W3 Flashcards
Commonest medical disorder in pregnancy
Anemia
A condition where/ circulating levels of Hb are quantitatively or qualitatively lower than normal
Anemia
Non pregnant women
Hb < 12gm%
Pregnant women (WHO)
● Hb < 11 gm%
● Haematocrit < 33%
Pregnant women (CDC)
● Hb <11 gm%
1st&3rd Trimester
2nd trimester
● Hb < 10.5 gm%
During pregnancy Total iron requirement
● 800-1000 mg extra iron is required
300 mg for Fetus & 50 mg for Placenta
Normal diet contain about________ of iron
14 mg
So daily supplement of_________ of elemental iron is required during pregnancy
40-60 mg
Signs of anemia
● pallor
● facial puffiness
● raised Jugular vein
● tachycardia
● tachypnea
● crepitations in lung bases load)
● hepato-splenomegaly
● pitting edema over abdominal wall & legs
Most Critical Period of anemia
- 28-30 weeks or pregnancy
- In labor
- Immediately after delivery
- Early Puerperium
- CHF
Iron absorption enhanced by____________
citrous fruits, Vit C
______elemental iron &______ ug of folic acid daily during pregnancy and 3 months thereafter
60 mg
400
In anemia therapeutic doses are___________
180-200 mg /d
Iron supplementation is not recommended in_____ trimester
first
Iron_______ for parenteral use
sucrose
The vitamin is important to the growth of the fetus’s spinal cord and brain.
Folic Acid
can cause severe birth defects known as neural tube defects.
Folic acid deficiency
The Recommended Dietary Allowance (RDA) for folate during pregnancy is______ micrograms (ug)/day.
600
How is Folic Acid Deficiency Anemia Diagnosed?
- Folic Acid levels
- СВС
- Rarely a bone marrow exam
What Nursing Interventions are useful for Folic Acid Deficiency Anemia?
- Inspect skin, mucous membranes and tongue
- Inspect for jaundice
- Hair for premature graying
Radio active Vit B12 absorption test
(Schilling Test)
is a condition wherein vasospasm occurs during pregnancy in both the small and large arteries in the body.
Pregnancy induced hypertension (PIH)
Originally, it was called_____ because researchers pictured a toxin of some kind being produced by the woman in response to the foreign protein of’the growing fetus
toxaemia
develops an elevated blood pressure (140/90 mmHg) but has no proteinuria or edema. no drug therapy is necessary.
Gestational Hypertension
blood pressure rises to 140/90 mmHg, taken on two occasions at least six (6) hours apart.
proteinuria (1+ or 2+ on a reagent test strip on a random sample).
Mild Preeclampsia
160 mmHg systolic and 110 mmHg diastolic or above on at least two occasions 6 hours apart at bed rest.
• Marked proteinuria. 3+ or 4+ on a random urine sample or more than 5 g in a 24-hour sample and extensive edema are also present.
Severe Preeclampsia
cerebral edema is so acute that seizure or coma occurs.
Eclampsia
HELLP Syndrome
Hemolysis
Elevated
Liver Enzymes
Low Platelet Count
group of physical changes including the breakdown of red blood cells, changes in the liver and low platelets (cells found in the blood that are needed to help the blood to clot in order to control bleeding).
HELLP syndrome
Medical Management for HELLP syndrome
Antiplatelet therapy.
To avoid progression of the disease to eclampsia,_______,_________, and_________ may be prescribed to reduce hypertension.
hydralazine
nifedipine
labetalol
time-honored term to denote that sluggishness of contractions, or the force of labor, has occurred
Inertia or dysfunctional labor.
Dysfunction can occur at any point in labor, but it is generally classified as primary (occurring________of labor) or secondary (occurring_____ in labor)
at the onset
later
number of contractions is unusually low or infrequent (not more two or three occurring in a 10-minute period). The resting tone of the uterus remains less than 10 mm Hg, and the strength of contractions does not rise above 25 mm Hg.
Hypotonic Contractions
Hypotonic contractions are most apt to occur during the _____ phase of labor.
Active
increase in resting tone to more than 15 mmHg. However, the intensity of the contraction may be no stronger
Hypertonic Contractions
hypertonic ones tend to occur frequently and are most commonly seen in the_______ phase of labor.
latent
This type of contraction occurs because the muscle fibers of the myometrium do not repolarize or relax after a contraction, thereby “_________” to accept a new pacemaker stimulus. They may occur because more than one pacemaker is stimulating contractions.
wiping it clean
A contraction sweeps down over the organ, encircling it; repolarization occurs; relaxation or a low resting tone is achieved; and another pacemaker activated contraction begins.
Uncoordinated Contractions
Uncoordinated contractions may occur so closely together that they do not allow good
cotyledon
uterine contractions are so strong that a woman gives birth with only a few, rapidly occurring contractions.
Precipitate Labor
latent phase that is longer than 20 hours in a nullipara or 14 hours in a multipara. This may occur if the cervix is not “ripe” at the beginning of labor and time must be spent getting truly ready for labor.
Prolonged Latent Phase
With a prolonged latent phase, the uterus tends to be in a
hypertonic state
is usually associated with cephalopelvic disproportion (CPD) or fetal malposition, although it may reflect ineffective myometrial activity
Protracted Active Phase
deceleration phase has become prolonged when it extends beyond 3 hours in a nullipara or 1 hour in a multipara.
Prolonged Deceleration Phase
Prolonged deceleration phase most often results from
abnormal fetal head position.
occurred if there is no progress in cervical dilatation for longer than 2 hours.
secondary arrest of dilatation
the rate of descent is less than 1.0 cm/hr in a nullipara or 2.0 cm/hour in a multipara.
Prolonged Descent
no descent has occurred for 1 hour in a multipara or 2 hours in a nullipara.
Arrest of Descent
hard band that forms across the uterus at the junction of the upper and lower uterine segments and interferes with fetal descent.
Contraction Rings
The most frequent type seen is termed a pathologic retraction ring
(Bandl’s ring).
Administration of IV __________or the inhalation of ___________may relieve a retraction ring.
morphine sulfate
amyl nitrite
occurs most commonly when a vertical scar from a previous cesarean birth or hysterotomy repair tears (it occurs in less than 1% of women who have a low transverse cesarean scar from a previous pregnancy; about 4% to 8% of women who have a classic cesarean incision).
Rupture
With a complete rupture, uterine contractions will immediately stop. Two distinct swellings will be visible on the woman’s abdomen:
retracted uterus and the extrauterine fetus
uterus turning inside out with either birth of the fetus or delivery of the
placenta.
Uterine Inversion
It may occur if traction is applied to the umbilical cord to remove the placenta or if pressure is applied to the uterine fundus when the uterus is not contracted.
It may also occur if the placenta is attached at the fundus so that, during birth, the passage of the fetus pulls the fundus down.
Uterine Inversion
a loop of the umbilical cord slips down in front of the presenting
fetal part.
umbilical cord prolapse
Cord prolapse automatically leads to
cord compression
This may be done by placing a gloved hand in the vagina and manually elevating the fetal head off the cord, or by placing the woman in a________________, which causes the fetal head to fall back from the cord.
knee–chest or Trendelenburg position
Initially, approximately 500 mL is infused (amnioinfusion), and then the rate is adjusted to infuse the least amount necessary to maintain a monitor pattern without variable decelerations.
Be sure the solution is_______ to body temperature before the infusion, to prevent chilling of the woman and fetus.
warmed
A scalp blood pH greater than_____ is considered normal for a fetus during labor
7.25
the fetal position is posterior rather than anterior. That is, the occiput (assuming the presentation is vertex) is directed diagonally and posteriorly, either to the right (ROP) or to the left (LOP).
In these positions, during internal rotation, the fetal head must rotate, not through a 90-degree arc, but through an arc of approximately 135 degrees
Occipitoposterior Position
Posterior positions tend to occur in women with
android, anthropoid, or contracted pelvis.
Because the fetal head rotates against the sacrum, a woman may experience____________________ owing to sacral nerve compression.
pressure and pain in her lower back
Applying counterpressure on the sacrum by a___________ may be helpful in relieving a portion of the pain. Applying heat or cold, whichever feels best, also may help
back rub
Most fetuses are in a breech presentation early in pregnancy. However, by week_____, a fetus normally turns to a cephalic presentation
38
With a breech presentation, fetal heart sounds usually are heard high in the
abdomen
rotation is allowed to occur, to bring the head into the best outlet diameter.
External
A second danger of a breech birth is
intracranial hemorrhage.
occurs in women with pendulous abdomens, with uterine fibroid tumors that obstruct the lower uterine segment, with contraction of the pelvic brim, with congenital abnormalities of the uterus, or with hydramnios.
Transverse lie
A mature fetus cannot be delivered vaginally from this presentation. Often, the membranes rupture at the beginning of labor. Because there is no firm presenting part, the cord or an arm may prolapse, or the shoulder may obstruct the cervix. Cesarean birth is necessary.
Transverse lie
A fetal head presenting at a different angle than expected is termed
asynclitism
presentation is rare, but when it does occur, the head diameter the fetus presents to the pelvis is often too large for birth to proceed.
Face (chin, or mentum)
The back is difficult to outline in this presentation because it is concave.
Face Presentation
In some infants, lip edema is so severe that they are unable to suck for a day or two.
________feedings may be necessary to allow them to obtain enough fluid until they can suck effectively.
Gavage
A_____ presentation is the rarest of the presentations
brow
Size may become a problem in a fetus who weighs more than______ (approximately 9 to 10 lb).
4000 to 4500 g
An oversized infant may cause uterine dysfunction during labor or at birth because of overstretching of the fibers of the
myometrium
The problem occurs at the______ stage of labor, when the fetal head is born but the shoulders are too broad to enter and be born through the pelvic outlet.
second
Although there is no evidence-based data, asking a woman to flex her thighs sharply on her abdomen (__________) may widen the pelvic outlet and allow the anterior shoulder to be born.
Applying________ pressure may also help the shoulder escape from beneath the symphysis pubis and be born
McRobert’s maneuver
suprapubic
narrowing of the anteroposterior diameter to less than 11 cm, or of the transverse diameter to 12 cm or less. It usually is caused by rickets in early life or by an inherited small pelvis.
Inlet Contraction
narrowing of the transverse diameter at the outlet to less than 11 cm. This is the distance between the ischial tuberosities, a measurement that is easy to make during a prenatal visit, so the narrow diameter can be anticipated before labor begins.
Outlet Contraction
suggested by lack of engagement at the beginning of labor, a prolonged first stage of labor, and poor fetal descent
Cephalopelvic Disproportion
condition of pregnancy in which the placenta is implanted abnormally
in the uterus. It is the most common cause of painless bleeding in the third trimester of pregnancy.
Placenta Previa
Bleeding with placenta previa
begins when the ________segment starts to differentiate from the upper segment late in pregnancy (approximately week 30) and the cervix begins to dilate
lower uterine
To ensure an adequate blood supply to a woman and fetus (placenta previa), place the woman immediately on bed rest in a
side-lying position.
An Apt or________ test (test strip procedures) can be used to detect whether the blood is of fetal or maternal origin
Kleihauer-Betke
Never attempt a___________
examination with painless bleeding late in pregnancy because any agitation of the cervix when there is a placenta previa may initiate massive hemorrhage, possibly fatal to both mother and child.
pelvic or rectal
If the previa is under ____by ultrasound, it may be possible for the fetus to be born past it.
30%
If over 30%, and the fetus is mature, the safest birth method for both mother and baby is often a
cesarean birth.
A steroid that hastens fetal lung maturity, may be prescribed for the mother to encourage the maturity of fetal lungs if the fetus is less than 34 weeks’ gestation.
Betamethasone
The normal placenta weighs approximately______ and is 15 to 20 cm in diameter and 1.5 to 3.0 cm
thick. Its weight is approximately one sixth that of the fetus.
500 g
placenta that has one or more accessory lobes connected to the main placenta by blood vessels.
Placenta Succenturiata
the fetal side of the placenta is covered to some extent with chorion. The umbilical cord enters the placenta at the usual midpoint, and large vessels spread out from there. They end abruptly at the point where the chorion folds back onto the surface.
Placenta Circumvallata
the cord is inserted marginally rather than centrally. This anomaly is rare and has no known clinical significance either.
Battledore Placenta
situation in which the cord, instead of entering the placenta directly, separates into small vessels that reach the placenta by spreading across a fold of amnion. This form of cord insertion is most frequently found with multiple gestation.
Velamentous Insertion of the Cord
the umbilical vessels of a velamentous cord insertion cross the cervical os and therefore deliver before the fetus.
Vasa Previa
unusually deep attachment of the placenta to the uterine myometrium so deeply the placenta will not loosen and deliver (Poggi, 2007). Attempts to remove it manually may lead to extreme hemorrhage because of the deep attachment.
Hysterectomy or treatment with methotrexate to destroy the still-attached tissue may be necessary.
Placenta accreta
Women who have had a previous cesarean birth that involved a_________________ incision are usually candidates for vaginal birth with their next pregnancy.
low transverse uterine
________of labor means that labor is started artificially
Induction
________of labor refers to assisting labor that has started spontaneously but is not effective
Augmentation
change in the cervical consistency from firm to soft, is the first step the
uterus must complete in early labor.
Cervical Ripening
Bishop (1964) established criteria for scoring the cervix. Using this scale, if a woman’s total score is____or greater, the cervix is considered ready for birth and should respond to induction
8
A more commonly used method of speeding cervical ripening is the application of a prostaglandin gel, such as_________, to the interior surface of the cervix by a catheter or suppository, or to the external surface by applying it to a diaphragm and then placing the diaphragm against the cervix.
misoprostol
Women should remain in bed in a_______ position to prevent leakage of the medication
side-lying
Oxytocin is always administered_______, so that, if hyperstimulation should occur, it can be quickly discontinued.
intravenously
After cervical dilatation reaches____ cm, artificial rupture of the membranes may be performed
to further induce labor, and the infusion may be discontinued at that point.
4
a side effect of oxytocin, may
cause extreme hypotension.
Peripheral vessel dilatation
If stopping the oxytocin infusion does not stop the hyperstimulation, a beta-adrenergic receptor drug such as __________________may be prescribed to decrease myometrial activity
terbutaline sulfate (Brethine) or magnesium sulfate
is first manifested by headache and vomiting. If you observe these danger signs in a woman during induction of labor, report them immediately and halt the infusion.
in its most severe form can lead to seizures, coma, and death because of the large shift in interstitial tissue fluid.
Water intoxication
The maximum dosage of oxytocin used may be as high as
36 to 40 mU/min.
is controversial because it violates the tradition of birth as a normal, procedure-free process. Because it can shorten labor, it has the potential to reduce the number of postpartal fevers that occur from infection or dehydration.
Active management
The term low forceps birth may be used to indicate that the fetal head is at a____ station or more.
2
If the fetal head is engaged but at less than 2 station, the procedure is called a
midforceps birth.
used most often as a prophylactic measure, to alleviate problems of
birth such as cephalopelvic disproportion or failure to progress in labor.
Cesarean Birth
two types of cesarean birth:
scheduled and emergent.
Both the_______________ will interview a woman preoperatively to obtain a health history and make an assessment and decision for safe use of anesthesia.
physician and the anesthesiologist or nurse-anesthetist
is a common device used postoperatively to encourage deep
breathing is an incentive spirometer. These devices which cause a small ping-pong-like ball to rise in a narrow tube or cause lights to flash, are not only easy and fun to operate
but give a woman a sense of reward for her effort.
Incentive Spirometry
The most effective way to stimulate lower extremity circulation after a cesarean birth is by early
ambulation
made vertically through both the abdominal skin and the uterus. It is made high on the uterus so that it can be used with a placenta previa, to avoid cutting the placenta. A disadvantage of this type of incision is that it leaves a wide skin scar and also runs through the active contractile portion of the uterus
classic cesarean incision
is one made horizontally across the abdomen just over the symphysis pubis and also horizontally across the uterus just over the cervix. This is the most common type of cesarean incision. It is also referred to as a Pfannenstiel incision or a “bikini” incision, because even a low-cut bathing suit will cover the scar.
low segment incision
