week 5 Complications of Pregnancy Flashcards
What are general reasons to come in for a check-up during pregnancy?
mild aches, contractions every 10 minutes, preterm labor (PTL
What is the biggest factor in preterm labor?
infection
Risk factor for preterm labor
The most consistent factor for preterm labor is a history of preterm birth
medication management to prolong labor: it’s not my time (I.N.M.T.)
- Indomethacin-NSAID- can cause early closing of ductus arteriosus, assess contractions to see if medication is working
-Nifedipine (CA channel blocker)- assess contractions, B/P prior to administration, although, not an indicator is is working
-Magnesium sulfate
-Terbutaline- assess HR/ educate on heart palpitations
What indicates nursing actions?
gestational age
Magnesium sulfate, when used, assessments, SEs?
-Before 32-weeks, neuroprophylaxis, prevent brain hemorrhage
-every hour set of vitals/ DTR assessment
-SEs; weak, foggy, flushed, warm, uncomfortable, maternal respiratory depression
ondansetron (Zofran)
serotonin antagonist
Terbutaline (Brethine)
Beta2-Adrenergic Agonists
Nifedipine
Beta2-adrenergic agonist
Azoles (3)
*ketoconazole
*miconazole (Monistat)
*Clotrimazole (Lotrimin)
Calcium Gluconate
Magnesium Sulfate
Methotrexate (Trexall and Rheumatrexate)
Nonbiologic (Traditional) DMARDs
What is preterm labor? When does it occur?
*(PTL)-regular contractions resulting in cervical changes at 20-37-weeks
Late Preterm, Very preterm, and Viability
*viability- 25 weeks gestation
*very preterm-before 32 weeks
*late preterm-34-36.6 weeks
S/S of preterm labor
-bag of water breaks
-< fetal movement
-low back aches, menstrual-like cramps, or intestinal cramps (w/ or w/o diarrhea)
-increased vaginal discharge
-fever higher than 38 C, 100.4 F
-feeling that something is not right
Half of woman at risk of PTL deliver full term, other half have no identifiable risk factors
*prior preterm birth, multiple gestations, uterine cervical abnormalities (DES/ shortened length)
Medical Management of preterm labor
*delay delivery for 48-72 hours to give steroids time to allow the baby’s lungs to mature.
*Tocolytics (up to 48 hours, allows for admin antenatal steroids)-no for dilations <2cm or none or > 34-weeks
*progesterone-HX PTB
*Cerclage-before 24 weeks for short cervix)
*Corticosteroids, 24-34 weeks w/in 7 days of delivery (fetal lung maturity)
PTL contraindication-why should labor not be held off?
*significantly preterm ROM
*fetal anomaly (lethal)
*intrauterine fetal demise
*severe preeclampsia
*bleeding/ hemodynamic instability
*infection-chorioamnionitis
Nursing actions for PTL
*review med rec for risk factors and gestational age
*assessments: infections, ROM, vaginal bleeding, dehydration, FHR, UCs
Magnesium sulfate indication, loading dose, nurse actions, edu, toxicity
*most used for neuro protection, is a tocolytic
*stay at bedside, monitor for Mag toxicity (RR<12, SPO2<95%,, stop admin), may cause resp < in neonate), serum mag levels 4-8, DTRs, calcium gluconate
Corticosteroids: 24-34 weeks, delivery w/in 7 days
*stimulate surfactant
*Adverse-hyperglycemia
*Betamethasone-12 mg IM-24 hoursX2
*Dexamethasone-4X6mg dose-Q12H
PROM-premature
*before onset of labor->18-24 hours, increase risk infection
*PPROM-before 37 weeks-infection related
*assess FHR, V/s, infection, BPP, AFI, and NST
Ferning-PROM
diagnostic of amniotic fluid, swabbed uterus/ microscope, no ferning/ activity
Medical Management = deliver VS prolonging gestation
34-36.6 weeks gestation - delivery
24-33.6 weeks gestation - prolong
23-24 weeks gestation - provide counseling for decision
ABX = Ampicillin and Erythromycin
Corticosteroids = Betamethasone
Mag Sulfate= neuro-protectant for fetus less than 32 weeks
Chorioamnionitis
*Inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection)-from prolonged labor
*induce-quicken birth, ampicillin/ gentamicin
Incompetent cervix
*Inability of the uterine cervix to retain a pregnancy in the absence of S/S of UCs or labor in the 2nd and 3rd trimester
*dilation after 1st trimester, with expulsion in the 2nd trimester, before 24 weeks
*cervical funnel, cramping, backache, cramping/ spotting, painless cervical dilation
Treatment-incompetent cervix
*cerclage suture
*w/ true labor, bleeding, infection, remove cerclage
*schedule removal 36-37 weeks
Multiple gestations
*mono/mono twins high risk for infant mortality
Multiple gestation assessment findings
*increased hCG (increase N/V)
*US confirmation
*other signs are obvious
Multiple gestation-medical management-intrapartum, medical management
*risk for preterm labor, abnormal presentation, cord prolapse, abruption and PPH (postpartum hemorrhage)
*Type and cross blood, US to confirm position, cont EFM, C/S option should be readily available (OR and staff), hemorrhage meds (pit/Methergine/Hemabate/Cytotec
Hyperemesis gravidarum-uncontrolled vomiting-hospitalization
*cause by increased HCG/progesterone/ estrogen
*B6 meds, histamine blockers., etc.
*peaks week 9, subside by weeks 12
Cholestasis of Pregnancy
*A reversible, hormonally influenced cholestasis. Develops in late pregnancy. Most common pregnancy related liver disease.
* Monitor labs, FKC, NST importance, Medical induction at 37-38 weeks.
Bi-weekly NST
*Bile acids above 40 HIGH RISK for severe fetal complications
Pre-gestational diabetes-risks form woman/ newborn
*mom-spontaneous abortion, polyhydramnios (fetal hyperglycemia, oligohydramnios)
newborn-congenital defects, macrosomia from hyperinsulinemia, hypoglycemia, hypocalcemia, IUGR, birth injury, stillbirth (**after 36 weeks)
Diabetes management
*extensive education
*arrange antenatal testing (NST, BPP)
Gestational Diabetes-diet controlled or insulin controlled
*risk for mom-hypoglycemia/ DKA/ pre-eclampsia, C/S
*baby: macrosomia, IUGR, hypoglycemia, shoulder dystocia, resp distress, still birth
Glucose Tolerance Test (GTT(
*step 1-50 gm glucose solution, 1-hour post measure venous plasma and serum glucose->130 requires second attempt
*step 2-measure fasting venous plasma or serum glucose, 100 grams-measure again at 1,2,3 hours, positive if > 2 or more times
Hypertensive Disorders of Pregnancy
*chronic HTN-before 20-weeks
*gestational HTN, after 20 weeks >140/90 no proteinuria
*preeclampsia-24-hour collection, after 20-weeks, BP >140/90 with lab changes
*preeclampsia with severe features; >160/110 Crt>1.1, plat<100,00, increase LE/ visual disturbances, RUQ pain
*eclampsia-seizures
*superimposed/ CHTN: w/ new onset of proteinuria decreased platelets
Preeclampsia Treatment- Mag-Sulfate
*4gm (6 if neuro protectant), loading in 20 minutes
*BP above 160-110; labetalol (IVP, hydralyzine IVP MD order, Nifedipine (after control)
*ASA (low dose aspirine) treat. if previous Pre-E or high risk
Ecplamsia
*by cerebral edema and vasospasm
*warning signs-other known, N/V, hyperreflexia with clonus
*EMERGENCY
Magnesium Sulfate-BURP
*Magnesium sulfate is indicated for women with severe features of preeclampsia.
*BP decrease
Urine output decreaserespiratory decrease
*patellar reflex absent
HELLP
-usually resolves within 48-hours PP
-1st stage-hemolysis, < o2, > RUQ pain
-2nd; thrombocytopenia
-last liver stuff
-moms risk, placenta abruption, renal failure, death
Placenta Previa-Placenta attaches to lower uterine segment or at the cervical os.
*painless vaginal bleeding…no SVE
*C/s indicated
Placenta Abruption: Bleeding at the connection of the placenta to uterine lining that causes partial or complete detachment prior to delivery of fetus
Risk Factors: previous hx, trauma, drugs (meth/coke/smoking)
Risks for Mom: Hemorrhage, hysterectomy, DIC
Risks for Fetus/Newborn: asphyxia, death, PTL, low birthweight
Assessment Findings: darker vaginal bleeding, clots, severe abdominal pain, abd. rigid, and tachysystole (>5 in 10 minutes)
*stat C/S
Placenta Accreta: Abnormal Implantation of the placenta to the uterine wall.
*Risks for Mom: hemorrhage, hysterectomy, increased risk for infection.
Risks for Fetus/Newborn: 34-26-week gestation delivery, high risk, placenta does not deliver intact.
*Assessment Findings: hypotension, tachy, shallow irregular breathing, cold/clammy skin.
Blood loss 3,000-5,000 ml after delivery
Medical Management: hysterectomy, surgical injury to organs.
Nursing Actions: monitor bleeding.
Ectopic pregnancy
*abdominal pain that radiates to the shoulders
*management, methotrexate
*possible RhoGAM
Hydatidiform mole-gestational thromboplastic disease (GTD)
*grape cluster
*assessment findings; vaginal bleeding, pelvic pain, anemia, hyperemesis
*management D&C, routine hCG levels for 6 months, give Rhogam
Many times STIs show no S/S
*perform routine screening
Urinary Tract Infection (UTI)
*most common
*Infection can cause PTL/PTB.
*If not treated, can turn into pyelonephritis.
GBS
*treat with ampicillin during labor, minimum of 2 doses before delivery
**vaginal/ rectal culture screening 36-37 weeks gestation
