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58 Cards in this Set
- Front
- Back
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high risk pregnancy
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**woman/fetus at increased risk of illness or death
risk factors-- • biophysical • psychosocial • socio-demographic • environmental |
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pregnancy induced hypertension (PIH)
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• 140/90; either systolic OR diastolic value
• 2 readings required, must be 6 hours apart • onset is after 20 weeks gestation OR increase in baseline-- > 30 mmHg systolic > 15 mmHg diastolic |
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preeclampsia
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**PIH w/ proteinuria; can occur up to 48 hours PP
• major cause of prenatal death • often a/w IUGR triad symptoms-- • HTN • proteinuria; ≥+1 • edema; weight gain can be up to 2 kg/wk >> fluid retention |
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preeclampsia s&s
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• headaches / visual changes r/t constriction
• epigastric pain; (-) liver perfusion, (+) liver enzymes • elevated BP • sudden excessive weight gain • hand/face edema • proteinuria |
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mild v. severe preeclampsia
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mild--
• BP 140/90 • 2+ to 3+ protein • moderate puffiness • DTRs are WNL (2+) severe-- • BP 160/110 • 3+ to 4+ protein • generalized edema, noticeable puffiness • hyperreflexive (3/4+) • symptomatic • oliguria; < 500 cc in 24 hours |
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preeclampsia management
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mild--
• rest in LLP periodically • high protein, high calorie diet • FMC • monitor BP q 2x/day • daily urine dip & weight severe-- • hospital & bed rest • (-) environmental stimulation • seizure precautions r/t increased pressure • I&O • fetal assessment- NST/BPP • magnesium sulfate |
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magnesium sulfate (MgSO4)
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• (-) BP and contractions
• normal levels are 4-7/8 • depressant >> LOC, (-) RR, (-) DTRs initial loading dose-- • IVPB • 4-6 g in 100-250 cc over 15-30 mins maintenance dose-- • 40g/1000cc of LR via pump @ 2 g/hr |
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What is the antidote for magnesium sulfate?
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calcium gluconate
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What is the only cure for preeclampsia?
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Birth!
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eclampsia
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**preeclampsia w/ convulsions
**treat w/ MgSO4 therapy |
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HELLP syndrome
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hemolysis
elevated liver enzymes; (+) ALT and AST low platelets; < 100,000 **life threatening; treatment is birth! • 10% pregnant women w/ preeclampsia • low platelet w/ normal co-ag >> abnormal clotting factor |
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What is a normal platelet count
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150,000 - 415,000
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risk factors a/w preeclampsia
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• chronic renal disease
• chronic HTN • family h/o PIH • primigravidity • maternal age < 14 y/o or > 40 y/o • DM • Rh incompatibility • obesity • twin gestation |
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early pregnancy bleeding
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• spontaneous abortion
• molar pregnancy • incompetent cervix • ectopic pregnancy • implantation spotting |
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spontaneous abortion (SAB)
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**pregnancy that ends before 20 weeks
• early SAB- before 12 weeks • late SAB- 12 to 20 weeks • 10-15% of pregnancies end in SAB • 75% occur within 8-13 weeks • 50% are due to chromosomal abnormalities |
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SAB types
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• complete v. incomplete
• threatened • inevitable • missed • recurrent |
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complete v. incomplete SAB
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complete--
• all products of conception are expelled • cervix is closed incomplete-- • some but not all products expelled >> some bleeding and tissues may remain • cervix is open |
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threatened SAB
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• vaginal bleeding
• poc not expelled • cramping • cervix closed treatment-- • bed rest • NPV |
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inevitable SAB
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**ROM & cervix dilation >> SAB cannot be stopped
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missed SAB
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• fetus dies but poc are retained
• cervix closed |
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recurrent SAB
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**3 or more consecutive SAB
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SAB risk factors
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• drug use
• infection • maternal structural problems • immunological factors • systemic disorders • inadequate nutrition • endocrine imbalance |
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incompetent cervix
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**passive, painless dilation in 2nd trimester
risks-- • h/o cervical lacerations • excessive cervical dilation • congenitally short cervix • cervical uterine abnormalities |
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incompetent cervix management
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**cerclage- tie cervix to prevent preterm birth
• not placed before 25 weeks • can be placed prophylactically if patient has h/o refrain from-- • sex • standing > 90 mins see provider if-- • bleeding, spotting • ROM |
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ectopic pregnancy
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**fertilized ovum implanted outside uterine cavity
• 95% occur in ampulla • painful lower quadrant pain • referred shoulder pain • vaginal spotting/bleeding • non viable fetus >> abortion clinical findings-- • HCG and ultrasound to confirm diagnosis; HCG low or slowly rising • adnexal tenderness/fullness |
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molar pregnancy
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causes--
• hydatidiform mole • getational trophoblastic disease (GTD)- abnormal proliferation of trophoblasts >> fill uterus w/ vesicles |
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complete v. partial molar pregnancy
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complete--
• no genetic material partial-- • fetal tissue/membranes present • chromosomal contribution present • nonviable fetus |
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molar pregnancy s&s
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• vaginal bledding
• n/v • uterus is large for dates • no fetal heart tones or activy • high hCG and rising rapidly |
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molar pregnancy management & follow-up
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management--
• immediate vacuum • identify tissues to determine malignant or benign cytology follow-up-- • weekly measurement of hCG; should be declining & undetectable @ 3 weeks • continued monitoring for up to 1 year to detect malignant changes or remaining trophoblastic tissue • avoid pregnancy for 1 year |
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late pregnancy bleeding
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placenta previa--
• placenta partially/completely covers internal cervical os • painless placenta abruption-- • premature separation of placenta from uterine wall • painful |
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previa risk factors
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• h/o previa, C-section
• elective TOP • multiple gestation • closely spaced pregnancies • AMA • smoking- larger placenta to compensate for decreased perfusion • cocaine use |
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previa management
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• bed rest
• NPV • evaluate fetal activity • NO vaginal exam >> C-section |
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placental abruption
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s&s--
• vaginal bleeding can be concealed in partial separation >> will eventually see bleeding in late stage • abdomen pain for contractions are greater than expected and may be localized “classic” s&s-- • uterine tenderness • board-like abdomen |
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T/F. A board-like abdomen is usually a sign of internal hemorrhage.
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True
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placental abruption risk factors
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• PIH- due to blood vessel constriction
• cocaine use • trauma • smoking • poor nutrition |
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gestational diabetes (GDM)
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**physiological glucose intolerance in pregnancy
• 4% of all pregnancies • 50% will develop glucose intolerance later on in life |
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GDM risk factors
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• maternal age > 30 y/o
• obesity • maternal family h/o DMI • previous baby >4000g • polyhydramnios • previous unexplained stillbirth • SAB • congenital anomalies • DM s&s • recurrent glucosuria on dip stick |
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When does GDM normally appear?
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Insulin requirement increases between weeks 18-24; GDM usually appear after week 24.
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glucose testing
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glucose challenge test (GCT)
• screen b/w 24-28 weeks • NPO, draw blood glucose tolerance test (GTT) • diagnostic; follow-up to (+) GCT • NPO, draw blood >> give glucose >> draw blood again to see if patient is able to tolerate |
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What are normal glucose levels?
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70-100 mg/dL
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diagnosing GDM
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**GCT value > 200 mg/dL
OR **two abnormal GTT values • fasting ≥ 105 mg/dL • 1 hour ≥ 190 mg/dL • 2 hours ≥ 165 mg/dL • 3 hours ≥ 145 mg/dL |
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GDM treatment
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**goal is to control glucose; 60-100 mg/dl
• fasting levels < 105 mg/dl • 2 hour postprandial < 120 mg/dl • diet and exercise • educate family |
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GDM dietary guidelines
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• standard diabetic diet
• small frequent meals • high fiber foods • lower fat intake • avoid sugar & concentrated sweets |
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size less than dates
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• intrauterine growth restriction (IUGR)
• small for gestational age (SGA) • oligohydramnios |
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IUGR
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**pathological; (-) O2 and nutrition available to fetus
symmetric-- • chronic “insult” • small in all parameters, i.e. head development asymmetric-- • late occurring/acute deprivation • head sparing >> small body w/ large head |
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IUGR risk factors
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• poor nutrition and maternal weight gain
• maternal vascular disease • preeclampsia • multiple gestations • smoking • genetic disease • drug & alcohol abuse • anemia |
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SGA
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• nonpathological
• constitutionally small fetus |
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amniotic fluid index (AFI) v. amniotic fluid volume (AFV)
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AFI normal value is 5-20 cm
AFV normal value is 800-1200 cc |
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oligohydramnios
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**abnormally small amount of fluid
• AFI < 5 cm • associated w/ marked perinatal mortality factors-- • congenital anomalies • IUGR • early rupture of membranes • post-maturity |
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oligohydramnios management
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• bed rest
• hydration • encourage good nutrition • assess fetal well-being, e.g. FMC, AFV, BPP • induction & delivery if severe and fetus is mature |
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size greater than dates
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• macrosomia
• large for gestational age • multifetal pregnancy • fibroid uterus • polyhydramnios |
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polyhydramnios
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**excessive amount of amniotic fluid; rule out GDM and ABO/Rh disease
• AFI > 20 cm • difficulty auscultating fetal heart tones & palpating fetus • unstable fetal lie |
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polyhydramnios risk factors
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• multiple gestations
• uncontrolled GDM • fetal malformations • chromosomal abnormalities |
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polyhydramnios complications
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• fetal malpresentation
• placental abruption due to excessive fluid weight • uterine dysfunction during labor- have to push harder • cord prolapse • preterm labor- body thinks it’s further along |
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post-term pregnancy
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**extends >42nd week gestation
• unknown cause • h/o previous incidents increases risk for future incidents by 30-40% |
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post-term clinical manifestations
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• maternal weight loss
• decreased uterine size • meconium in fluid b/c fetus is mature • advanced bone maturation of fetal skeleton w/ hard skull |
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post-term risks
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maternal risks--
• dysfunctional labor • perineal trauma • PPH • infection • interventions may be necessary, e.g. forceps, vacuum, c-section • emotional stress fetal risks-- • macrosomia • birth trauma • distress • hypoxia/asphyxia |
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post-term management
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• BPP, NST, FMC
• cervical assessment for ripeness • induction |
