Complications Of Pregnancy

Front 1

What is considered a medical emergency during pregnancy?

Back 1

Bleeding

Front 2

Spontaneous abortion

Back 2

Term used to identify the termination of pregnancy prior to age of viability

Front 3

Ectopic pregnancy

Back 3

any fetus that is implanted outside the uterus, 95% occur in the right fallopian tube

Front 4

Ectopic pregnancy: risk factors

Back 4

Hx of PID, STDs, failed tubul-ligation, multiple induced abortions, over the age of 35, smokers, douching as a form of birth control

Front 5

S&S of Ectopic pregnancy

Back 5

pt c/o pain, amenorrhea, syncope, neck/shoulder pain, adnexal mass palpated on right side

Front 6

How can an ectopic pregnancy be diagnosed?

Back 6

ultrasound

Front 7

What can be a complication of an ectopic pregnancy?

Back 7

If fallopian tube ruptures, bleeding will occur in the abdominal cavity and will put pressure on the diaphragm and intestines.

Front 8

How will a slow bleed present?

Back 8

Abdomen will be firm and rigid.

Front 9

What are treatment options for an ectopic pregnancy?

Back 9

Methtrexate is a form of chemotherapy used to terminate the pregnancy whilst saving the integrity of the tube.
May have to perform surgery- laparoscopy to remove the fetus.

Front 10

What is a hydatiform mole?

Back 10

Noninvasive, abnormal placenta characterized by large edematous and vesicular chorionic villi accompanied by various amounts of trophoblasts. Cells become fluid filled and look like clusters of grapes. These can be benign or malignant.

Front 11

What are S&S of hydatiform mole?

Back 11

Excessively high levels of HCG, excessive bleeding if SAB occurs, the fundal height may be higher than a normal pregnancy, may have hyperemesis.

Front 12

What are treatment options for hydatiform mole?

Back 12

Evacuate the mole and extensive follow-ups! HCG levels are drawn on these pts every 4 wks until lvls are back to normal. Chest x-ray and HCG levels drawn every year.

Front 13

When is the patient with the hydatiform mole able to conceive again?

Back 13

Pregnancy can't be attempted until 1 year after HCG levels have gone back to normal. (If not, doubles chance of recurrence.)

Front 14

What should be suspected if HCG hits a plateau in the follow-up visits?

Back 14

Indicative of choriocarcinoma.

Front 15

Hydatiform mole : Nursing Considerations

Back 15

Monitor for shock, start 2 IV lines(incase need blood products), monitor I&Os

Front 16

Placenta previa

Back 16

Implants in the lower uterine segment. Classifications are based on degree to which the cervix is covered.

Front 17

Factors that increase the chances of placenta previa:

Back 17

Multigravida, women over the age of 35, multiple gestations (twins,trips, quads), previous C-sections, a prior previa, smoking, cocaine usage, any time of previous uterine surgery

Front 18

How is placenta previa usually diagnosed?

Back 18

by ultrasound

Front 19

What are S&S of placenta previa?

Back 19

Bright red painless vaginal bleeding. Uterus is soft, nontender. Usually warning episodes will occur (hemorrhaging). Fetal heart tones are usually stable.

Front 20

What is the source of the bleeding seen with placenta previa?

Back 20

The bright red painless vaginal bleeding is maternal blood. The sinuses in the lower part of the uterus are whats causing the bleeding.

Front 21

Treatment options for placenta previa if less than 37 wks gestation:

Back 21

If baby is stable: try to stop the bleeding and keep a close watch on the mother. Put mother on bedrest and perform pad counts to mointor the amt of bleeding. IV access in place for blood products, keep mother until closer to 37 weeks.
If the baby is showing any signs of distress, induce labor.

Front 22

Treatment options for placenta previa if more than 37 wks gestation

Back 22

Once previa diagnosed, deliver. The classification of the previa depends on whether or not vaginal birth or c-section is necessary.

Front 23

Low-line previa

Back 23

Placenta is at the very top of the cervix. May see signs of fetal distress in these babies d/t baby putting pressure on the placenta.

Front 24

Partial previa

Back 24

Covers about half of the cervix. w/ partial previa the physician may determine its necessary to perform a c-section.

Front 25

Complete previa

Back 25

Placenta completely covers the cervical os.

Front 26

Placenta previa : Nursing Responsibilities

Back 26

ensure well being of client and fetus, client education, these patients are in need of a lot of emotional support, it can be very disturbing not to know whether or not they will be able to carry this pregnancy to term.

Front 27

Abruptio placenta

Back 27

Premature separation of the placenta after 20 weeks.

Front 28

Previa vs. abruption

Back 28

Important to differentiate between previa and abruption. Abruption you may not have vaginal bleeding, almost always show abdominal pain.

Front 29

What are S&S of abuptio placenta?

Back 29

Uterine irritability, high uterine resting tone, may not have vaginal bleeding, abdominal pain, rigid abdomen, fetal heart tones may or may not be present.

Front 30

Diagnosis of abruptio placenta

Back 30

made by ultrasound

Front 31

Causes of abruptio placenta

Back 31

Any kind of terine anomaly, multigravideas, PIH, hypertension, previous C-sections, renal or vascular disease, trauma, abnormally large placenta, short cord, anything that can cause sudden change in intrauterine pressure, smoking & cocaine

Front 32

Marginal abruption

Back 32

placenta pulls loose at the edge, vaginal bleeding occurs

Front 33

Concealed abruption

Back 33

Placenta pulls loose from the middle, still attached at the edge. Bleeding causes blood build up between the abdominal wall and the placenta, no vaginal bleeding. More pain associated w/ concealed.

Front 34

Complications of abruptions

Back 34

Shock leading to renal failure, vascular spasms, DIC
high infant mortality rate.

Front 35

Abruptio placenta: Nursing Responsibilities

Back 35

Constant monitoring of the mother & baby is necessary. Watch VS, amt of bleeding, watch for S&S of shock, Need to keep accurate I&Os. Bed rest, check fibrinogen levels

Front 36

Kleinhaur-Betke

Back 36

Test to determine if there is any fetal blood in circulation. If this test is positive- indicative of an abruption.

Front 37

Disseminated Intravascular Coagulation

Back 37

Defect in coagulation that consumes large amount of clotting factors.

Front 38

What are S&S of DIC?

Back 38

unsual bleeding; tachycardia. Decreased fibrinogen and platelets, prolonged PT, PTT; increased FSP

Front 39

What are treatment options for DIC?

Back 39

Priority is to get baby delivered and to get the bleeding to stop. Must resolve the underlying problem, then administer blood products, Monitor I&Os, monitor for renal failure.

Front 40

Describe the pathophysiology of DIC

Back 40

Anticoagulation and coagulation factors are released at the tsame time. Thromboplastin is released and activates widespread clotting in small vessels. Fibrinolytic system is activated to destroy clots. Simultaneous decrease in clotting facotrs and an increase in circulating anticoagulants leads to inability to clot.

Front 41

DIC : Nursing Considerations

Back 41

Assess amt and nature of bleeding, presence of pain, VS, fetal HR, presence of contractions, monitor for signs of impending shock.

Front 42

Labwork done w/ DIC

Back 42

CBC (Hgb&Hct, platelets), PT, PTT, Fibrinogen

Front 43

DIC : Interventions

Back 43

always be alert to possibility of shock and be able to intervene quickly. Always start OB pt with 18g cath line (at least) in the event the pt will need blood products.

Front 44

Hypovolemic Shock

Back 44

the body will attempt to compensate for decreased blood volume by shunting blood to essential organs. Uterus is not considered essential, blood shunted away from the uterus.

Front 45

Early Signs of Hypovolemia

Back 45

first sign: fetal tachycardia (antyhing >160bpm). Maternal tachycardia, decreased peripheral pulses, increased respitartory rate, cool clammy skin, BP WNL or slightly decreased.

Front 46

Late Signs of Hypovolemia

Back 46

Decreased BP, decreased urine output, restlessness, agitation, cold & clammy

Front 47

Pregnancy Induced Hypertension

Back 47

disease unique to pregnancy, aka pre-eclampsia

Front 48

What are S&S of PIH?

Back 48

Involves progressive hypertension, proteinuria, generalized edema. Arterial vasopsasms cause increased peripheral resistance and decreased perfusion.

Front 49

Pts with increased risk for PIH

Back 49

Hypertension, kidney disease, primigravidas. Common in teenage moms and moms over 30.

Front 50

Diagnosis of PIH

Back 50

Systolic BP greater than or equal to 140 or diastolic BP greater than or equal to 90, classified hypertension. If pt has low baseline, more than 30pts systolic/15pts diastolic increase. More than 1 elevated BP in a 6 hour period.

Front 51

What are the S&S of mild PIH?

Back 51

Systolic pressure usually 140-160. Disatolic pressure usually 80-110. Usually 1-2+ prtein seen. Edema approximately 2+

Front 52

What are S&S of severe PIH?

Back 52

Systolic pressure greater than 160. Diastolic pressure greater than 110. More than 2+ protein, visual disturbances, dec in urine output, may have elevated creatinin, edema usually 3-4+

Front 53

Management of mild PIH

Back 53

Pt put on bed rest with bathroom privileges usually at home. Pt must document BP, daily weights, check urine daily and perform daily kick counts. Noncompliance leads to hospitalization.

Front 54

Management of severe PIH

Back 54

Complete bed rest, hospitalized. Foley, urine outputs recorded. VS checked hourly. Some antihypertension meds administered. Maternal safetey is priority d/t possibility of maternal seizures.

Front 55

severe PIH more than 34 weeks gestation

Back 55

may try to deliver.

Front 56

severe PIH less than 34 weeks gestation

Back 56

Magnesium sulfate administered to stabilize until delivery.

Front 57

What is a usual dosage of magnesium sulfate when stabilizing the pt with severe PIH?

Back 57

Usually administer bolus of 4-6g mag sulfate over 30 minutes, then infusion rate of 1-3g/hr.

Front 58

Nursing responsibilities for pt on Mag Sulfate

Back 58

Hourly nursing rounds: VS, DTRs, monitor urine output.

Front 59

Eclampsia

Back 59

Defined as development of cseizures or come in a pt with pre-eclampsia. Tonic clonic seizures-- starts w/ facial twitching > rigidity > apnea

Front 60

Complications of eclampsia

Back 60

Complications may include pulmonary edema, aspiration, abruption, cardiac failure, intracranial bleeding, transient blindness.

Front 61

Vasospasms of cerebral vessels can lead to..

Back 61

inc cerebral edema and increased ICP

Front 62

Eclampsia management

Back 62

Control seizures (Magnesium sulfate), correct hypoxia (anywhere from 8-10L), control hypertension (apresoline), and delivery once mother is stable. Lasix may be given to control edema and may need to administer Digoxin.

Front 63

HELLP Syndrome

Back 63

Under the umbrella of PIH
H- hemolytic anemia
E
L- elevated liver enzymes
L
P- low platelets

Front 64

Vasospasms in artery causes..

Back 64

destruction of RBCs,causes hemolytic anemia. also suffer from thrombocytopenia, platelet counts usually less than 100k

Front 65

Liver enzymes elevated d/t

Back 65

obstructed hepatic blood flow

Front 66

What are S&S of HELLP syndrome?

Back 66

epigastric pain, nausea and vomiting, flu like symptoms, malaise, edema and sometimes hypertension.

Front 67

HELLP syndrome treatment

Back 67

delivery is necessary
usually poor maternal and fetal outcomes

Front 68

Complications of HELLP syndrome

Back 68

high chance of complete renal failure, hepatic rupture, DIC, death.

Front 69

Chronic Hypertension

Back 69

Defined and graded by specific diastolic pressures
–Mild 90-104
–Moderate 105-114
–Severe >115
Elevations occur prior to 20 weeks

Front 70

Chronic Hypertension : Management

Back 70

Diet, increased protein and low sodium, medications, antihypertensives used if DBP > 100, aldomet, apresoline only in crisis.

Front 71

Rh incompatability

Back 71

Mother must be Rh negative and the fetus Rh positive. Occurs when fetal and maternal blood mix (usually 3rd stage of labor)

Front 72

Rh incompatability : Pathphysiology

Back 72

Destruction of RBCs > increased bilirubin levels > encephalopathy. This process leads to rapid production of erthroblasts which cannot carry O2. Erthrblastosis fetalis. Anemia so severe > hydrops fetalis.

Front 73

Rh incompatability treatement

Back 73

Rhogam

Front 74

ABO incompatability

Back 74

Mother type O fetus type A, B, AB. Develop either anti-A or anti-B antibody titers. Either IgG or IgM. Cross placenta and cause hemolysis of fetal cells.

Front 75

Pathological jaundice

Back 75

occurs within the first 24 hours of life, extremely high lvls of bilirubin d/t destruction of RBCs. Easiest treatment = phototherapy.

Front 76

Kernicterus

Back 76

deposists of bilirubin in the brain that can lead to CNS damage.

Front 77

Concurrent Disorders

Back 77

one in which a concurrent disorder, pregnancy related complication or external factor jeopardizes the health of the mother and/or the fetus

Front 78

Concurrent Disorders : Conditions

Back 78

Anything that effects fluid & electrolyte balance, alters cardiovascular or respiratory function, certain infections.

Front 79

Concurrent Disoders : Risk Factors

Back 79

homeless, no prenatal care, no support system, poor coping skills, some type of genetic disposition or infection occurring and age.

Front 80

Diabetes

Back 80

Chronic metabolic disease caused by disturbance in normal production of insuline.
Body doesn't produce enough OR doesn't utilize properly.

Front 81

When does gestational diabetes usually occur?

Back 81

second trimester.

Front 82

Risk Factors for gestational diabetes

Back 82

Obesity, family hx, > 30 yrs, unexplained loss, LGA, congential anomalies

Front 83

What are maternal S&S of gestational diabetes?

Back 83

excessive thirst, hunger, weight loss, blurred vision, polyhydramnios, UTIs (d/t glucose spill.)

Front 84

What are fetal S&S of gestational diabetes?

Back 84

macrosomic

Front 85

Diabetes Education

Back 85

maternal understanding of proper diet and exercise is important.

Front 86

Diabetes: Nutrition & Exercise

Back 86

Complex carb may be needed prior to exercise. Exercise lowers serum glucose levels.

Front 87

Diabetes : Management, 1st Trimester

Back 87

Insulin requirements decrease d/t baby using a lot of glucose.

Front 88

Diabetes : Management : 2nd Trimester

Back 88

Insulin requires increase, check blood sugar before meals & at bedtime. Beginning around 26wks stress test performed checking fetal HR for adaptation.

Front 89

Diabetes : Postpartum adjustments

Back 89

Mother may not need insulin at all after delivery for a few days, then usually go back to regular dosage. High risk for postpartum hemorrhage d/t LGA & polyhydramnios.

Front 90

Maternal Effects of Diabetes

Back 90

Risk for: PIH, Ketoacidosis, UTI, Hydramnios, C-section, Hemorrhage

Front 91

Fetal Effects of Diabetes

Back 91

Risk for congenital anomalies, macrosomia or IUGR

Front 92

Newborn Effects of Diabetes

Back 92

Risk for: Cardiac dysfunction, hypoglycemia, hypocalcemia, hyperbilirubinemia, RDS

Front 93

Cardiac Disease : Incidence

Back 93

Major complications r/t congenital defects, rheumatic fever and advanced maternal age.
S&S difficult to identify

Front 94

Cardiac Disease: Warning signs

Back 94

severe chest pain, SOB (with or without activity), extreme fatigue, dyspnea, syncope

Front 95

Cardiac Disease- Type 1:Uncompromised

Back 95

(i.e. Mitral Valve Prolapse) Before they have any kind of procedure done, need prophylactic antibiotics d/t susceptibility to endocarditis. Few activity limitations on these pts most times asymptomatic.

Front 96

Cardiac Disease- Type 2

Back 96

Few limitations on activity. Most likely put on bed rest. ordinary activity can result in fatigue and dyspnea. Chest pain on excertion.

Front 97

Cardiac Disease- Type 3

Back 97

Marked limitations on physical activity. Pts usually comfortable at rest. ordinary activities are pretty difficult for these patients, can lead to excessive fatigue, palpitations & chest pain (i.e. Rheumatic Fever complications, Mitral stenosis)

Front 98

Cardiac Disease- Type 4

Back 98

Unable to perform any kind of physical activity without pain.

Front 99

Left Sided Heart Failure

Back 99

Normal tachycardia or pregnancy shortens diastole and decreases time available for blood to cross valve > back pressure on pulmonary trunk > distention, decreased BP, pulmonary HTN > fluid leaks interstitial spaces > pulmonary edema. Orthopnea

Front 100

Left Sided Heart Failure : Causes

Back 100

Coarctation, Stenosis, Rheumatic Fever

Front 101

Left Sided Heart Failure S&S

Back 101

Pt will present w/ fatigue, drop in BP, tachycardia

Front 102

Left Sided Heart Failure: What are these pts at high risk for?

Back 102

SAB, fetal demise, preterm labor, etc. because their body is unable to compensate for increased blood levels. Pt unable to nourish the pregnancy d/t inefficient O2/CO2 exchange.

Front 103

Right Sided Heart Failure : pathophysiology

Back 103

Output of RV is < what RA receives causing back pressure > congestion of systemic venous circulation and decreased cardiac output to lungs. BP aorta decreases > inc pressure in vena cava > vein distention > liver and spleen congestion > increased abdominal fluid > ascites > peripheral edema

Front 104

Cardiac Disease : Maternal Assessment

Back 104

need complete health hx, what exercise lvl is, inquire about presence of dyspnea or cough, VS, EKG, echo, and chest x-ray all necessary, check CRT & JVD, encourage lots of rest, good nutrition, avoid any risks for infection, evaluate current heart medication regimen & determine if any increases are necessary

Front 105

Cardiac Disease: Fetal Assessment

Back 105

Inadequate circulation can effect fetal growth and result in LBW, PTL & fetal distress.

Front 106

Cardiac Disease: Considerations for Delivery

Back 106

Should not push (baby allowed to descend on its own, delivered w/ forceps or vacuum), monitor closesly (HR under 100, keep legs down, dont massage uterus)

Front 107

Cardiac Disease : Postpartum Considerations

Back 107

D/t rapid blood return, pt placed on complete bed rest until their cardio system stabilizes. This can take 24-48hrs. Pt w/ bed rest inc risk for DVTs, put pt on anticoagulants.

Front 108

Iron Deficiency

Back 108

Hbg < 10, Hct < 30. Seen in younger pts d/t poor nutrtion.
Predisposes client to infection & hemorrhage.

Front 109

Iron Deficiency: S&S

Back 109

Severe fatigue, exercise intolerance, headaches, tachycardia

Front 110

Iron Deficiency: Treatment

Back 110

Prenatal vitamins w/ iron and an additional iron supplement. Need to be taken with OJ, vitamin C aids in absorption of Iron. If PO cannot be tolerated, Fe injections available.

Front 111

Sickle Cell

Back 111

Recessive inherited hemolytic anemia caused by an abnormal amino acid in the beta chain. RBCs are abnormal in shape. Pregnancy increases risk.

Front 112

Sickle Cell : Assessment

Back 112

Pt requires sickle cell screening as initial prenatal panel. Usually in sickle cell pts their Hgb around 6-8, in crisis Hgb can drop to less than 5. Elevated bilirubin level.

Front 113

Sickle Cell : Management

Back 113

Need to be on Folic acid, need at least 8, 8oz glasses a day, MUST stay hydrated. If necessary, pt can receive exchange transfusion. In crisis, give O2 and something for pain.

Front 114

Folic Acid

Back 114

Essential component for fetal cell growth and formation of RBCs. Maternal needs double w/ pregnancy.

Front 115

Folic Acid Deficiency

Back 115

Increases risk for SAB, abruption, anomalies, neural tube defects.

Front 116

Folic Acid is found in..

Back 116

Dietary liver, kidney & lima beans, green leafy vegetables.