTD’s
  3. Hydrocephaly
  4. cardiovascular defects
  5. Macrosomia
  6. Hypoglycemia
  7. birth injury-shoulder dystocia
  8. NICU admissions
156
Q

What should we know about pregnancy after bariatric surgery?

A
  1. Postpone pregnancy for 12-14 months after surgery
  2. Assess for vitamin and nutritional deficiency
  3. Monitor for signs of interstion obstruction
  4. Education, health promotion, monitoring for complications and psychological support are vital
157
Q

What should we know about cardiac disease and pregnancy?

A
  1. Now the leading cause of indirect maternal death
  2. Hemodynamic changes in pregnancy have a profound effect on patients with cardiac disease; managment related to the disorder present and impact on cardiac funciton
  3. assess for cardiac decompensation
158
Q

What are our goals with Class 1 and II cardiac diseases?

A
  1. limit physical activity
  2. avoid excessie weight gain
  3. prevent anemia
  4. prevent infection
  5. careful assessment for the development of CHF or pulmonary edema
159
Q

What are our goals for class III or IV cardiac disease?

A
  1. primary goal- prevent cardiac decompensation and devleopment of CHF
  2. May need to rest most of the day
  3. Cardiac decompensation is likely with little or no activity
160
Q

What is our antepartum managment of a pregnant women with cardiac diseases?

A
  1. Prevent valsalva maneuvers even during the second stage
  2. avoid the use of stirrups
  3. try to minimize the effects of labor on the cardiovascular system, may need to operative assist
  4. manage VI fluid administerion to prevent fluid overload
  5. Position women on her side with head and shoulder elevated
  6. Pulse ox to monitor o2 sat- use o2 is sats is under 95%
  7. administer pain meds/epidural earlier
  8. quiet and calm environment
  9. fetus moonitored contionusly
  10. signs of cardiac decompensation should be reported immediately
161
Q

What is our postpartum managment of mom who delivered and has cardiac disease?

A
  1. Fourth stage of labor associated with risks-monitor closely
  2. After placenta delivery, 500-1000ml of blood return to intravascular volume
    • 80% increase in cardiac output in 10 to 15 min
  3. Avoid abrupt position changes
  4. No evidence of distress in intrapartum, may have cardiac decompensation postpartum
  5. Observe closely for signs of infection,PPH, and thromboembolism
  6. Breastfeeding imposes extra demands on the heart-advised on an individual basis
    • Lactation consultant- which drugs safe for breastfeeding
162
Q

What is hyperemesis gravidarum?

A
  1. Persistent, uncontrollable vomiting that begins in the 1st few weeks of pregnancy and my continue throughout pregnancy
163
Q

What might a patient with hyperemesis gravidaum experience?

A
  1. Loss of 5% or more of pre-pregnancy weight
  2. Dehydration-increased urine specific gravity and oliguria
  3. Acidosis from starvation or alkalosis from loss of acid in gastric fluids
  4. Fluid and electrolyte imbalance
  5. Elevated levels of blood and urine keytones
  6. Hypokalemia
  7. deficeincy of vitamin thiamin, riboflavin, vit b, vit a, and retinonol-binding protiens
  8. Psychological stress
164
Q

How do we manage hyperemesis gravidarum?

A
  1. Exclude other causes of persistent n/v
  2. assess Hgb and Hct levels, electrolytes-report abnormalities
  3. Treatment occurs primary at home-inital steps
    • Try to control nausea with methods used for morning sickness
    • Possible additonal vitamins
    • Prescription antemetics
  4. If simpler methods are unsuccessful and weight loss or electrolyte imblance perists
    • Iv fluid and electrolyte replacement as an outpatient- rapid improvment in some women
    • TOtal parentral nuttriton (TPN) may be considered if all other treatmetns do not work
165
Q

What is our nursing interventions/teaching for hyperemesis gravidarum?

A
  1. Record of elimination and observe for signs of dehydration
  2. Daily weight in hospital
  3. Food should be attractily presented in small portions; low fat and easily digested
  4. soups and other liquids in between meals
  5. use ginger
  6. sit upright after meals
  7. provide emotional support
166
Q

What are the two groups that diabetes is divided into in pregnancy?

A
  1. pre-gestation: type 1 or type 2 known diabetic- no need for screening
  2. Gestational: glucose intolerance not present before pregnancy
167
Q

What are some diabetes and pregnancy quick facts?

A
  1. Prengnacy is a condition characterized by progressive insulin resistance
  2. Glucose is transported across the placenta easily by carrier-mediated facilitated diffusion; maternal insulin does not readily cross the placenta
  3. Glucose levels in the fetus are directly proportional to maternal levels
  4. 10th week gestation- fetus begins secreting insulin at levels adequate to use maternal glucose
  5. 2nd and 3rd trimesters- pregnancy exerts a diabetogenic effect of maternal metabolic status
168
Q

How do we test for gestational diabetes?

A
  1. 1hr glucose challenge test (24-28weeks)
    • Patient ingests 50g of oral glucose solution and a blood sample is taken 1 hour later
    • If blood glucose is equal or >140g/dl then a 3 hours oral GTT is recommended
169
Q

What should we know about the hour oral glucose tolerance test?

A
  1. Gold standard for diagnosing diabetes
  2. Women must fast from midnight on the day of the test
  3. Obtain fasting plasma glucose, patient then ingests 100g of oral glucose solution
  4. Plasma glucose are determined at 1,2 and 3 hours post injections
  5. at least two or more values must meet or exceed the threshold for a postive diagnosis
170
Q

What are the insulin requirements during the 1st trimester?

A
  1. Decreased need for insulin- r/t sickness and not feeling well
171
Q

What are the insulin requirement during the 2nd trimester?

A

increased need for insulin; glucose use increases
r/t decrease in sickness and weight gain

172
Q

What are the insulin requirements during 3rd trimester?

A

Increased need for insulin due to placental maturation and human placental lactogen (hPL) production

173
Q

What is the insulin requirement during labor?

A
  1. Usually decreased need for insulin-diabetic women will have glucose level checked hourly and contionous infusion of insulin and glucose is started if needed
174
Q

What is the insulin requirement for postpatrum period

A

Decreased need for insulin-breastfeeding helps lower the amount of insluin needed
r/t going back to prepregnancy status and level needs

175
Q

What is the fetal effects from maternal hyperglycemia?

A
  1. fetal death
  2. macrosomia-LGA
  3. IUGR if mother is type 1 with vascular changes
  4. RDS-resp distress
  5. Hyperbilirubinemia
  6. hypoglycemia
  7. prematurity
  8. cardiomyopathy or cardiac anomaly
  9. congential defects
  10. psychiatric disorders
176
Q

What are the maternal complications from diabetes?

A
  1. Infection
  2. Preeclampsia
  3. Hydraminos
  4. Ketoacidosis
  5. Hypoglycemia
  6. Hyperglycemia
177
Q

What is our patient self-management of diabetes?

A

Extensie teaching on all aspects of care
1. Check blood glucose levels 4-8 per day
- Record blood glucose levels, food intake, activity, and insulin
2. Self-monitor of urine ketones
3. Provide an expected paln of prenatal care, tests and fetal surveillance
4. Diet is individualized
5. provide an expected plan for delivery– higher risk of needing cesection due to large baby
6. Urine dipstick for glucose and protien each office visit
7. Exercise 3 times/weeks for at least 20 mins unless contraindicated
8. Know symptoms of hypoglycemia; always have fast-acting carbohydrate
9. daily kick counts

178
Q

If a person with Rh (-) is exposed to Rh+ blood what happens

A
  1. Antigen-antibody response occurs
  2. Antibodies form Rh(-) person is considered sensitized (alloimmunized;isoimmunized)
  3. Sensitization may occur in the antepartum via small tranplacental bleeds
179
Q

What are the fetal/neonatal risks for RH incompatiblity?

A
  1. Primarly for subsequent pregnancys after isoimmunization
  2. Hemolysis is caused by maternal IgG antibodies
  3. Results in fetal anemia
    • Fetus increases RBC producation; presence of nucleated RBC (erthroblasts)- erythroblastosis fetalis
    • RBC destrcution can lead to hyperbilirubinemia (kernicterus)
    • Untreated anemia causes fetal edema called hydrops fetalis
180
Q

What is hydrops fetalis?

A

Fetal edema

181
Q

How are moms screend for Rh incompatibility and sensitization?

A
  1. Maternal blood type, Rh factor, Rh antibody screen- begins at 1st prenatal visit
  2. Maternal Rh factor is negative with a negative antibody screen
    • Rho(D) immune globulin will be give at 28 weeks
    • If there is a risk for maternal/fetal blood mixing (amnio, CVS, abruptio placentae, trauma, EVC)
  3. Repeat antibody screen in Rh(-) women at delivery if baby is Rh(+)
    • Indirect coombs test- detects antibodies against RBCs present unbound in the patients serum
182
Q

What should we know about Rh immune globulin products?

A
  1. Prevent the producation of anti-rh(D) antibodies
  2. Rh(d) immune globulin-consent required-blood products
    • antepartum: 1500IU/300mcg IV/IM at 28-30 weeks\
    • Postpartum: 1500IU/300mcg IV/IM within 72hrs of delivery if Rh+ fetus
    • Given any risk of blood mixing (trauma, abortion, etc.)
183
Q

Is Rho(D) given to a mother that is alloimmunized?

A

It will not be adminstered to the patient- it is too late

184
Q

What do we do if a patient with a negative blood type is sesitized and pregnant?

A
  1. Anti-d antibody titers are evaluated every 2-4 weeks, beginning at 16-18weeks gestation
  2. If titers remain negative- fetus is not at risk
  3. Goal: birth of a mature fetus who has not devleoped severe hemoysis/anemia in utero
185
Q

What should we know about ABO incompatibility?

A
  1. Common, with rare signficant hemolysis
  2. Most cases involve type o mothers with type A and B fetus
  3. Anti-a and anti-b antibodies are naturally occuring
  4. Once pregnant, maternal anti-a and anti B antibodies cross the placenta and cause hemoysis of fetal RBCs
  5. Not treated during antepartum period
  6. Affected neonates-mild anemia, hperbilirubinemia
186
Q

How is ABO incompatibility treated?

A

Blue light after delivery

187
Q

What is placenta accreta?

A
  1. Invasion of the trophoblast is beyound the normal boundary (80%)
188
Q

What is placenta increta?

A

Invasion of trophoblast extends into uterine myometrium (15%)

189
Q

What is placenta percreta?

A
  1. Invasion of trophoblast extends into uterine musculature; can adhere to other pelvic organs (5%)
190
Q

What is the tx for morbidly adherent placentas (placenta accreta, increta, percreta)?

A

Hysterectomy- watch for profuse hemorrhage- because they will not be able to get the placenta to detach?

191
Q

What is a prolapsed umbilical cord

A
  1. Umbilical cord slips under fetal presenting part
    • Usually occurs soon after ROM
    • Presenting part decends onto the cord, reduces or eliminates blood flow
192
Q

What are risk factors of a prolapsed cord?

A
  1. Breech
  2. high station
  3. preterm gestation
  4. High parity
193
Q

What might we see on the FHM with a baby whose cord prolapsed?

A
  1. Sustained bradycardia
  2. Variable decelerations
  3. Prolonged decels
194
Q

What are your steps if you feel loop of cord during vaginal exam?

A
  1. Call for assistance
  2. Gloved fingers- push upward lifting the fetal presenting part off of the cord
  3. Stop the oxytocin infusion
  4. Oxygen 10L/min nonrebreather
  5. Large-bore IV inserted (18g)
  6. Giver terbutaline sQ to decrease contractions
  7. notify anesthesiolgoy and neonatolgy
  8. Insert catheter- fill the bladder with 500ml warmed sterile saline
  9. Place patient on side, knees to chest or in knee-chest or trendelburg
  10. Maintain pressure on the presenting part until the fetus is born via csection
  11. Keep calm and keep family informed
  12. Promp delivery is a priority this is an EMERGENCY
195
Q

What should we know about trauma in pregnancy

A
  1. Tramua is the leading cause of maternal death during pregnancy
  2. maternal death by trauma- most often due to a abdominal injury
    • MVC most common
  3. Placental abruption- monitor up to 24 hours following trauma
  4. Uterine rupture
  5. penetrating trauma (such as gunshot wounds)
  6. Unresolved bleeding can lead to maternal exsanguination in 8-10mins
196
Q

What is a uterine rupture?

A
  1. Tear-wall of the uterus because the uterus cannot withstand the pressure
197
Q

What are the 3 variations of uterine rupture

A
  1. Complete-direct communication between uterine and peritoneal cavitites
  2. Incomplete- tear in the peritoneum lining of the uterus or broad ligament but not the peritoneal cavity
  3. Dehiscense- partial separation of an old uterine scare
    • little or no bleeding occurs, often no s/s
198
Q

What are the s/s of uterine rupture?

A
  1. FHM- earlist signs- non reassuring FHR, or absent FHR, and loss of contraction pattern
  2. constant abdominal pain or change in pain, cessation of contractions
  3. loss of fetal station on abdominal palpation
  4. referred chest or shoulder pain
  5. hematuria
  6. hypovolemia shock
199
Q

How do we manage a uterine rupture?

A
  1. Emergency csection-immediate blood products
  2. neonatal resucitation should be anticipated
200
Q

What should we know about anaphylactoid syndrome of pregnancy/Amniotic fluid embolism?

A
  1. Amniotic fluid enters the maternal circulation and is carried to the lungs
  2. Fetal particulate matter in fluid obstructs pulmonary vessels
  3. failure of the right ventricle occurs early and leads to hypoxemia
  4. left ventricular failure follows
  5. Abrupt resp. distress, depressed cardiac function and ciruclatory collapse occurs
  6. DIC is likely
  7. Disorder is often fatal and survivors have neuro defects
201
Q

What should we know about the effects of alcohol (depressant) use in pregnancy?

A
  1. Most common effect is teratogen
  2. Can cause physical and mental birth defects, preterm and miscarriages
  3. zero alcohol during pregnancy; passess swiftly to the fetus through the placenta
202
Q

What should we know about smoking/tobacco use in pregnancy?

A
  1. More likely preterm, weigh half a pound less and threefold risk of sids
  2. Nictoine reduces uterine blood flow
  3. Carbon monoxide binds to hemoglobin, reducing oxygen-carring capcity of blood
  4. abruptio placentae is a risk
  5. Residual effects past the neonatal period
    • deficits in growth, intellectual and emotional development and behavior
    • Increased risk for prematurity, bronchitis and pneumonia
203
Q

What should we know about methamphetmine use during pregnancy

A
  1. Cheap, highly addictive stimulant
  2. Seizures, heart attacks, strokes, and maternal dealth can occur with overdose
  3. Fetus at risk for IUGR, preterm birth, microcephaly, and abruptio placentae
204
Q

What should we know about cocaine use during pregnancy (risk factors for mom and dad)

A
  1. Maternal- vasoconstrition, seizures, abruptio placentae, hallucinations, pulmonary edema, cerebral hemorrhage, resp failure and heart problems
  2. Fetus-IUGR, microcephaly, cerebral infarctions, shorter body length, altered brain development, increased incidence of PROM, meconium staining and premature birth
205
Q

What should we know about the use of marijuana in pregnancy?

A
  1. Maternal- tachycardia, low blood pressure which can result in orthostatic hypotention
  2. Fetus- crosses to placenta; increases carbon monxide levels, reducing oxygen to fetus
  3. Shortented gestation and higher incidence of IUGR
  4. Neonates- altered response to visual stimuli, increased tremulousness, high-pitched cry
  5. Long-term effects- deficits in memory, attention, cognitive funciton or motor skills
206
Q

What should we know about the use of heroin/opiods in pregnancy

A
  1. Abuse is linked to adverse consequences for the mother and fetus
  2. Fetal risks-fetal physiological depenendance and maternal lifestyle associated with herion use
  3. Use methadone in labor-avoid giving naloxone
  4. NAS (neonatal abstinence syndrome)
207
Q

What are interventions for perinatal loss?

A
  1. Allow expression of feelings
  2. acknowledging the infant
  3. presents the infant to the parents
  4. preparing a memory packet
  5. respect cultureal practices
  6. assist with other needs
  7. provide follow -up including referrals

Module 6 (19 decks)

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