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173 Cards in this Set
- Front
- Back
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Trends in birth
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more intervention ie fetal monitoring
more pain meds 1:5 induction lead to 1:4 with C/S VBAC trend is going back to once a CS always CS fewer episiotomy |
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Malpractice
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There is an increase in md not wanting to deliver babies. accsess to heathcare in rural areas significantly harder. CS more common r/t malpractice
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Some reasons why US has a high mortality and low birth weight babies
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increase in moms age
increase in multiple babies obesity increase in drug use access to prenatal care limited |
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Why prenatal care
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ongoing assessment that insures that any deviations from the normal process are acted upon in timely manner
for every dollar spent in prenatal care save over 3$ in NICU cost |
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Health perception/management
Presumptive signs of preg. LMP |
last menstrual period. want date of first day. ask about length, flow, regularity, birthcontrol type, how and when last used
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Health perception/management
Presumptive signs of preg. Quickening |
fetal movement felt 18-20weeks
fluttering. mom may not know what she is feeling at first |
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Health perception/management
Presumptive signs of preg. Nausea |
common in first trimester
nausea is a good sign that things are progressiving normally |
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Health perception/management
Presumptive signs of preg. breast tenderness deepening pigmentation |
also good sign
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Health perception/management
Presumptive signs of preg. urinary freq bloating |
due to expansion of uterus pressing on bladder
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Health perception/management
Probable sign of preg urine/blood |
urine able to detect ACG 7-10d after conception
Blood 1 wk after conception |
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Shy would you want to know the level of ACG in a blood sample
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helps to determine "how" pregnant you are. May also detect some abnormalities
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Health perception/management
Physiological signs Goodells sign chadwicks sign |
softening of cervix
blue cervix and vagina-due to increase blood supply to area |
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Health perception/management
Physiological signs Hefars sin abdominal enlargement braxton hicks ballotment straie |
softening of th eisthmus of the cervix
6-7 wk uterus becomes soft and globulare. Does not rise to abd cavity until wk 12 |
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Health perception/management
Physiological signs braxton hicks ballotment straie |
The baby is pushed up within and can feel it bounce back. felt later in preg
stretch marks-genetic |
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Health perception/management
Positive signs of preg fetal heart beat Ultrasound fetal movement felt by examiner |
Hear beat hear by doppler 10-12wk, stethoscop 20wk
confirm preg by US 5-6wk from LMP Must be felt by examiner not mom to be POSITIVE sign |
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Dating the preg
EDC Nagele's rule |
Est. date of confinement
1st day of LMP, minus 3 months add 7 days=due date |
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Length of preg
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from gestation 38wks
from LMP 40 wks 80% delivered +/- 10 days |
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Health Status
MOM/present |
RX include OTC
illness since LMP esp febrile ones drugs/etoh/smk ^cleft pallate allergies |
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health status
MOM/past |
bleeding disorder/transfusion
DM or past GD HTN or past PIH cong. heart disease vaginal infections |
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health status
Mom/family history |
DM
genetic defects multiple births |
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health status
DAD |
paternal status/history
present health genetics etoh/drug woman higher risk for battery when preg |
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Nutritional-metabolic
underweight |
if underwieght before conception increased risk of LBW despite adq nutrition. goal is to be nutritional healthy before preg
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nutritional-metabolic
ideal weight gain |
if normal BMI look to gain 25-35lbs consider ht, bone structure and prepreg nutritional staus
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nutritional-metabolic
overweight complications for baby |
still birth
preemies IUGR-intrauterine growth retardation LBW, LGA shoulder dystocia >NICU admissions congenital anomalies,cardiac and neural defects |
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nutritional - metabolic
overweight complications-mom |
higher rate of C-sect
unsuccesful VBAC PIH,GD, thromboembolism dysfunctional labor, wound complications, UTI, hemorrhage,failed epidural |
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weight gain distribution
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fetus 7-8.5lbs, placenta 2-2.5lbs amniotic fluid 2lbs, uterus 2lbs, breasts 1-4lb, >blood volume 4-5lbs, fluid and fat 7-11lbs
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recommended nutrition
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protein 60gm ^by 10gm
fat 30-40% diet CHO-whole grain/fiber Ca 1000mg, Fe 30mg Vit D, folic acid, B-12 |
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why is Fe important?
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Stored in the babys liver in last 3 months very important
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Pigmentation changes
Linea nigra |
brown line down belly, less intense after preg
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Pigmentation changes
cholasma |
"mask of pregnancy"
more common is people with dark skin and sun exposure seen on cheeks goes away after preg |
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Pigmentation changes
Straie |
stretch marks
you get um or you dont caused secondary to increased cortisol affect |
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Pigmentation changes
spider angiomas |
increased levels of estrogen bring blood vessels to surface (?)
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MUSCULOSKELETAL changes
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joints: increase in relaxin => in mobility of sacroiliac, sacrococcygeal, and pubic joints. cause waddle and back ache
rx-pelvis rock and flat shoes |
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MUSCLE changes
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leg cramps-usually due to low ca or high phos. rx: exercise and flex toes
Diastasis recti-seperate shuold go back after preg Caarpal tunnel syndrom from >steroidal hormones should resolve |
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ELIMINATION PATTERN
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compression of bladder in first and third trimester=urinary freg
>UTI, can lead to plyelonephritis. due to compressed ureters. worry because risk of spont. abortion, preterm labor and still birth |
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GU-cont
physiologic edema |
caused by >fluid volume and < venous return(from uterine pressure)
normal to see in feet, ankles, hand NOT FACE |
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GU-cont
Treatment for edema |
lay on L side- this increases GFR and helps edema
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GI system
N/V |
>progesteron <GI motility
N/V peaks at 12wks, eat small meals, smell lemon or ginger tea bags, accupressure, last resort is meds ie phenergan suppository |
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GI system
heart burn |
Reflux uterus pushing up on stomach
rx; <spicy food, <lying down antacids NO ASA/NA+ |
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GI
Constipation |
due to >progesterone, >fe and > pressure of uterus
rx exercise, fiber, fluids |
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GI
Gall Bladder |
higher risk of gall bladder disease due to >progesterone
rx <fat in diet |
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ACTIVITY-EXERCISE
cardiovascular |
50%>blood volume by end of second trimester. exercise as you did prepreg. may see systolic murmur normal, may see anemia due to dilution effect.
CO > P> 10-15 BP< in second trimester >fiberinogen levels=hypercoagulibility |
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Supine Hypotensive syndrome
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due to pressure of uterus on aorta and vena cave causes drop in BP, feelings of faint.
RX Lay on left side increase blood flow to uterus, relieves pressure on aorta/vena cava and increase GFR |
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RESP. system
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>O2 consumption
>tidal volume pressure on diaphragm=sob may see more rhinosinusitus-NO DECONGESTIVES,cause vasoconstirction less blood to baby, severe asthma worse, mild better |
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Sleep pattern
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fatigue in 1st and 3rd trimester. offer warm milk
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Cognitive-perceptual
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neuro change-more headache in 1st trimester due to increase blood volume-normal
teaching!!!-hazards, process, nutrition, discomforts, changes in body and self, S/S complications |
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Signs of complications
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visual disturbances
swelling of face severe,freq or continous headache muscle irritability epigastric pain, persistent V vaginal fluid discharge signs of infection severe abd pain-placenta abruptus absence or < in fetal movmt |
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Saftey in preg
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travel
seat belts get out and walk around on long car trips >risk of thromboembolus |
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Discomforts in the third trimester
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SOB-pressure on lungs
Heartburn-stomach compress and >progesterone urinary freq backache round ligament pain braxton hicks contractions |
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SELF-PERCEPTION
Rubins taks and behavioral manifestations 1st trimester |
task: seeking safe passage for self and infant
accepting th epreg. may feel ambivelent-normal confirmation of preg makes it real |
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SELF-PERCEPTION
2nd trimester |
tasks:ensuring acceptance of her child by significant people in life.may reconnect with mother friends.
bonding to her child. this is the time when begin to think about what the baby is like. |
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SELF-PERCEPTION
3rd trimester |
task: learning to give of herself
woman my withdraw, feel vulnerable and want to be taken care of |
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Paternal tasks
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accepting of role and responsibility changes
develping a relationship with the child |
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ROLE AND RELATIONSHIP PATTERN
assessment |
what is the support system>
What are the economic resources do they nn referrals? WIC, social worker ect... |
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SEXUALITY AND REPRODUCTIVE
assessment of current |
current preg nn to know LMP,
any cramping, bleeding, spotting since lmp, when preg test done |
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SEXUALITY AND REPRODUCTIVE
assessment of past preg |
# and outcomes
Gravida-total # of preg including current one Para-#of PREG (not babies) to be carried thru 20wks TPAL-term, preemie, abortion,live |
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SEXUALITY AND REPRODUCTIVE
assessment of past preg |
length and complications
length of labor-how did she percieve her experience mothering experiences perinatal status of previous kids birth wt, complications and development |
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normal length of labor for first and second child
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first 12hours
second 8hours |
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Rh status
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need Thogam at 28wks and w/i 72 hours postpartum if mom is Rh neg and Baby is Rh pos
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GYN history
assessment |
infections:monlia-yeast ok
chlamydia and gonorrhea-can transmit and cause pnuemo and eye infections. syphilis-stillbirths, genetic anomilies if not treated before 16wk gestation herpes-vaginal birth can transmit if active outbreak esp first outbrake-high mortatlity rate and brain damage if baby lives bacterial bafinosis-can cause preemie and uterine rupture surgery-scar tissue |
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HIV IN PREG
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25% chance if untreated
8% if treated-use antivirals during preg, labor and give to baby 6wks 4% if C-section nn informed consent to test for HIV |
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PHYSICAL Assessment
Uterus |
growth is not symmetrical. wall become thinner and stronger due to >fiber and elasticity. estrogen=muscle changes. progesteron=muscle relaxation
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PHYSICAL Assessment
What is McDonalds rule? |
height of fundus = gestational week until third trimester.
Can be subjective |
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Norms for fundal height
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12wks-fundus at symphasis pubis
16wk-half way b/w symphasis pubis and umbilicus 20wks- umbilicus 38wks-ensiform cartilage 40wks-2cm below 38wks |
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CERVICAL CHANGES
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>softness-goodells
>blue-chadwick softening of isthmus-hegars glands hypertrohpy-mucous plug provides a mechanical barrier. |
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VAGINAL CHANGES
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>vaginal secretions-leukorrhea(no douche/tampons)
>estrogen=>glycogen and acid environment-<bacteria and increased yeast infections. |
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BREAST CHANGES
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>size and sensitivity
>momgomery's tubercles(sebaceous glands) >superficial veins +/- straie |
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BONY PELVIS
inlet anterior-posterior |
diagonal conjugate=12.5cm measured at initial exam.
Obstetic conjugate= -1.5cm need to be 11cm for head to fit |
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Bony Pelvis
Mid pelvis |
transverse distance b/w the ischial spines. said to be either encroaching-sticking out into birth canal or non-encroaching
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Bony Pelvis
Outlet |
anterior-posterior distance b/w the ischial tubrerosities. Should be >9cm
use fist |
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COPING AND STRESS MGMT PATTERN
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1/3 births to unmarried woman
70 with kids under 6 work at least parttime 9-20% battered support systems in place? |
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VALUE-BELIEF patter
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religion and culture.
and how they may affect the preg. cultural considerations-modesty, wellness orientation. clothing diet. |
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ADOLESCENT PREG
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1:10 teens become pregnant.
US rates one of the highest in teen preg. many results in lwr educational attainment and lifelong poverty |
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RISK for ADOLESCENT PREG
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<15 years: >CPD(cephelopelvicdistortion), >PIH, >Fe deficiency, >LBW and premature
>15 worry most about exposure to teratogens, etoh, drugs, smking,prenatal care |
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PREG in older woman
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ideal time to have baby is b/w 20-25 after 35 risk for genetic anomolies up, fertility down
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COMMON LAB TESTS
Strep B |
test for the bacteria strep B which is common in woman. #1 cause of neonatal sepsis
Given antibiotics during deliver |
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when must the Strep B antibiotics be given
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1st dose needs to IV and finished four hours prior to delivery, then given q4. If having a planned C-section no need unless membrane ruptures
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COMMON LAB TESTS
Rubella titer |
Tetragenic to fetus when exposed during first trimester. if titer is <1:8 the meravax vacine is given.MUST BE GIVEN POST PARTUM, NEVER DURING PREG
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COMMON LAB TESTS
h&h |
Done at beginning for baseline as anemia is common in preg
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COMMON LAB TESTS
Ultrasound |
done for dates(done early)and diagnosticly (done later)
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COMMON LAB TESTS
Alpha-fetal protein: |
If high may indicate neural tube defects, if low may indicate down syndrom
many false positive results not definitive |
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COMMON LAB TESTS
Triple marker test |
done if alpha-fetal protein <
HCG (elavate Downs) Estriol(decreased) AFP (decreased) Placental protein A (decrease Inhibin A (increase) |
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Nursing Diagnosis
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knowledge deficit
injury, fetal risk for coping family;readiness for enhance family processes, interrupted |
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ANTEPARTAL CARE
Low risk Time schedule |
Q4wk thru 28
Q2 wk thru 36 Q 1wk thru delivery |
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ANTEPARTAL CARE
High risk schedule |
Qwk and then 2x wk near end
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ANTEPARTAL CARE
What type of assessments are included? |
VS-esp BP
Weight-look for pattern usually 1pd a wk after 12wk Edema-ankles feet ok face not Uterine/fundal size Fetal heart rate 120-160 Fetal movement-cont/reg Urinealysis-looking for protein, make sure not contaiminated 2hr glucose screen-GD |
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ANTEPARTAL CARE
When and why assessment of well being esp with high risk |
as placenta ages function declines.
>42wks suspected IUGR hx of unexplained still birth maternal HTN, PIH, Diabetes Maternal age <16 or >45 |
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Amniocentesis
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done for karyotyping-genetic profile
Lung studies (L/S) performed at term. normal is 2:1, GD 3:1 otherwise amnio done at 15wks with ultrasound |
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Chorionic villus sampling
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done for genetic screening
can be done tranabdominal or transcervical done at 10-12 wk |
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Doppler flow studies
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measures blood flow and resistence in the placenta
used to evaluate postterm, IUGR, effect of nicotine 15wks-term |
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ANTEPARTAL CARE
What type of assessments are included? |
VS-esp BP
Weight-look for pattern usually 1pd a wk after 12wk Edema-ankles feet ok face not Uterine/fundal size Fetal heart rate 120-160 Fetal movement-cont/reg Urinealysis-looking for protein, make sure not contaiminated 2hr glucose screen-GD |
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ANTEPARTAL CARE
When and why assessment of well being esp with high risk |
as placenta ages function declines.
>42wks suspected IUGR hx of unexplained still birth maternal HTN, PIH, Diabetes Maternal age <16 or >45 |
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Amniocentesis
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done for karyotyping-genetic profile
Lung studies (L/S) performed at term. normal is 2:1, GD 3:1 otherwise amnio done at 15wks with ultrasound |
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Chorionic villus sampling
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done for genetic screening
can be done tranabdominal or transcervical done at 10-12 wk |
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Doppler flow studies
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measures blood flow and resistence in the placenta
used to evaluate postterm, IUGR, effect of nicotine 15wks-term |
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PERCUTANEUOS UMBILICAL BLOOD SAMPLING
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uses: karyotyping, fetal infection, acid-base status of fetus with IUGR
Assess and rx isoimmunization(Rh factor) needle inserted into fetal umvilical vessel winder ultra sound done later in preg |
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NON STRESS TEST
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TEST FETAL WELL BEING
DOES THE FETAL HEART RATE INCREASE WITH ACTIVITY? |
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NON STRESS TEST RESULTS
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REACTIVE: at least 2 accelerations of 15bpm over 20 min REASSURING
NONREACTIVE: less than above results, NONREASSURING |
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CONTRACTION STRESS TEST
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how does fetal HR respond to stress of simulated labor. done with pitocin or nipple stimulation
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CONTRACTION STRESS TEST
RESULTS |
NEGATIVE:3 contractions w/i 10 min w/o late decelerations REASSURRING
POSITIVE:late decelerations with over 50% of contractions NONREASSURING |
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BIOPHYSICAL PROFILE
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done after 24wks assesses for
fetal breathing movements gross body movements fetal tone reactive fetal heartbeat amniotic fluid volume Low VF bad |
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BIOPHYSICAL PROFILE
SCORING |
each worth 2pt perfect score is 10
anything under 5 cause for concern |
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MATERNAL MORTALITY RATES
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#of deaths per 100,000 births-includes preg+42 day pp
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WHAT ARE THE LEADING CAUSES OF DEATH FOR MOTHERS
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thromboembolism
cardiac disease HTN complications sepsis |
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INFANT MORTALITY
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#DEATHS per 1,000 births
ranked 26th in world bad |
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What are some of the reasons for maternal/infant mortality
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economic status
access to care teens without prenatal care have a 60%higer rate than avg. |
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COMPLICATIONS OF PREGNANCY
bleeding disorders for first and second half of pregnancy |
first:miscarriage (SpAb)
ectopic pregnancy and gestational trophoblastic disease. SECOND: placenta previa and abruptio placenta |
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SPONTANEOUS ABORTION-MISCARRIAGE
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preg loss before 20wks
80% occur in first trimester accounts for 15-20% of all pregnancies most common reason is chromosomal abnormalities |
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What are the risk for future preg with SpAb
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One time- no risk
2+ times-risk of carring to term significantly lower |
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TYPES OF MISCARRIAGE
Threaatened |
slight bleeding and maybe cramping. No dilation or effecing.
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TYPES OF MISCARRIAGE
Inevitable |
cervical changes, increased bleeding and cramping, dilation occurs
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TYPES OF MISCARRIAGE
Incomplete |
some retained tissue-continued bleeding, pain, fever, pt needs a D&C
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TYPES OF MISCARRIAGE
Complete |
all tissue has been expelled- no care is needed
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TYPES OF MISCARRIAGE
Missed |
fetal demise contents remain in utero
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Recurrent preggnancy loss
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internal os (opening) is wweakened resulting in painless early dilation and loss of prefnancy, usually 12-20 wks
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Recurrent preg loss
Treatment |
Cerclage-a stiching up of the cervix, opened at term or onset of labor
rest repeat cerclage w/ all preg |
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ECTOPIC PREGNANCY
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implantation of the preg in other than endometrium ie, ovary, fallopian tubes, cervis and intestines
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ECTOPIC PREGNANCY
Assessment |
S: +/- vaginal bleeding
+/- abdominal pain +/- shoulder pain, fainting or shock O: +/- adenexal mass HCG is lwr that normally expected at time of preg. |
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ECTOPIC PREGNANCY
Diagnosis and treatment |
dx: HCG level-RIA
Ultrasound-gestational sac in uterus (used to r/o ectopic) RX: methotresate-chemo agent remove contents;increases risk for future ectopic preg due to scar tissue |
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GESTATIONAL TROPHOBLASTIC DISEASE
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developmental abnormality of the placenta
HYDATIFORM MOLE-begin CHORIOCARCINOMA-invasive |
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GESTATIONAL TROPHOBLASTIC DISEASE
Assessment |
S: increased N/V
O: dark brown vag bleeding, grape-like vesicles passed vaginally size>date >BP and PIH before 20wks no Fetal HR >HCG than normal |
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GESTATIONAL TROPHOBLASTIC DISEASE
Diagnosis and treatment |
grows faster than normal fetus. Ultrasound
RX: D&C to evacuate uterus. follow up with HCG as hydraform mole can become choriocarcinoma fast. its aggressive but receptive totx |
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PLACENTA PREVIA
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placenta implants on lower uterine segment and encroaches upon or covers internal os
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PLACENTA PREVIA
Types |
total- definite C-sect
partial- probable C-sect marginal-vaginal delivery possiable |
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PLACENTA PREVIA
Risk, assessment, dx and rx |
risk >35yo and multiparty(>5)
Assess: painless bright red bleeding after 20wks DX: ultrasound NO VAG EXAM RX:bed rest and delivery by CS |
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PLACENTA PREVIA
WHAT IS THE CARDINAL SIGN |
painless bright red bleeding after 20wk usually 22-24wks
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Placenta abruptio
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separation of theplacenta before birth of baby
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Placenta abruptio
risks |
multiparity, >30yo, poor nutrition, cigarette and cocaine use, MVA
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Placenta abruptio
Assessment |
S: severe abd pain
O:heavy vaginal bleeding, uterus is board like and rigid abd, <or no fetal activity or HR, <BP progressing to shock HAPPENS QUICK |
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Placenta abruptio
DX and RX |
ultrasound if time allows
RX: C-sect if fetus viable, stabilize pt and monitor for DIC |
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ANEMIA
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hEMOGLOBIN <10
MOST COMMON PROBLEM OF PREGNANCY 75% Fe DEFICIENCY ANEMIA |
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ANEMIA
Risks to MOM |
infection
fatigue PP hemorrhage hgb<6 risk for cardiac failure |
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ANEMIA
Risks to Baby |
stillbirth
Small for gestational age hypoxia during labor |
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ANEMIA
RX and Teaching |
Fe supplement 300mg TID
increase Fe in diet and take supplements with Vit C |
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SICKLE CELL ANEMIA
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maternal mortality up to 20%
infant mortality up to 50%(due to decreased O2 supply and infarcts of placenta) Preg may >crisis |
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SICKLE CELL ANEMIA
Assessment |
assess for UTI, CHF, and PIH
Will need O2 during labor to help prevent crisis |
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PIH
OTHER NAMES/CLASSES |
pre-eclampsia
eclampsia-seizures chronic HTN Chronic HTN superimposed PIH Transient HTN |
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PATHO OF PIH
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>BP or vasospasm-decreased placental perfusion--endothelial cell activation--vasoconstiction, coagulation cascade, intravascular fluid redistributer--<organ perfusion
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ETIOLOGY OF PIH
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?womans antibody system overwhelmed by fetal antigens, also genetic component
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RISK FOR PIH
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primigavida- 5-6x higher
multiple gestation obesity DM <16yo Risk is higher for second baby if different dad |
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SICKLE CELL ANEMIA
Assessment |
assess for UTI, CHF, and PIH
Will need O2 during labor to help prevent crisis |
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PIH
OTHER NAMES/CLASSES |
pre-eclampsia
eclampsia-seizures chronic HTN Chronic HTN superimposed PIH Transient HTN |
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PATHO OF PIH
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>BP or vasospasm-decreased placental perfusion--endothelial cell activation--vasoconstiction, coagulation cascade, intravascular fluid redistributer--<organ perfusion
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ETIOLOGY OF PIH
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?womans antibody system overwhelmed by fetal antigens, also genetic component
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RISK FOR PIH
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primigavida- 5-6x higher
multiple gestation obesity DM <16yo Risk is higher for second baby if different dad |
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CARDINAL SIGNS OF PIH
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hypertension 140/90
edema-facial proteinuria +2 X2 |
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Additions assessments PIH
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headaches in later preg
vision changes epigastric pain hyperreflexia--end in seizure N/V Oliguria severe |
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NSG Interventions for mild PIH
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monitor VS esp BP
DTR's and Clonus Rest on left side Weigh QD >protein in diet-helps w/fluid exretion and replaces lost protein Monitor FH,NST, CST ultrasound to monitor placenta |
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Nsg interventions for Severe PIH
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All of the above +
quiet room, <stimulus strict I&O magnesium sulfate as ordered sedative, antihypertensive as ordered |
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MAGNESIUM SULFATE
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a CNS depressant and smooth muscle relaxant
DOSE 4-6gm IV, Therapuetic range 4-8mg.dl Monitor BP and DTR for irritability,Resp<12 DC MGs04 |
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MAGNESIUM SULFATE
antagonist and evaluation |
calcium gluconate-kept at bedside 1gm ivp over 3 min
know working if diuresis w/i 24h |
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HELLP COMPLICATION OF PIH
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H-hemolysis of red blood cell
EL-elevated liver enzymes LP-low platelets |
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HELLP PATHO
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vasospasm=endothelial damage=platelet aggregation=tissue hypoxia (liver failure)
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HELLP
mortality rate rx |
2-12% of PIH and HELLP will show no s/s of PIH
mortality rate is 24% RX; DELIVERY |
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HYPEREMESIS GRAVIDARUM
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sever vomiting of preg causes severe wt loss, dehydration, electrolyte imbalance. maylast whole preg
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HYPEREMESIS GRAVIDARUM
risk care |
risks: <20, obese, multifetal, molar preg
care:rehydrate, may need TPN and antiemetics Tends to reoccur with each pregnancy |
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UTI's
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12% have asymptomatic bacterium
Can progress to pyelonephritis=SpAb, premature labor or stillbirth |
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UTI's
treatment |
sulfa and cephlosporins
keflex bactrium |
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GESTATIONAL DIABETES
Define |
any degree of glucose intolerance with its onset or first regnition during preg 50% go onto type II in 20years
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GESTATIONAL DIABETES
Etiology |
2nd and 3rd trimester:insulin resistence due to >cortisol, estrogen, proesterone and human placental lactogen.bodies normal nn may increase by 2-4X
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GESTATIONAL DIABETES
Screening |
20-28wk, glucola test if >130-140 than need GTT
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GESTATIONAL DIABETES
interventions |
monitor BS closely, diet, insulin prn and monitor baby. goal is strict BS control, babies tend to be bigger due to ++ sugar
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PREGESTATIONAL DM TYPE I OR II
risks to mom |
considered high risk preg
vascular disease worsens, increase of freq and severity of infections, PIH risk 4x greater, polyhydramnios-too much amniotic fluid |
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PREGESTATIONAL DM
risk to NB |
anomalies(caridac, skeletal, and neuro
Resp Distress Syndrome L/S should be 3:1 preterm deliveries macrosomia/IUGR stillbirths high close to term |
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PREGESTATIONAL DM
why do most woman deliver early? |
high risk of stillborn close to term, almost always induced
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PREGESTATIONAL DM
Monitoring |
starting in 2nd trimester
fetal count kicks NST 2X wk Biophysical profile Q wk access infant wt |
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Insulin Requirements
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May < 1st trimester
> 2nd and 3rd maintain BS <100 during labor PP dramatic drop in insulin needs Type II no PO meds |
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risk for baby being hypoglycemic
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due to high sugar of mom, causing baby to secrete excess insulin, once born high levels of sugar gone but still secreting high insulin
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Cardiace disease in Preg
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Generally see only if they have repaired genetic anomolis
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Cardiace changes
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>intravascular volume
<systemic vascular resistence |
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Assessment for cardiac decompensation
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>fatique,>dyspnea,cough, smothering feeling,palpitations, edema, irrg and weak pulse, orthopnea. crackles at bases, R>25 cyanosis
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Interventions for cardiac
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most cardiace rx ok-most do not cross placenta, avooid tocicity adj dose as needed,
bedrest, NA restriction and diuretics and digitalis |
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what is and is not used for coagulation treatments
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NO coumadin-very tetergenic
use HEPARIN |
