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182 Cards in this Set
- Front
- Back
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Examples of biophysical risks that lead to a high risk pregnancy
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HTN, multiple gestational pregnancies
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Examples of psychosocial factors that increase the risk for high risk pregnancy
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rape victim, low socioeconomic/ educational status, "unmarried" status
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Examples of socio-demographic factors that increase the risk for high risk pregnancy
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AA
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Examples of environmental factors that increase the risk for high risk pregnancy
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contaminated water, air pollution
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Examples of hypertensive disorders of pregnancy
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pregnancy induced HTN, pre-eclampsia, eclampsia
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Systolic and Diastolic BP's associated with chronic HTN
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Systolic > 140mmhg
Diastolic > 90mmhg |
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When is chronic HTN presented during pregnancy
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elevated BP's noted before 20 weeks gestation and/ or after the pp period
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Onset of Gestational HTN (PIH)
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after 20 wks gestation
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BP's associated with gestational HTN
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> 140/90 or, increase in baseline: systolic + 30mmhg/ diastolic + 15mmhg
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PIH is seen in what percentage of pregnancies
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6-7%
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What criteria is necessary when diagnosing gestational HTN
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2 elevated readings at least 6h apart
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What hypertensive disorder seen in pregnancy is not associated with proteinuria
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gestational HTN
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Pre-eclampsia (BP, proteinuria)
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> 140/90mmhg, accompanied by proteinuria
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What dipstick reading are we expecting to find with a woman suspected of pre-eclampsia
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>= +1 (+2)
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Why might we see pre-eclampsia 48h into the pp period?
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pregnancy is dilated state, after delivery of placenta increased BV enters maternal circulation
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What disorder are the "triad" symptoms seen with?
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pre-eclampsia
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List the "triad symptoms" seen in pre-eclampsia
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HTN, proteinuria, edema
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Explain the type of edema observed with pre-eclampsia
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edema in non-dependent areas (face, hands, abdomen)
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Explain the weight gain associated with pre-eclampsia
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woman is gaining 2kg (~4.5lbs)/wk when she should only be gaining ~1lbs/wk
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Prevalence of edema and weight gain seen in pre-eclampsia
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universally
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What population is more likely to suffer from pre-eclampsia? Primtips or multips?
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primtips
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_____________ is associated with maternal HTN (hint: fetal disorder)
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IUGR
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Time frame associated with pre-eclampsia
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>20wks into pp period
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headaches, visual changes, epigastric pain, elevated BP, sudden excess weight gain, hand and face edema, and proteinuria are all s&s's of what hypertensive disorder seen during pregnancy
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pre-eclampsia
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Explain epigastric pain r/t pre-eclampsia
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elevated liver enzymes as a result of decreased liver perfusion ie/ AST
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ACRONYM for AST
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alcohol, statin, tylenol - just to remember
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There are two levels of pre-eclampsia, what are they
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mild and severe
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BP, mild vs. severe pre-eclampsia
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>140/90, >160/110
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Proteinuria, mild vs. severe pre-eclampsia
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+1, >+3
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Edema, mild vs. severe pre-eclampsia
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moderate puffiness, anasarca/noticeable puffiness
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DTRs, mild vs. severe pre-eclampsia
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WNL, hyperreflexive
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What level of pre-eclampsia is associated with oliguria
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severe pre-eclampsia
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Oliguria
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decreased urinary output, <500cc/day
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Anasarca
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generalized edema
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Van pre-eclampsia be monitored at home?
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yes, mild pre-eclampsia
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Instructions for home care with mild pre-eclampsia
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bed rest in LLP, BP 2x/daily, daily urine dips, daily weights, FMC
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What bed rest position should a woman with pre-eclampsia avoid
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supine
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Good times to take BP if instructed to take it twice daily
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morning and night BP
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What is priority management concerning severe pre-eclampsia
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prevent, control seizures
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Management for severe pre-eclampsia
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hospitalization, bed rest, decreased environmental stimulation, I&O's, seizure precautions, magnesium sulfate, fetal assessment
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Fetal Assessment measures
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NST, BPP
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Why is magnesium sulfate the drug of choice as tx for severe pre-eclampsia
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relaxes smooth muscle, increases uterine blood flow, helps w/ seizures
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What differentiates severe pre-eclampsia from eclampsia
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pre-eclampsia w/ convulsions
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Describe the loading dose associated with MgSO4 therapy and eclampsia
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IVPB 4-6g in 100-250cc over 15-30min
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What is the purpose of a loading does administered during pharmacological therapy
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to jump up to therapeutic levels
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Describe the maintenance dose administered with MgSO4 therapy and eclampsia
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40g/1000cc LR via pump at 2g/hr
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What borders do we need to monitor with MgSO4 therapy
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maintain therapeutic serum levels (4-7) and observe for s&s's of toxicity
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What is the most important goal when managing eclampsia
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prevention or controlling convulsions
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What is HELLP syndrome
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Hemolysis, Elevated liver enzymes, Low platelets
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Severity of HELLP syndrome and what population is it associated with?
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life-threatening occurrence seen in 10% of woman with pre-eclampsia or eclampsia
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It is suspected that a woman is suffering from HELLP syndrome. The doctor wants to have labs drawn. What value do we expect her platelet count to be?
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<100,000
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Examples of liver enzymes
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AST, ALT, SGOT
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chronic renal disease, chronic HTN, family h/o PIH, primigravidity, maternal age > 40y/o, diabetes, obesity, twin gestation are all risk factors of what?
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hypertensive disorders of pregnancy
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Spontaneous abortion (SAB), Molar pregnancy, incompetent cervix, ectopic pregnancy, and implantation spotting are all what type of pregnancy disorders?
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vaginal bleeding
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What gestational age marks spontaneous abortion?
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< 20wks
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What gestational ages are associated with early SAB? Late SAB?
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<12wks, 12-20wks
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What percentage of clinically known pregnancies result in SAB
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10-15%
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Of the known SAB, what percentage result from congenital anomalies?
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50%
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What time period is referred to as "all or nothing"
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1st trimester
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POC and some examples
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products of conception; fetus, membranes
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Complete SAB (POC, cervix, tx)
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all products of conception expelled; closed; none
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Incomplete SAB (POC, cervix, bleeding, tx)
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some, but not all products of conception are expelled; open; actively bleeding; will complete w/in a few days
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Threatened SAB (POC, cervix, bleeding, tx)
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products of conception are not expelled; closed; some bleeding; hospitalization, bed rest, NPV
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Inevitable SAB (symptoms, bleeding, cervix)
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symptoms of abortion cannot be stopped and a miscarriage will happen; membranes will rupture and cervix will dilate
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Missed SAB (fetus, POC, cervix)
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the fetus dies; products of conception are not expelled; closed
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Recurrent SAB
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three or more consecutive pregnancies end in SAB
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Endocrine imbalance, infection, maternal structural problems, immunological factors, systemic disorders, drug use, inadequate nutrition are all factors of what?
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SAB
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Incompetent cervix
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Passive and painless dilation of cervix in 2nd trimester
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Why does h/o cervical lacerations act as a risk for an incompetent cervix
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scar tissue doesn't function properly
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Why does a congenitally short cervix act as a risk factor for an incompetent cervix
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starting out with less, so as it stretches, it dilates
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What management is used to treat an incompetent cervix
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cerclage
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What is a cerclage
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cervical stitch that holds the cervix closed all around
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What percentage of incompetent cervixes treated with a cerclage end with a viable baby?
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80-90%
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At what gestational age is a cerclage typically performed as prophylaxis when there is h/o an incompetent cervix
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10-14wks
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At what gestational age is a cerclage rarely performed
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>25wks
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At what gestation age is a cerclage typically removed
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37wks
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What instructions are given to a pt with a cerclage? What do they all have in common?
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NPV, avoid standing >90min; both put pressure on the cervix
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Describe two reasons why NPV is the recommended after placement of a cerclage
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pressure on cervix, semen stimulates labor
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How does semen stimulate labor
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prostaglandins promote dilation
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What description of pain should set off a light bulb that says, "ectopic pregnancy!"
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lower quadrant and same side should pain
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Describe ectopic pregnancy
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fertilized ovum is implanted outside of the uterine cavity
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If ectopic pregnancy is suspected, what is done for diagnosis
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HCG to confirm pregnancy and U/S
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Tx of ectopic pregnancy? Why?
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Abort pregnancy, it is not viable
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Aside from lower quadrant and should pain, what might a woman report w/ ectopic pregnancy
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positive pregnancy test and vaginal spotting or bleeding
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What is the significance of low or slow-rising HCG levels associated with an ectopic pregnancy?
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fetus is not receiving adequate nutrition
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What is the significance of adnexal tenderness and fullness on an exam associated with an ectopic pregnancy
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typically refers to a lump in the fallopian tube, or location of implantation outside the uterine cavity
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Define Molar Pregnancy
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abnormal growth of trophoblastic cells that attach the fertilized ovum to the uterine wall
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What do the proliferating trophoblasts that fill the uterus resemble
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grape clusters
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What should develop from the trophoblasts
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placenta
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Although the cause of GTD is unknown, what is believed that occurs
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sperm replicates its own chromosomes and inactivates the ovum's
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Partial GTD versus complete GTD
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fetal tissues or membranes are present but the fetus is not viable
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Vaginal bleeding, elevated hCG, hCG levels rising rapidly, severe N/V, uterus is large for dates, no FHR, and no fetal activity are s&s's of what disorder
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molar pregnancy, GTD
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What pregnancy hormone is believe to cause N/V associated with "morning sickness"
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hCG
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What is the significance of a uterus that is large for dates?
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GTD
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Management for GTD (include what u need to r/o and necessary monitoring)
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immediate vacuum evacuation, identify tissues to identify malignant or benign, weekly measurements of hCG, continue monitoring for one year, avoid pregnancy for 1 year
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What is additional concern with GTD
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cancer
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What are we expecting after tx of GTD when measuring hCG levels
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declining levels
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Placenta previa
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placenta partially or completely covers the internal cervical os
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Placenta abruption
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premature placental separation from the uterine wall
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Describe the pain level associated with placenta previa
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painless
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Describe the pain level associated with placenta abruption
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painful
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Can a fetus be delivered vaginally with placenta previa
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no
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Previous previa, previous c/s, elective TOP, multiple gestation, closely spaced pregnancies, AMA, smoking and cocaine use are all risk factors of what disorder seen in pregnancy
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placenta previa
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What is the significance of a c/s as a risk factor for placenta previa
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scar tissue w/ c/s
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What is the significance of TOP as a risk factor for placenta previa
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scraping of uterine lining
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What is the significance of multiple gestations as a risk factor of placenta previa
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fighting for space
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What is the significance of closely spaced pregnancies as a risk factor of placenta previa
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decreased recovery time
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What is the significance of smoking as a risk factor of placenta previa
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vasoconstrictive state so placenta makes itself bigger in order to get adequate blood supply
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Bed rest, NPV, evaluate fetal well being, no vaginal exam and c/s are management criteria for what pregnancy disorder
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placenta previa
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Why shouldn't a vaginal exam be performed when a women has placenta previa
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risk of exposing dilated vessels
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Explain the bleeding observed with placenta abruption
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it may be concealed
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What description might a pt use when discussing her cx's
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stronger than expected, localized
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Uterine tenderness and "board-like" abdomen commonly describe what disorder of pregnancy
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placenta abruption
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PIH, Cocaine, Trauma, smoking, poor nutrition are risk factors of what pregnancy disorder
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placenta abruption
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Physiologic glucose intolerance of pregnancy describes what disorder of pregnancy
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Gestational diabetes (GDM)
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Typical onset of GDM
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>24wks
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What gestational age is associated with increased insulin requirements
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18-24wks
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GDM occurs in what percentage of pregnancies
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4%
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What percentage of women that experience GDM go on to develop glucose intolerance later in life?
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50%
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maternal age > 30, obesity, family hx of IDDM, previous baby weighing > 4000g, polyhydramnios, previous unexplained stillbirth, SAB, congenital anomalies, s&s's of diabetes, recurrent glucosuria noted on dip stick are risk factors for what disorder of pregnancy
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GDM
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Polyhydramnios
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increased amniotic fluid
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Why is polyhydramnios associated with GDM
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if baby drinks a lot, baby will pee a lot
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Increased thirst, increased urination, increased glucose levels indicate what disorder
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diabetes, GDM
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Name the two types of glucose testing
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glucose challenge test, glucose tolerance test
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Of the two types of glucose tests, which is used for diagnostic purposes
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glucose tolerance test (GTT)
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Of the two types of glucose tests, which is used to screen for GDM
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glucose challenge test (GCT)
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What is a screen test used for
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to see what pt's are at risk for a disorder
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What gestational age are mom's screened for GDM
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24-28wks
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What test is f/u for GCT
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GTT
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What GCT value is needed to diagnose GDM
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>200
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What GTT values are needed to diagnose GDM
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2 abnormal values
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Abnormal BG values observed @ fasting, 1h, 2h, and 3h w/ GTT
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>= 105mg/dl, 190mg/dl, 165 mg/dl, 145mg/dl
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GCT
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pt comes in fasting, get BG levels
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GTT
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pt comes in fasting, get BG levels, administer, glucola, get BG levels 1h, 2h, 3h
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What is the goal of treatment for GDM
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controlling glucose levels
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Ideally, what fasting BG value do we want to see when treated GDM
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<105mg/dl
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Ideally, what BG value do we want to see when treating GDM 2h postprandial
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<120mg/dl
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What fasting and 2h postprandial BG values are the ultimate goal w/ GDM treatment
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60mg/dl and 100mg/dl
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Do we recommend diet and exercise as treatment options for GDM
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yes
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What dietary guidelines are recommended when treating GDM
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standard diabetic diet, smaller frequent meals, high fiber foods, low fat intake, avoid sugar and concentrated sweets
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What assessments are monitored with size-date discrepancies
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fetal size and amniotic fluid volume
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Examples of S<D
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IUGR, SGA, Oligohydramnios
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Oligohydramnios
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decreased amniotic fluid, < 500cc's at term
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Normal amniotic fluid volume at term
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800-1200cc's
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IUGR is pathological/ non-pathological
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pathological
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IUGR results from decreased and inadequate what?
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decreased O2 and inadequate nutrition available to the fetus
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Types of IUGR
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symmetrical, asymmetrical
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What type of IUGR is associated with chronic/ long-term insult
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symmetric
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Describe size of parameters with symmetric IUGR
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small, including head
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What type of IUGR is associated with late/ short-term deprivation
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asymmetric
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Describe the size of parameters with asymmetric IUGR
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small body, large head
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What type of IUGR is termed "head sparing"
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asymmetric
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poor nutrition, maternal weight gain, pre-eclampsia, multiples, smoking, genetic disease, drug and alcohol use, and anemia are risk factors for what disorder during pregnancy
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IUGR
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SGA is pathological/ non-pathological
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non-pathological
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General description of SGA fetus
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small fetus
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AFI associated with oligohydramnios
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<5cm
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Normal AFI
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5-20cm
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Oligohydramnios is associated with marked perinatal ____________
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mortality
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congenital anomalies, IUGR, early rupture of membranes, post-maturity are factors associated with what pregnancy disorder
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oligohydramnios
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Bed rest, hydration, encourage good nutrition, assess fetal well being, and induction if severe and fetus is mature are forms management for what pregnancy disorder
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oligohydramnios
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Assessment of fetal well being
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FMC, AFV, BPP
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Conditions associated with late bleeding during pregnancy
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placenta previa, placenta abruption
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Macrosomia, LGA, multifetal pregnancy, fibroid uterus, and polyhydramnios are all associated with what
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S>D
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AFI seen polyhydramnios
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>20cc's of amniotic fluid
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Macrosomia
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big baby
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What do you need to r/o when suspected polyhydramnios
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GDM and ABO/Rh disease
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Fetal malpresentation, placenta abrpuption, uterine dysfunction during labor, PPH, Cord prolapse, PTL are complications associated with what disorder
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polyhydramnios
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Why is fetal malpresentation a complication seen with polyhydramnios
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baby is floating
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Why is placenta abruption a complication seen with polyhydramnios
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more pressure, more pulling
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Why might you see uterine dysfunction during labor with polyhydramnios
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it is expanded more, needs to contract harder
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Why might you see PPH with polyhydramnios
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it expanded more, more stretched out, has to contract harder
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Why might you see cord prolapse with polyhydramnios
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r/t fetal malpresentation
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Why might you see PTL with polyhydramnios
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increased pressure
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Post-term GA
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>42wks
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Maternal weight loss, decreased uterine size, meconium in the fluid and advanced bone maturation of the fetal skeleton/head are clinical manifestations associated with what disorder
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polyhydramnios
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What GA is the fundus at the umbilicus
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20wks
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How does fundal height increase after 20wks GA
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increases 1cm/wk
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Why might you see decreased uterine size during a post-term pregnancy
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the body is trying to kick the baby out
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Dysfunctional labor, perineal trauma, PPH, infection, instrumentation/interventions, and emotional stress are maternal risks associated with what disorder
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polyhydramnios
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Why might you see infection with polyhydramnios
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big baby - more likely to intervene with instrumentation - probing and introduction of infectious agents
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Fetal risks associated with polyhydramnios
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macrosomia, birth trauma, distress, hypoxia, asphyxia
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Why might you administer agents for cervical ripening or induce labor with polyhydramnios
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get baby out
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