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107 Cards in this Set

  • Front
  • Back
What age women are considered High Risk Pregnancy
less then 20 years of age or older then 35
Risk factors for high risk pregnancy
biophysical
psychosocial
socio-demographic
environmental
Blood pressure needed to diagnose Chronic Hypertension
systolic blood pressure greater then or equal to 140
or
diastolic blood pressure greater then or equal to 90
that was known to exist before pregnancy or before 20 weeks

two readings at least 6 hours apart
Gestational Hypertension is
hypertension in pregnancy with onset after 20 weeks of pregnancy
to diagnose gestational hypertension you need
systolic blood pressure greater then or equal to 140
or
diastolic blood pressure greater then or equal to 90

two reading at least 6 hours apart
An alternative criteria for gestational hypertension is
systolic going up from baseline by 30 and diastolic by 15
Does proteinuria occur in gestational hypertension?
no
if yes ( scant or trace)
Pre-eclampsia is diagnosed with
systolic blood pressure greater then or equal to 140
or
diastolic blood pressure greater then or equal to 90
proteinuria greater or equal to 1+
Pre-eclampsia can occurs up to
48 hours postpartum
triad of symptoms for pre-eclampsia
HTN
proteinuria
Edema
Pre-eclampsia occurs after the
1st trimester
pre-eclampsia is the leading cause of
peri-natal death
What is a common occurrence in infants
IUGR
With pre-eclampsia women can have ____ weight gain per week
2kg (4.5lbs)
pre-eclampsia occurs predominantly in
prinips
Signs and Symptoms of pre-eclampsia
headache
visual change
epigastric pain
elevated BP
sudden excessive weight gain
hand and face edema
proteinuria
Which liver enzymes are elevated with pre-eclampsia
AST
Signs of mild pre-eclampsia
SBP greater or equal to 140 but less then or equal to 160
DBP greater or equal to 90 but less then or equal to 110
+1 protein
moderate puffiness
DTRs WNL
Signs of severe pre-eclampsia
SBP greater or equal to160
DBP greater or equal 110
3+ protein or higher
generalized edema and noticeable puffiness
hyperreflexive
oliguria
anasarca
generalized edema
oliguria
urine output less then 30cc per hour
500cc over 24 hours
Management of mild pre-eclampsia
BR in LLP periodically
BP Q2H
Daily urine dip and daily weights
FMC
management of severe pre-eclampsia
hospital and bed rest
decreased environmental stimulation
seizure precautions
I and O
Fetal Assessment
Magnesium Sulfate
Normal Magnesium is
4-8mg
Eclampsia
pre-eclampsia with convulsions
What is the cure for eclampsia?
Birth
What is the therapy for eclampsia?
Magnesium Sulfate
What is the dose for Magnesium sulfate with eclampsia?
IVBP with initial loading dose of 4-6 grams in 100-250cc over 15-30min
What is the maintenance dose for Magnesium Sulfate with eclampsia?
40g/1000 LR via pump at 2grams per hour
Main goal with eclampsia
prevention or control of convulsions
HELLP Syndrome
hemolysis
elevated
liver
low
platelets
HELLP syndrome is
life threatening
With HELLP syndrome coagulation factor
coagulation factor is normal but abnormal clotting factor
The treatment for HELLP syndrom is
birth
Risk factors for HELLP syndrome
chronic renal disease
chronic HTN
family h/o PIH
Primigravida
maternal age > 40
diabetes
obesity
twin gestation
Bleeding Complications of Pregnancy
spontaneous abortion (SAB)
molar pregnancy
incompetent cervix
ectopic pregnancy
implantation spotting
Spontaneous abortion is
when pregnancy ends before 20 weeks
early SAB is
prior to 12 weeks
late SAB is
12-20 weeks
a Complete SAB is
all products of conception are expelled
cervix is closed
an incomplete SAB is
some but not all POC are expelled
bleeding is major manifestation
cervix is open
(could be an SAB in progress)
a threatened SAB
vaginal bleeding occurs but the POC are not expelled
an inevitable SAB is
an abortion that cannot be stopped when their is ROM and dilation of the cervix
a missed SAB
the fetus dies but the POC are not expelled
a recurrent SAB
three or more consecutive pregnancies that end in SAB
Of all clinical pregnancies how many end in SAB
10-15%
Risk Factors for SAB
endocrine embalance
infection
maternal structural problems
immunological factors
systemic disorders
drug use
inadequate nutriton
incompetent cervix
passive and painless dilation of the cervix in the 2nd trimester
Risk factors for an incompetent cervix
H/O of previous cervical laceration
excessive cervical dilation
congenital short cervix
cervical uterine abnormalities
Management of an incompetent cervix
cerclage
What is cerclage
pull the cervix closed by putting a tie around it
For women with H/O an incompetent cervix a cerclage can be done at
10-14 weeks
Cerclage is removed at
37 weeks
After a cerclage patient should NOT
stand for 90 minute
NPV
a cerclage is rarely performed after
25 weeks
ectopic pregnancy
fertilized ovum implanted outside the uterine cavity
a sign associated with an ectopic pregnancy is
referred shoulder pain with L lower quadrant pain
Signs of an ectopic pregnancy
pregnancy
vaginal bleeding or spotting
further along = more pain
low or slow to rise HCG
normal HCG levels
double every day
adnexal
outside the uterine cavity
Clinical Findings with an ectopic pregnancy
low or slow rising HCG levels
Adnexal tenderness and fullness on exam
Referred shoulder pain
Molar Pregnancy also known as
gestational trophoblastic disease
Gestational trophoblastic disease
an abnormal growth of trophoblastic cells that attach the fertilized ovum to the uterine wall

the proliferating trophoblasts fill the uterus with vesicles that resemble a cluster of grapes
the cause of GTD is
unknown
molar pregnancy can be
cancerous
Molar Pregnancy: Complete
believed that this occurs when the ovum is fertilized by a sperm and then duplicates its own chromosomes while the chromosomes of the ovum are inactivated
Molar Pregnancy: Partial
fetal tissue or membranes are present
chromosome contribution is present
nonviable fetus
Signs and Symptoms of Molar Pregnancy
Vaginal Bleeding
Severe NV
Uterus is large for dates
No fetal heart tones or activity
HCG levels high and rising rapidly
Management of Molar Pregnancy
immediate vacuum evacuation
identify tissue to identify malignant or benign cytology
Weekly measurement of HCG
Monitoring for up to one year
Avoid pregnancy for 1 year
Placenta Previa
placenta completely or partially covers the internal os
painless
placenta abruption
painful
premature separation of placenta from the uterine wall
Risk factors for placenta previa
previous previa
previous c-section
elective TOP
multiple gestation
closely placed pregnancies
AMA
smoking
cocaine
Management of previa
bed rest
NPV
evaluate fetal well being
NEVER do a vaginal exam
C-section
Signs of Placenta Abruption
vaginal bleeding ( may be concealed)
abdominal pain with contractions greater then expected
uterine tenderness
board like abdomen
fetal tachy
Risk factors of placenta abruption
PIH
Cocaine Use
Trauma
Smoking
Poor Nutriton
Gestational Diabetes
physiological glucose intolerance in pregnancy
typical onset of gestational diabetes is
at 24 weeks
starts to go up between 18-24 weeks
50% of mother with gestational diabetes will
develop glucose intolerance later in life
GDM Risk Factors
maternal age >30
obesity
family history of IDDM
previous baby weighing > 4000g
polyhydramnios
previous unexplained stillbirth
SAB
congenital anomalies
signs and symptoms of diabetes
recurrent glucosuria note on dip stick
polyhydramnios
increase in amniotic fluid
glucose challange test (GCT)
screen for glucose
24-28 weeks
Glucose Tolerance Test (GTT)
f/u to elevated GCT
diagnostic
Value of GCT that is indicative of a positive test
>200
2 abnl values on GTT
fasting > 105
1 hour > 190
2 hour > 165
3 hour > 145
Treatment of gestational diabetes
goal is glucose control
fasting level < 105
2 hours postprandial <120
goal 60 and 100
diet and exercise
postprandial
after eating
Dietary Guidelines for gestational diabetes
standard diabetic diet
small frequent meals
high fiber foods
lower fat intake
avoid sugar and concentrated sweets
IUGR
pathological process
decreased O2 and nutritional availability
symmetrical or unsymmetrical
symmetric IUGR
represents chronic/long term insult
small in all parameters including head development
asymmetric IUGR
late occuring
short term deprivation
head sparing
small body and large head
Risk factors for IUGR
poor nutriton and maternal weight gain
maternal vascular disease
pre-eclampsia
multiples
smoking
genetic disease
drug and alcohol abuse
anemia
anemia
reduced oxygen carrying capacity because decreased heme
SGA
nonpathalogical
constitutionally small fetus
Oligohydramnios
Abnormally small amount of fluid
AFI <5cm
associate with marked perinatal mortality
normal AFI
5-20cm
factors a/w oligohydramnios
congenital anomalies
IUGR
early rupture of membrane
post-maturity
Management of oligohydramnios
bed rest
hydration
encourage good nutrition
assess fetal well being
induction and delivery if severe
LGA
macrosomia
multifetal pregnancy
fibroid uterus
polyhydraminos
polyhydraminos
excessive amount of amniotic fluid
difficult ascultating and palpating fetus
unstable fetal lie
rule out GDM and ABO/RH disease
risk factors polyhydraminos
multiples
uncontrolled GDM
Fetal malformation
chromosomal abnormalities
Complications of polyhydraminos
fetal malpresenation
placental abruption
uterine dysfunction during labor
PP Hemorrhage
cord prolapse
preterm labor
post-term pregnancy
pregnancy that extends past 42 weeks of gestation
cause of post-term pregnancy
unknown
clinical manifestations of post-term pregnancy
maternal weigh loss
decreased uterine size
meconium fluid
advanced bone maturation of the fetal skeleton with a hard skull
maternal risk of post-term pregnancy
dysfunctional labor
perineal trauma
PPH
infection
interventions
emotional stress
Fetal risks with post term pregnancy
macrosomia
birth trauma
distress
hypoxia/ asphyxia
Management of post term pregnancy
BPP, NST, FMC
cervical assessment for ripeness
induction