Labor And Delivery Exam 3

Front 1

3 reasons sexually transmitted infections are important during pregnancy

Back 1

- Transmission to baby

- most common in women of child bearing age (not using protection or they would have not gotten pregnant)

- Mom might have an STI undetected

Front 2

Definition of Gestational Hypertension

Back 2

The onset of hypetension without proteinuria or other systemic findings diagnostic for preeclampsia after week 20 of pregnancy (>140/90)

Front 3

Diagnosis of GH

Back 3

Hypertension recorded on two occasions, 4 hours apart > 20 weeks gestation; woman had previously normal blood pressure. (only systolic or diastolic pree

Front 4

Gestational hypertension does not persist longer than __ weeks PP? Usually resolves during the ____ PP week?

Back 4

12 weeks/ 1st week

Front 5

Preeclampsia Definition

Back 5

The onset of hypertension and proteinuria after 20 weeks gestation or early postpartum, in a woman who previously had neither condition.

OR the absence of proteinuria with the onset of hypertension accompanied by thrombocytopenia, renal insufficiency, impaired liver function, pulmonary edema, or cerebral or visual symptoms.

Front 6

Eclampsia Definition

Back 6

Development of convulsions or coma not attributable to other causes in a preeclamptic woman (seizures occur before, during, and after birth)

Front 7

Chronic hypertension Definition

Back 7

Hypertension in a pregnant woman present before pregnancy OR hypertension that is diagnosed during pregnancy, and lasts 12 weeks postpartum.

Front 8

Hypertension diagnosis in severe preeclampsia

Back 8

BP greater than or equal to 160/110 x2, at least 4 hours apart while the client is on bed rest

Front 9

Thrombocytopenia ( decreased amount of platelets) is the same, decreased, or increased in severe preeclampsia compared to regular preeclampsia. Values?

Back 9

The same (< 100,000)

Front 10

severe preeclampsia includes what 2 S/S that are not included in regular preeclampsia? Other S/S?

Back 10

pulmonary edema, and cerebral/ visual disturbances.

Massive proteinuria (> 5g in 24 hours), abnormal elevation of liver enzymes (2x normal amount), abnormal increase in serum creatinine)

Front 11

Severe preeclampsia invloves what type of pain that is indicative of liver dysfunction

Back 11

Severe, persistent epigastric or right upper quadrant pain unresposive to medication (coincides with N/V and elevated liver enzymes)

Front 12

BUN increase, decreased, or stays the same in preeclampsia/ HELLP

Back 12

Increases

Front 13

normal platelet value

Back 13

150,000- 400,000

Front 14

Hgb/ Hct increases/ decreases in preeclampsia?

HELLP?

Back 14

increases/ decreases

Front 15

Common risk factors for Preeclampsia

Back 15

Younger than 19, OR older than 40

Family Hx

Multifetal gestation

Obesity

First pregnancy with a new partner

Preexisting medical conditions

Pregnancy onset snoring

Front 16

The root cause of preeclampsia is ? (what organ)

Back 16

Placenta

Front 17

What is the cure for preeclampsia

Back 17

Birth of baby and the placenta

Front 18

Vascular remodeling does not take place in women with preeclampsia as does in normal pregnancy to handle the increase in blood volume. This results in?

Back 18

decreased placental perfusion, endothelial cell dysfunction, and hypoxia

Front 19

Preeclampsia effects on the fetys?

Back 19

IUGR, oligohydramnios, low birth weight, preterm birth

Front 20

Due to the effects of inadequate vascular remodeling in preeclamptic women, which leads to endothelial cell dysfunction, which then leads to increased permeability and capillary leakage, what results?

Back 20

protenuria, edema, pulmonary edema -> dyspnea, hemoconcentration -> increased hematocrit

Front 21

What algorithym is used as a lab diagnosis for severe preeclampsia? What does it stand for?

Back 21

H: Hemolysis

E: Elevated

L: Liver enzymes

L: Low

P: Platelet counts

(DIC, placental abruption, liver hemorrhage/ failure, acute respiratory distress syndrome, preterm birth)

Front 22

HELLP usually occurs when?

Back 22

Antepartum period ( S/S nonspecific)

Front 23

Preeclampsia prevention

Back 23

Low dose aspirin (60-80 mg) late in 1st trimester

Front 24

Blood pressure measurement characteristics of preeclamptic women

Back 24

Woman seated or lateral recumbant (no talking), allow 10 minutes of rest time before taking BP, refrain from tobacco or caffeine 30 minutes before BP reading, use the right arm each time, support the arm at heart level horizontally, proper sized cuff (cover 80% of the arm), slow/ steady deflation rate, take an average of 2 readings at least 6 hours apart, accurate equipment, kortokoff phase V (dissapearance of sound)

Front 25

Physical assessment of preeclampsia

Back 25

Pitting edema (1+- 4+), DTR's (normal 2+, abnormal is clonus- hyperreflexia), proteinuria ( 24 hour collection), severe headaches, epigastric pain, RUQ pain, visual distrubances.

Front 26

The goal for mom with mild GH or mild preeclampsia is?

Back 26

Deliver a healthy newborn as close to term as possible (Mild cases managed at home with BP less than 150/ 100)

Front 27

Induction of labor for preeclamptic women takes place at how many weeks?

Back 27

37 weeks

Front 28

4 or fewer fetal movements per hour may indicate

Back 28

Fetal compromise

Front 29

Labs for preeclampsia

Back 29

serum creatinine

liver enzymes (weekly)

24 hour urine protein assessment (weekly)

platelet count (weekly)

(BP 2x/ week)

Front 30

Severe features of preeclampsia?

Back 30

blurred vision, severe headache, mental confusion, RUQ pain, epigastric pain, N/V, SOB, decreased urinary output.

Front 31

Fetal evaluation with preeclamptic mom

Back 31

Daily fetal movement counting

NST

BPP (1-2x/ week)

Amniotic fluid status

Estimated fetal weight

Front 32

activity restriction is or is not recommended for preeclampsia?

Back 32

recommended

Front 33

Diet recommendations for preeclamptic women

Back 33

Regular diet, limit salty foods, increase roughage, 6-8 oz. water/ day, avoid alcohol/ tobacco, limit caffeine intake

Front 34

Which medication are preeclamptic pregnant women put on to prevent seizures?

Back 34

Mag sulfate

Front 35

Maternal assessment during severe preeclampsia

Back 35

monitor BP, urine output, cerebral status, epigastric pain, tenderness, labor, vaginal bleeding ( Labs: platelet, liver enzymes, serum creatinine)

Front 36

Fetal assessment during severe preeclampsia

Back 36

FHR monitoring, BPP, US of fetal growth/ amniotic fluid

Front 37

continuing birth after ___ weeks for a preeclamptic woman, does not outweigh the risks of continuing pregnancy

Back 37

34 weeks

Front 38

For women less than 34 weeks/ severe preeclamptic, what is expected management?

Back 38

oral antihypertensives (maintain BP less than 160/110), ongoing maternal/ fetal assessment, corticosteroids (betamethasone- enhance fetal lung maturity less than 34 weeks), activity restriction, quiet/ dark environment, Iv fluids not exceeding 125ml/ hr.

Front 39

Immediate birth is indicated for preeclamptic women if?

Back 39

uncontrollable severe hypertension, eclampsia, pulmonary edema, placental abruption, DIC, nonreassuring fetal status, intrapartum fetal demise

Front 40

Mag sulfate has an effect OR has no effect on maternal BP when administered via IV infusion

Back 40

No effect

Front 41

S/S of mag toxicity

Back 41

absent DTRs, respiratory depression, blurred vision, slurred speech, severe muscle weakness, cardiac arrest

Front 42

Other magnesium sulfate notes

Back 42

Never abbreviate as MgSO4, the effect of FHR variability is controversial; other causes of fetal hypoxemia need to be ruled out. NOT USED TO DECREASE BP, during infusion, woman may feel flushed/ sedated/ nauseated/ burning at IV site. Woman positioned side- lying during infusion.

Front 43

Antihypertensive therapy used during pregnancy

Back 43

Hydralazine (Apresoline)

Labetalol (Trandate)

Nifedipine (Procardia)

Methyldopa (Aldomet)

Front 44

Seizure prophylaxis is continued after birth (Mag sulfate) for how long?

Back 44

12- 24 hours usually

Front 45

Resolution of preeclampsia? (S/S)

Back 45

Diuresis

Decreased Edema

Front 46

Bp surveillence for a preeclamptic or GH mom should continue for how long after birth?

Back 46

72 hours PP, then rechecked in 7-10 days

Front 47

Seizure activity as seen in eclampsia is preceded by?

Back 47

headache, blurres vision, epigastric/ RUQ pain, altered mental status

Front 48

Interventions during seizure activity

Back 48

Airway patent

Turn head to side

Padding/ pillow under one shoulder

Call for help

Raise side rails- Pad side rails

Observe/ record convulsion activity

Front 49

Post- convulsion interventions

Back 49

Suction as needed

Oxygen- nonrebreather- 10L

Pulse Ox

Start IV fluids

Mag sulfate

Catheter

Monitor fetal/ uterine status

Lab work