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173 Cards in this Set

  • Front
  • Back
Trends in birth
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
Malpractice
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
Some reasons why US has a high mortality and low birth weight babies
increase in moms age
increase in multiple babies
obesity
increase in drug use
access to prenatal care limited
Why prenatal care
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
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
Health perception/management
Presumptive signs of preg.

Quickening
fetal movement felt 18-20weeks
fluttering. mom may not know what she is feeling at first
Health perception/management
Presumptive signs of preg.
Nausea
common in first trimester
nausea is a good sign that things are progressiving normally
Health perception/management
Presumptive signs of preg.
breast tenderness
deepening pigmentation
also good sign
Health perception/management
Presumptive signs of preg.
urinary freq
bloating
due to expansion of uterus pressing on bladder
Health perception/management
Probable sign of preg
urine/blood
urine able to detect ACG 7-10d after conception
Blood 1 wk after conception
Shy would you want to know the level of ACG in a blood sample
helps to determine "how" pregnant you are. May also detect some abnormalities
Health perception/management
Physiological signs
Goodells sign
chadwicks sign
softening of cervix

blue cervix and vagina-due to increase blood supply to area
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
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
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
Dating the preg
EDC
Nagele's rule
Est. date of confinement

1st day of LMP, minus 3 months add 7 days=due date
Length of preg
from gestation 38wks
from LMP 40 wks
80% delivered +/- 10 days
Health Status
MOM/present
RX include OTC
illness since LMP esp febrile ones
drugs/etoh/smk ^cleft pallate
allergies
health status
MOM/past
bleeding disorder/transfusion
DM or past GD
HTN or past PIH
cong. heart disease
vaginal infections
health status
Mom/family history
DM
genetic defects
multiple births
health status
DAD
paternal status/history
present health
genetics
etoh/drug woman higher risk for battery when preg
Nutritional-metabolic
underweight
if underwieght before conception increased risk of LBW despite adq nutrition. goal is to be nutritional healthy before preg
nutritional-metabolic
ideal weight gain
if normal BMI look to gain 25-35lbs consider ht, bone structure and prepreg nutritional staus
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
nutritional - metabolic
overweight
complications-mom
higher rate of C-sect
unsuccesful VBAC
PIH,GD, thromboembolism
dysfunctional labor, wound complications, UTI, hemorrhage,failed epidural
weight gain distribution
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
recommended nutrition
protein 60gm ^by 10gm
fat 30-40% diet
CHO-whole grain/fiber
Ca 1000mg, Fe 30mg
Vit D, folic acid, B-12
why is Fe important?
Stored in the babys liver in last 3 months very important
Pigmentation changes
Linea nigra
brown line down belly, less intense after preg
Pigmentation changes
cholasma
"mask of pregnancy"
more common is people with dark skin and sun exposure
seen on cheeks goes away after preg
Pigmentation changes
Straie
stretch marks
you get um or you dont
caused secondary to increased cortisol affect
Pigmentation changes
spider angiomas
increased levels of estrogen bring blood vessels to surface (?)
MUSCULOSKELETAL changes
joints: increase in relaxin => in mobility of sacroiliac, sacrococcygeal, and pubic joints. cause waddle and back ache
rx-pelvis rock and flat shoes
MUSCLE changes
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
ELIMINATION PATTERN
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
GU-cont
physiologic edema
caused by >fluid volume and < venous return(from uterine pressure)
normal to see in feet, ankles, hand NOT FACE
GU-cont
Treatment for edema
lay on L side- this increases GFR and helps edema
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
GI system
heart burn
Reflux uterus pushing up on stomach
rx; <spicy food, <lying down
antacids NO ASA/NA+
GI
Constipation
due to >progesterone, >fe and > pressure of uterus
rx exercise, fiber, fluids
GI
Gall Bladder
higher risk of gall bladder disease due to >progesterone
rx <fat in diet
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
Supine Hypotensive syndrome
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
RESP. system
>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
Sleep pattern
fatigue in 1st and 3rd trimester. offer warm milk
Cognitive-perceptual
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
Signs of complications
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
Saftey in preg
travel
seat belts
get out and walk around on long car trips >risk of thromboembolus
Discomforts in the third trimester
SOB-pressure on lungs
Heartburn-stomach compress and >progesterone
urinary freq
backache
round ligament pain
braxton hicks contractions
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
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.
SELF-PERCEPTION
3rd trimester
task: learning to give of herself
woman my withdraw, feel vulnerable and want to be taken care of
Paternal tasks
accepting of role and responsibility changes
develping a relationship with the child
ROLE AND RELATIONSHIP PATTERN
assessment
what is the support system>
What are the economic resources
do they nn referrals? WIC, social worker ect...
SEXUALITY AND REPRODUCTIVE
assessment of current
current preg nn to know LMP,
any cramping, bleeding, spotting since lmp, when preg test done
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
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
normal length of labor for first and second child
first 12hours
second 8hours
Rh status
need Thogam at 28wks and w/i 72 hours postpartum if mom is Rh neg and Baby is Rh pos
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
HIV IN PREG
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
PHYSICAL Assessment
Uterus
growth is not symmetrical. wall become thinner and stronger due to >fiber and elasticity. estrogen=muscle changes. progesteron=muscle relaxation
PHYSICAL Assessment
What is McDonalds rule?
height of fundus = gestational week until third trimester.
Can be subjective
Norms for fundal height
12wks-fundus at symphasis pubis
16wk-half way b/w symphasis pubis and umbilicus
20wks- umbilicus
38wks-ensiform cartilage
40wks-2cm below 38wks
CERVICAL CHANGES
>softness-goodells
>blue-chadwick
softening of isthmus-hegars
glands hypertrohpy-mucous plug provides a mechanical barrier.
VAGINAL CHANGES
>vaginal secretions-leukorrhea(no douche/tampons)
>estrogen=>glycogen and acid environment-<bacteria and increased yeast infections.
BREAST CHANGES
>size and sensitivity
>momgomery's tubercles(sebaceous glands)
>superficial veins
+/- straie
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
Bony Pelvis
Mid pelvis
transverse distance b/w the ischial spines. said to be either encroaching-sticking out into birth canal or non-encroaching
Bony Pelvis
Outlet
anterior-posterior distance b/w the ischial tubrerosities. Should be >9cm
use fist
COPING AND STRESS MGMT PATTERN
1/3 births to unmarried woman
70 with kids under 6 work at least parttime
9-20% battered
support systems in place?
VALUE-BELIEF patter
religion and culture.
and how they may affect the preg. cultural considerations-modesty, wellness orientation. clothing diet.
ADOLESCENT PREG
1:10 teens become pregnant.
US rates one of the highest in teen preg.
many results in lwr educational attainment and lifelong poverty
RISK for ADOLESCENT PREG
<15 years: >CPD(cephelopelvicdistortion), >PIH, >Fe deficiency, >LBW and premature
>15 worry most about exposure to teratogens, etoh, drugs, smking,prenatal care
PREG in older woman
ideal time to have baby is b/w 20-25 after 35 risk for genetic anomolies up, fertility down
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
when must the Strep B antibiotics be given
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
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
COMMON LAB TESTS
h&h
Done at beginning for baseline as anemia is common in preg
COMMON LAB TESTS
Ultrasound
done for dates(done early)and diagnosticly (done later)
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
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)
Nursing Diagnosis
knowledge deficit
injury, fetal risk for
coping family;readiness for enhance
family processes, interrupted
ANTEPARTAL CARE
Low risk
Time schedule
Q4wk thru 28
Q2 wk thru 36
Q 1wk thru delivery
ANTEPARTAL CARE
High risk schedule
Qwk and then 2x wk near end
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
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
Amniocentesis
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
Chorionic villus sampling
done for genetic screening
can be done tranabdominal or transcervical
done at 10-12 wk
Doppler flow studies
measures blood flow and resistence in the placenta
used to evaluate postterm, IUGR, effect of nicotine
15wks-term
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
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
Amniocentesis
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
Chorionic villus sampling
done for genetic screening
can be done tranabdominal or transcervical
done at 10-12 wk
Doppler flow studies
measures blood flow and resistence in the placenta
used to evaluate postterm, IUGR, effect of nicotine
15wks-term
PERCUTANEUOS UMBILICAL BLOOD SAMPLING
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
NON STRESS TEST
TEST FETAL WELL BEING
DOES THE FETAL HEART RATE INCREASE WITH ACTIVITY?
NON STRESS TEST RESULTS
REACTIVE: at least 2 accelerations of 15bpm over 20 min REASSURING
NONREACTIVE: less than above results, NONREASSURING
CONTRACTION STRESS TEST
how does fetal HR respond to stress of simulated labor. done with pitocin or nipple stimulation
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
BIOPHYSICAL PROFILE
done after 24wks assesses for
fetal breathing movements
gross body movements
fetal tone
reactive fetal heartbeat
amniotic fluid volume Low VF bad
BIOPHYSICAL PROFILE
SCORING
each worth 2pt perfect score is 10
anything under 5 cause for concern
MATERNAL MORTALITY RATES
#of deaths per 100,000 births-includes preg+42 day pp
WHAT ARE THE LEADING CAUSES OF DEATH FOR MOTHERS
thromboembolism
cardiac disease
HTN complications
sepsis
INFANT MORTALITY
#DEATHS per 1,000 births
ranked 26th in world bad
What are some of the reasons for maternal/infant mortality
economic status
access to care
teens without prenatal care have a 60%higer rate than avg.
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
SPONTANEOUS ABORTION-MISCARRIAGE
preg loss before 20wks
80% occur in first trimester
accounts for 15-20% of all pregnancies
most common reason is chromosomal abnormalities
What are the risk for future preg with SpAb
One time- no risk
2+ times-risk of carring to term significantly lower
TYPES OF MISCARRIAGE

Threaatened
slight bleeding and maybe cramping. No dilation or effecing.
TYPES OF MISCARRIAGE
Inevitable
cervical changes, increased bleeding and cramping, dilation occurs
TYPES OF MISCARRIAGE
Incomplete
some retained tissue-continued bleeding, pain, fever, pt needs a D&C
TYPES OF MISCARRIAGE
Complete
all tissue has been expelled- no care is needed
TYPES OF MISCARRIAGE
Missed
fetal demise contents remain in utero
Recurrent preggnancy loss
internal os (opening) is wweakened resulting in painless early dilation and loss of prefnancy, usually 12-20 wks
Recurrent preg loss
Treatment
Cerclage-a stiching up of the cervix, opened at term or onset of labor
rest
repeat cerclage w/ all preg
ECTOPIC PREGNANCY
implantation of the preg in other than endometrium ie, ovary, fallopian tubes, cervis and intestines
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.
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
GESTATIONAL TROPHOBLASTIC DISEASE
developmental abnormality of the placenta
HYDATIFORM MOLE-begin
CHORIOCARCINOMA-invasive
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
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
PLACENTA PREVIA
placenta implants on lower uterine segment and encroaches upon or covers internal os
PLACENTA PREVIA
Types
total- definite C-sect
partial- probable C-sect
marginal-vaginal delivery possiable
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
PLACENTA PREVIA

WHAT IS THE CARDINAL SIGN
painless bright red bleeding after 20wk usually 22-24wks
Placenta abruptio
separation of theplacenta before birth of baby
Placenta abruptio
risks
multiparity, >30yo, poor nutrition, cigarette and cocaine use, MVA
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
Placenta abruptio
DX and RX
ultrasound if time allows
RX: C-sect if fetus viable, stabilize pt and monitor for DIC
ANEMIA
hEMOGLOBIN <10
MOST COMMON PROBLEM OF PREGNANCY
75% Fe DEFICIENCY ANEMIA
ANEMIA
Risks to MOM
infection
fatigue
PP hemorrhage
hgb<6 risk for cardiac failure
ANEMIA
Risks to Baby
stillbirth
Small for gestational age
hypoxia during labor
ANEMIA
RX and Teaching
Fe supplement 300mg TID
increase Fe in diet and take supplements with Vit C
SICKLE CELL ANEMIA
maternal mortality up to 20%
infant mortality up to 50%(due to decreased O2 supply and infarcts of placenta)
Preg may >crisis
SICKLE CELL ANEMIA
Assessment
assess for UTI, CHF, and PIH
Will need O2 during labor to help prevent crisis
PIH
OTHER NAMES/CLASSES
pre-eclampsia
eclampsia-seizures
chronic HTN
Chronic HTN superimposed PIH
Transient HTN
PATHO OF PIH
>BP or vasospasm-decreased placental perfusion--endothelial cell activation--vasoconstiction, coagulation cascade, intravascular fluid redistributer--<organ perfusion
ETIOLOGY OF PIH
?womans antibody system overwhelmed by fetal antigens, also genetic component
RISK FOR PIH
primigavida- 5-6x higher
multiple gestation
obesity
DM
<16yo
Risk is higher for second baby if different dad
SICKLE CELL ANEMIA
Assessment
assess for UTI, CHF, and PIH
Will need O2 during labor to help prevent crisis
PIH
OTHER NAMES/CLASSES
pre-eclampsia
eclampsia-seizures
chronic HTN
Chronic HTN superimposed PIH
Transient HTN
PATHO OF PIH
>BP or vasospasm-decreased placental perfusion--endothelial cell activation--vasoconstiction, coagulation cascade, intravascular fluid redistributer--<organ perfusion
ETIOLOGY OF PIH
?womans antibody system overwhelmed by fetal antigens, also genetic component
RISK FOR PIH
primigavida- 5-6x higher
multiple gestation
obesity
DM
<16yo
Risk is higher for second baby if different dad
CARDINAL SIGNS OF PIH
hypertension 140/90
edema-facial
proteinuria +2 X2
Additions assessments PIH
headaches in later preg
vision changes
epigastric pain
hyperreflexia--end in seizure
N/V
Oliguria severe
NSG Interventions for mild PIH
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
Nsg interventions for Severe PIH
All of the above +
quiet room, <stimulus
strict I&O
magnesium sulfate as ordered
sedative, antihypertensive as ordered
MAGNESIUM SULFATE
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
MAGNESIUM SULFATE
antagonist and evaluation
calcium gluconate-kept at bedside 1gm ivp over 3 min
know working if diuresis w/i 24h
HELLP COMPLICATION OF PIH
H-hemolysis of red blood cell
EL-elevated liver enzymes
LP-low platelets
HELLP PATHO
vasospasm=endothelial damage=platelet aggregation=tissue hypoxia (liver failure)
HELLP
mortality rate
rx
2-12% of PIH and HELLP will show no s/s of PIH
mortality rate is 24%
RX; DELIVERY
HYPEREMESIS GRAVIDARUM
sever vomiting of preg causes severe wt loss, dehydration, electrolyte imbalance. maylast whole preg
HYPEREMESIS GRAVIDARUM
risk
care
risks: <20, obese, multifetal, molar preg
care:rehydrate, may need TPN and antiemetics
Tends to reoccur with each pregnancy
UTI's
12% have asymptomatic bacterium
Can progress to pyelonephritis=SpAb, premature labor or stillbirth
UTI's
treatment
sulfa and cephlosporins
keflex bactrium
GESTATIONAL DIABETES
Define
any degree of glucose intolerance with its onset or first regnition during preg 50% go onto type II in 20years
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
GESTATIONAL DIABETES
Screening
20-28wk, glucola test if >130-140 than need GTT
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
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
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
PREGESTATIONAL DM
why do most woman deliver early?
high risk of stillborn close to term, almost always induced
PREGESTATIONAL DM
Monitoring
starting in 2nd trimester
fetal count kicks
NST 2X wk
Biophysical profile Q wk
access infant wt
Insulin Requirements
May < 1st trimester
> 2nd and 3rd
maintain BS <100 during labor
PP dramatic drop in insulin needs
Type II no PO meds
risk for baby being hypoglycemic
due to high sugar of mom, causing baby to secrete excess insulin, once born high levels of sugar gone but still secreting high insulin
Cardiace disease in Preg
Generally see only if they have repaired genetic anomolis
Cardiace changes
>intravascular volume
<systemic vascular resistence
Assessment for cardiac decompensation
>fatique,>dyspnea,cough, smothering feeling,palpitations, edema, irrg and weak pulse, orthopnea. crackles at bases, R>25 cyanosis
Interventions for cardiac
most cardiace rx ok-most do not cross placenta, avooid tocicity adj dose as needed,
bedrest, NA restriction and diuretics and digitalis
what is and is not used for coagulation treatments
NO coumadin-very tetergenic
use HEPARIN