Hehi Test 2- Pregnancy Complications Supplement

Front 1

How does hypertension cause multi-system failure?

Back 1

The intermittent vasoconstriction throughout the vasculature (vasospasms) cause damage to endothelial lining, allowing fluid to leak out. The body tries to repair the damage with platelets and fibrin clots at site, these build up in the area and blood is not able to squeeze past. The result is hypoxic body tissues in that area. This is RANDOM and can occur in any organ system with damage throughout the body

Front 2

How does hypertension cause congestive heart failure and MI in the mother?

Back 2

CHF b/c fluid leaks out of vessels into intervascular space, including the lungs. MI due to lack of oxygen to cardiac vessels.

Front 3

What is the most common pulmonary complication of hypertension and how does it happen?

Back 3

PULMONARY EDEMA. May be non-cardiogenic (leaky vessels, hypovolemic with low CO, low UOP) or cardiogenic (high BP, blood can't get out of L side of the heart, it backs up and you get pulmonary edema, hypervolemic, need BP lowered so volume can get out)
Hard to tell what type, try by looking at UOP and other noninvasive parameters

Front 4

Why oliguria in hypertension?

Back 4

Vasoconstriction in renal vasculature, hypovolemia, high systemic vascular resistance all mean the kidneys are not getting perfused. Carefully watch UOP, this can lead to acute renal failure

Front 5

Why might a hypertensive mothers retina detach?

Back 5

High pressure

Front 6

What is abruption?

Back 6

When the placenta tears off from the side of the uterus

Front 7

What is placental infarction?

Back 7

Infarct (due hypoxia) making a portion of placenta dysfunctional

Front 8

Intrauterine growth restriction (IUGR)

Back 8

If chronic HT and vasoconstriction the baby is not getting everything it needs to grow

Front 9

HELLP is a complication of...?

Back 9

pre-eclampsia

Front 10

Why do you get hemolysis in HELLP syndrome?

Back 10

With vasospasms throughout the vasculature, RBCs try to squeeze past but cannot fit so they become torn or lysed, this decreases the mothers O2 carrying capacity

Front 11

Where will a woman with HELLP complain of pain?

Back 11

RU quadrant, due to liver ischemia and elevated liver enzymes

Front 12

Why will you see low platelets (<150,000) in HELLP?

Back 12

Platelets respond to the damage caused by vasospasms, the platelets are consumed and the circulating number is decreased

Front 13

How do you identify HELLP?

Back 13

Pre-eclampsia
Labs- platelet counts and liver enzymes
High BP, proteinuria, edema, headache, blurred vision, n/v
Billirubin rise as a very late sign

Front 14

What is the standard of care for pre-eclampsia?

Back 14

**MAGNESIUM SULFATE**
to prevent, but more to control seizure activity should it occur
1. 4-6g IV loading bolus over 30 minutes
2. 1-2g IV/hr basal rate with goal of 4-8ml/dl
3. 10g IM q4h
maintain for at least 12-24h postpartum

Front 15

How often should you check DTRs on a pt on MgSO4?

Back 15

EVERY 1-2hrs, be concerned if you can't get them, as serum levels increase, reflexes decrease

Front 16

Hydralazine and the hypertensive patient

Back 16

Med of choice (labetalol is also a good choice) in hypertensive crisis (with DBP> 100 mm Hg)
Afterload reducer
NOTE: these women were healthy before pregnancy so will respond to wimpy HT meds and small doses

Front 17

What MUST you be sure of before giving harder anti-hypertensive meds?

Back 17

VOLUME STATUS, cannot give these if low volume

Front 18

Nifedipine

Back 18

a calcium channel blocker, not used much for HT in this population

Front 19

What is the difference between MgSO4 administration in pre-eclampsia and eclampsia?

Back 19

in pre-eclampsia the loading bolus is given over 30 minutes, in eclampsia it is given over 5-10 minutes

Front 20

What is the recurrence risk when previous preterm birth?

Back 20

17-37%

Front 21

What is cervical incompetence?

Back 21

Cervix is weakened (secondary to trauma from prior OB/GYN procedure or from unknown cause) leading to cervix dialting early, difficult to maintain pregnancy

Front 22

Chorioamnionitis

Back 22

infection of the membranes, need to deliver

Front 23

What is the purpose of tocolytic agents?

Back 23

to delay preterm labor

Front 24

Group B strep and preterm labor

Back 24

Group B strep linked to neonatal sepsis that can cause preterm labor but culture and treatment has not been established as beneficial

Front 25

Hydralazine and the hypertensive patient

Back 25

Med of choice (labetalol is also a good choice) in hypertensive crisis (with DBP> 100 mm Hg)
Afterload reducer
NOTE: these women were healthy before pregnancy so will respond to wimpy HT meds and small doses

Front 26

What MUST you be sure of before giving harder anti-hypertensive meds?

Back 26

VOLUME STATUS, cannot give these if low volume

Front 27

Nifedipine

Back 27

a calcium channel blocker, not used much for HT in this population

Front 28

What is the difference between MgSO4 administration in pre-eclampsia and eclampsia?

Back 28

in pre-eclampsia the loading bolus is given over 30 minutes, in eclampsia it is given over 5-10 minutes

Front 29

What is the recurrence risk when previous preterm birth?

Back 29

17-37%

Front 30

What is cervical incompetence?

Back 30

Cervix is weakened (secondary to trauma from prior OB/GYN procedure or from unknown cause) leading to cervix dialting early, difficult to maintain pregnancy

Front 31

Chorioamnionitis

Back 31

infection of the membranes, need to deliver

Front 32

What is the purpose of tocolytic agents?

Back 32

to delay preterm labor

Front 33

Group B strep and preterm labor

Back 33

Group B strep linked to neonatal sepsis that can cause preterm labor but culture and treatment has not been established as beneficial

Front 34

What classes are included as tocolytics for the delay of preterm labor?

Back 34

All prevent smooth muscle contraction of the uterus
beta-agonists
MgSO4
Indomethacin
Nifedipne

Front 35

Beta-agonists

Back 35

Tocolytic agents, specifically RITODRINE and TERBUTALINE
MOA= promotes binding of intracellular calcium, inhibits actin and myosin chain

Front 36

Ritodrine

Back 36

beta-agonist tocolytic used to delay preterm labor. This the only FDA approved drug, but no one uses it because it is expensive

Front 37

Terbutaline

Back 37

beta-agonist tocolytic with similar structure to ritodrine.
This is an asthma med and not approved for this use
25mg every 4-8h, subQ and IV, or continuous pump

Front 38

What is the main side effect of beta agonists?

Back 38

**MATERNAL TACHYCARDIA**

Front 39

Most important nursing care for a mom on beta agonists?

Back 39

**Check HR and hold if 120 or greater of if hypotensive***
Look for signs of cardiogenic pulmonary edema

Front 40

What is the goal level for MgSO4

Back 40

4-8 mg/dL

Front 41

MgSO4 as a tocolytic

Back 41

Drug of choice for many
Neuromuscular blockade so uterus can't contract
Administered the same as in pre-eclampsia

Front 42

What MUST you continually assess for a mom on MgSO4?

Back 42

DTR

Front 43

What is the number one cause of cerebral palsy?

Back 43

Preterm delivery. IV MgSO4 may decrease risk by 50%

Front 44

What will the baby look like if delivered on MgSO4?

Back 44

Limp, won't want to breath, low APGARs

Front 45

Indomethacin and prostaglandins

Back 45

Prostaglandins help with labor, so inhibit these with indomethacin and decrease preterm birth

Front 46

How long can you use indomethacin for?

Back 46

72 hrs

Front 47

Corticosteroids and tocolytics

Back 47

Delay preterm birth iwth tocolytics to get corticosteroids on board to accelerate fetal lung maturity

Front 48

2 examples of cortiocosteroids

Back 48

betamethasone
dexamethasone

Front 49

Preterm labor and antibiotics

Back 49

B/c one of the major causes of preterm labor is infection, antibiotics have been used successfully with tocolytics to prolong gestation

Front 50

Folic acid and preterm birth

Back 50

Folic acid taken for one year before conception significanly decreases the risk for preterm birth