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91 Cards in this Set
- Front
- Back
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what is pre-eclampsia |
when a woman develop HTN and PROTEINURIA during pregnancy -after 20wks -can cause damage to placenta = decrease blood and oxygen to the fetus
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how common is pre-eclampsia? |
5-8% of all preg woman |
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what causes pre-eclampsia? |
-genetic -mother diet -autoimmune disease -blood vessel problems
(theory says maybe due to placenta attachment, spasm of spiral uterine arteries causing vasoconstriction) |
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what are the risk factors of pre-eclampsia |
-1st preg -twins or more -obese - >40 -women with hx of: diabetes, HTN, kidney Ds
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what are the S/S of pre-eclampsia? |
Mild: -edema in hands and face -sudden weight gain Severe: -constant headache not relieved -belly pain below ribs and the right side -oliguria -N/V -vision changes |
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what do we do about pre-eclampsia? |
DELIVER THE BABY if the baby is underdeveloped with mild pre-eclampsia they try to manage it until it becomes mature enough must be delivered if: fetus isn't getting blood or O2, diastolic BP over 100, abnormal liver function results, severe headaches, abdomen pain, seizures |
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what can pre-eclampsia lead to? |
-most likey to occur with next pregnancy -premature baby -bleeding probs -placenta abruption -hepatic rupture -stokes -death |
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what is eclampsia |
development of seizures in women with severe pre-eclampsia -rarely seen anymore with good prenatal care |
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what causes eclampsia |
not fully understood
no prenatal care
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what are the risk factors for eclampsia |
-age -hx of preeclampsia -high BP -certain diseases -multiple gest |
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what are the S/S of eclampsia |
-same as pre-eclampsia -seizures -headache |
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what do we do about eclampsia |
DELIVERY OF BABY
-mag sulfate for seizures -BP meds |
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what can eclampsia lead to |
-liver and kidney failure -bleeding/clotting problems -HELLP syndrome -placental abruption -oligohydramnios |
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what is HELLP syndrome |
H: hemolysis EL: elevated liver enzymes LP: low platelet levels |
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what are the risk factors of HELLP syndrome |
-previous HELLP -pre-eclampsia -multiple gest |
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what are the S/S of HELLP syndrome |
-headache -N/V -upper right abdominal pain -fatigue -edema -proteinuria -high BP |
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what do we do about HELLP syndrom |
DELIVERY OF BABY -bed rest and admission to hospital -mag sulfate -corticosteroids -blood transfusion -BP meds -FHR monitoring
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what can HELLP syndrome lead to |
-placental abruption -pulmonary edema -DIC -adult reps distress syndrome -liver failure |
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what is placenta previa |
when the placenta attaches to the lower uterine segment of the uterus near or over the internal cervical os, instead of the body or funds of the uterus |
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4 types of placenta previa |
total: the placenta completely covers the internal cervical os partial: placenta partially covers the internal cervical os marginal: placenta at the margin of the internal cervical os low lying: placenta is implanted in the lower uterine segment in close proximity to the internal cervical os |
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how common is placenta previa |
1 in 300 women |
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what causes placenta previa |
-impaired vascularization also redirects the placenta from the usual fundal implantation to over the cervical os -increased placental mass -multiple gestation |
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what are the risk factors of placenta previa |
mothers who have had: -endometrial scarring -previous placenta previa -prior c-section -abortion -multiparity impaired endometrial vascularization -advanced maternal age -diabetes -HTN -smoking -uterine abnormalities |
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what are the s/s of placenta previa |
-PAINLESS uterine bleeding |
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what do we do about placenta previa |
-assess vaginal bleeding (color, character, amount) NO VAGINAL EXAMS -bed rest -assess FHR with contractions -C-section -monitor labs -blood transfusion if needed |
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what can placenta previa lead to |
-C-section -labor and dilation with placenta previa=placental hemorrhage -vag birth may happen with low lying |
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what is placenta abruption |
the premature separation of a normally implanted placenta after 20wks -initiated by hemorrhage into the decimal basalis. a hematoma forms that leads to destruction of the placenta adjacent to it can be partial or total and can be grade 1,2,3. |
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how common is placenta abruption |
1 in 200 |
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what causes placenta abruption |
-initiated by hemorrhage into the decimal basal is. a hematoma forms that leads to destruction of the placenta adjacent to it -injury to the belly area r/t accident or trauma -sudden loss of uterine volume usually r/t rapid loss of amniotic |
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what are the risk factors for placenta abruption |
-previous abruption -HTN -abdominal trauma -cocaine, meth, cigarettes -premature anomalies/fibroids |
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what are the s/s of placenta abruption |
-severe sudden onset of intense abdominal pain -rapid uterine contractions -uterine tenderness -dark vaginal non clotting bleeding may or may no be present -if separation occurs in the middle of placenta bleeding is concealed -signs of hypovolemia -abnormal FHR -severe back pain |
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what do we do about placenta abruption |
-O2 -palpate uterus -C section -watch maternal volume status -restore blood loss -monitor fetal status -monitor coagulation defects -expediting delivery -corticosteroids |
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what can placenta abruption lead to |
-decreased blood volume -decreased fetal sufficiency -moderate to profound shock -tachypnea -DIC |
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what is placenta accreta |
abnormality of implantation defined by degree of invasion into uterine wall of trophoblast of placenta
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placenta accrete |
invasion of the trophoblast is beyond the normal boundary |
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placenta increta |
invasion of the trophoblast extends into uterine myometrium |
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placenta percreta |
invasion of the trophoblast extends into the uterine musculature and can adhere to other pelvic organs |
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what are the S/S of placenta accreta |
the placenta does not separate from the uterine wall after birth |
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what are the risk factors for placenta accreta |
-placenta previa -prior C-section
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what do we do about placenta accreta |
-control hemorrhage and transfuse as needed surgical intervention: -D&C -Hysterectomy |
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what can placenta accreta lead to |
-postpartum hemorrhage -hysterectomy -death |
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what is neonatal abstinence syndrome |
prenatal or maternal use of substances that results in withdrawal symptoms |
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how common is NAS |
1 baby every hour |
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what are the risk factors for NAS |
-unborn babies are most at risk during the first trimester |
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what causes NAS |
the consumption of drugs and/or alcohol by the mother while pregnant and affects the newborn baby or postnatal r/t the discontinuation of medications |
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what are the S/S of NAS |
-hypertonia -tremors -hyperreflexia -seizure -yawning -sneezing -irritability -high pitch cry -feeding probs -sleep probs -apnea -failure to gain weigh -behavior probs |
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what do we do about NAS |
-monitor, get toxicology report -assess feedings and daily weight, increased activity, decreased sleep,vomiting, poor behavior may result in increased caloric need -frequent and small feedings, a high cal formula, allow them to rest during feeds, position them up right |
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what can NAS lead to? |
-fetal alcohol syndrome -alcohol related birth defects -alcohol related neurodevelopment disorder |
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fetal alcohol syndrome |
-distinctive facial feature, small eyes, thin upper lip, short nose -heart defects -joint,limb, and finger deformities -delayed physical growth -vision problems -hearing problems -mental retardation -behavior disturbances |
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alcohol related birth defects |
-congenital anomalies heart, skeleton, kidneys, eyes, and ears |
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alcohol related neurodevelopment disorder |
-neurological problems (poor hand eye coordination and fine motor skills, hearing loss) -decreased cranial size, brain anomalies -cognitive and behavioral probs |
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what is post mature |
neonate who is delivered after the completion of 41 wks |
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how common is post mature |
7% |
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what are the risk factors of post mature |
-anencophaly -hx of post term preg -first preg multiple preg |
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what are the S/S of post mature |
-dry, peeling, cracked skin -lack of vernix -profuse hair -long finger nails -thin, wasted appearance -meconium staining -hypoglycemia -poor feeding behavior |
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what do we do about post mature |
-monitor for hypoglycemia -early and frequent feedings if reps status stable -monitor I/O |
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what can post mature lead to |
-death -postmaturity syndrome: placental insufficiency r/t aging of placenta. fetus uses fat stores and uses glycemic stores rather than nutrition from placenta -decreased placental function causes altered oxygenation and nutrient transport. increase risk for hypoxia and hypoglycemia at onset of labor -macrosomia -meconium aspiration -fetal hypoxia: due to decreased amniotic fluid causing cord compression -neuro compromises: seizure r/t asphyxia during labor -hypothermia: lack of subcutaneous fat -polycythemia -birth trauma |
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two major complications of post mature |
-meconium aspiration -persistent pulmonary HTN of newborn |
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meconium aspiration |
-results in reps morbidity and mortality -fetus passes meconium stool into amniotic fluid caused by relaxation of the fetal anal sphincter due to fetal asphyxia in utero -risk that fetus can aspirate meconium at time of delivery
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complications of meconium aspiration |
-obstruction of airway -hyperinflation of the alveoli -chemical pneumonia -decreased surfactant proteins -hemorrhagic pulmonary edema |
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assessment findings in meconium aspiration |
-meconium stained amniotic fluid -meconium visualized in vocal cords -greenish yellowish discoloration of skin, nails -resp depression at time of birth -low apgar scores -need for resuscitation -signs of resp distress -low blood gases |
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medical management of meconium aspiration |
-suctioning of the oropharynx and nasopharynx to remove meconium -arterial blood gases -chest x-ray -blood glucose monitoring -O2 -surfactant therapy -sedatives -antibiotics |
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persistent pulmonary hypertension of the newborn |
when the normal vasodilation and relaxation of the pulmonary vascular bed do not occur -elevation of pulmonary vascular resistance, right ventricular HTN,and R to L shunting of blood |
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risk factors for PPHN |
-hypoxia and asphyxia -RDS, meconium aspiration, pneumonia -bacterial sepsis -delayed circulatory transition at birth -hypothermia -hypoglycemia -polycythemia |
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what is prematurity |
very premature: born <32 wks
premature: born between 32 and 34 wks
late premature: born between 34 and 37 wks |
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how common is prematurity |
12.2%
more common is A.A. |
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what causes prematurity |
spontaneous preterm labor or intentional due to complications |
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non modifiable risk factors for prematurity |
-previous preterm birth -multiple abortions -race/ethnic groups -uterine anomaly -multiple gestations -poly/oligohydramnios -placenta previa -short interval between pregnancies -abruptio placenta -premature ROM
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modifiable risk factors for prematurity |
- <17 or >34 -unplanned preg -single -low education level -poverty -domestic violence -obesity -infection -substance abuse -no prenatal care |
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what are the S/S of prematurity |
-tone and flexion increase with age -the fast the arms return to flexed position the greater the age -popliteal angle in less with age -theelbow crossesthe midline les the greater the age -the less of flexion with heel to ear the greater age -the greater the age the less translucent -languno decreases with age -the more crease on the soles of the feet the more term -the greater degree of nipple formation the greater the age -the more define the ear the greater age -testes are more descended with age |
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what do we do about prematurity |
-determine lung maturity -corticosteroids -cardiac monitoring -rep support -las -sodium bicarbonate: metabolic acidosis -dopamine: hypotension -antibiotic:infection -opioids:pain |
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what can prematurity lead to |
-resp. distress syndrome -bronchopulmonary dysplasia -PDA -periventricular/intraventricular hemorrhages -necrotizing entercolitis -retinopathy of prematurity |
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what is PROM |
the amniotic sac breaks prior to the onset of true labor |
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how common is PROM |
6-19% |
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what are risk factors for PROM |
-previous PROM -preterm delivery -bleeding -hydramnios -multiple gestations -infection -cigarette smoking -poor nutrition |
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what are the S/S of PROM |
-assessment of ROM: speculum, nitrazine, cytologic (ferning) tests, and ultrasound, dipstick tests |
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what do we do about PROM |
-between 34-36 wks DELIVERY OF BABY -<32 wks assess pulmonary system -antibiotics -coritcosteroids (betamethasone) -prophylactic antibiotics for GBS -NO VAG EXAM -monitor for signs of infection |
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what can PROM lead to |
-infection -increased rate of C-section -preterm labor/delivery for baby: -hypoxia/asphyxia r/t cord compression -fetal sepsis -prematurity -fetal deformities |
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what is prolapsed cord |
the umbilical cord presents before the fetus' presenting part -occult: the cord cannot be seen or felt -complete: can be felt as a pulsating mass -frank: cord precedes the fetal head or feet and can be seen protruding |
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how common is a prolapsed cord |
1/300 |
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what are the risk factors for a prolapsed cord |
-malpresentation -unengaged fetus -small/preterm fetus -multiple gestation -high parity -long cord -hydramnios -PROM |
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what are the S/S for a prolapsed cord |
-sudden fetal bradycardia (prolonged decels) |
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what do we do about a prolapsed cord |
-lift presenting part off the cord with a vaginal exam -hand must remain in bag until delivery -position changes to remove pressure on cord(knee chest, trandelenburg) -O2 -discontinue oxytocin -IV hydration bolus -tocolytics |
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what can a prolapsed cord lead to |
-causes a drop in the fetus' blood pressure, along with O2 which can lead to brain damage -decreased fetal perfusion and oxygenation and ultimately death |
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what is dystocia |
labor that is obstructed, not progressing
trouble with the powers: -hypertonic uterine contractions -hypotonic uterine contractions -precipitous labor -inadequate pushing |
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how common is dystocia |
12% |
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what are the risk factors for dystocia |
-previous C-section dystocia -nulliparous women -multiparous women r/t insufficient uterine contractions -maternal obesity -women with prolonged second stage labor beyond 4 hours
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what causes dystocia |
-high anxiety and fear -dysfunction labor r/t hypertonic or hypotonic pattern -inadequate expulsive force -maternal diabetes -obesity -male -forcep or vacuum interventions |
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what are the S/S of dystocia |
-hypertonic uterine dysfunction-frequent and painful contractions that do not effectively promote dilation and effacement -abnormal contractions (intra-uterine pressure catheter -partogram |
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what do we do about dystocia |
-hydration -pain management -augmentation of labor with oxytocin -possible C-section, vacuum, forceps -position changes |
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what can dystocia lead to |
-hypoxia -prolonged labor |
