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185 Cards in this Set
- Front
- Back
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What are the leading causes of neonatal death?
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Early Gestation
RDS- Respiratory Distress Syndrome Low Birth Rate Congenital Anomalies Effects of maternal complications |
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What is the most accurate risk assessment test?
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BPP (Biophysical Profile)
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What does the BPP use to examine the fetus? What does it monitor?
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It combines US and external fetal monitoring.
It looks at fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate, and amniotic fluid volume (in a qualitative manner). |
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How is the scoring done for a BPP?
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Possible score in each of the 5 areas (fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate, and amniotic fluid volume) is 0, 1, or 2 (similar to Apgar). Normal/reassuring is considered a 8-10.
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What are some advantages of a BPP?
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noninvasive, less costly- done on outpatient basis. Results are immediately available.
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When an infant is experiencing hypoxia and worsening acidosis, what will you see?
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late decelerations
accelerations of heart rate will disappear fetal breathing movement stops fetal movement stops fetal tone will be absent. |
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What does a Doppler US blood flow assessment look at?
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assesses fetal blood flow through umbilial artery
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What are some indications for doing a Doppler US blood flow assessment?
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Hypertensive mother or suspected IUGR
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What does IUGR stand for and what is it usually related to?
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Intrauterine growth restriction/retardation
It is usually related to placental insufficiency. |
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What type of US is most common during 1st trimester? How about 2nd and 3rd trimesters?
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1st- Transvaginal
2nd & 3rd transabdominal |
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For an transabdominal US, what is required of the mother?
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She needs a full bladder (drink at least1 L) to displace the intestines and elevate the uterus for better visibility.
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In the 1st trimester, what does the US tell you about the fetus?
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confirms viability, estimates age, identifies need for follow up testing,
determines size, location, multifetal gestations (# of amniotic sacs) fetal cardiac activity, fetal movement, and swallowing |
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In the 1st trimester, what does the US tell you about the mother?
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detects uterine abnormalities, fibroids, cysts, etopic pregnancy
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During the 1st trimester, what is the most reliable indicator of gestational age?
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crown-rump length
(p. 323) |
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During the 2nd & 3rd trimesters, the uterus is out of the pelvis and accessible by transabdominal US. What do these tests tell you/what are you looking for at this time?
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Looking for fetal viability
gestational age growth pattern anomalies body movement breathing movement determine fetal presentation evaluate amniotic fluid volume also used as a guide for amniocentesis and PUBS |
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During the 2nd half of the pregnancy, what are some ways to determine fetal age?
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biparietal diameter, femur length, abdominal circumference.
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Estimating fetal age by ultrasonography after ___ weeks is subject to major error.
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32
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What is AFI? What's the normal value?
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Amniotic Fluid Index- a method that adds the depths of amniotic fluid in 3 uterine quadrants at term. Measured during US.
Established normal values don't exist, but volume sums greater than 10 is considered reassuring. < 5 is oligohydramnios > 18-20cm hydramnios (Sandy says 5-8cm is normal WTF) |
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What is DFMC? When is it done?
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Daily Fetal Movement Count
also known as "Kick Count" Done at 16-18 weeks gestation. |
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What are some implications for DFMC?
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-baby needs to be in awake cycle, If not asleep, you can give 7-up to wake up a baby or wait until sleep cycle is over
-Looks for presence of fetal movement (reassuring sign of fetal wellbeing) -Count movements for 30 min 3x a day or movements over 12 h period Absence of movement for 12 h or more is a concern, get follow up testing. Fewer than 4 movements in 30 min. warrants further testing. At least 10 movements in 12 h reassuring. |
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What is the name of the test that involves inserting a thin needle into the pregnant woman's belly to take a sample of amniotic fluid?
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Amniocentesis
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The fluid from an amniocentesis contains skin cells shed from the fetus which are grown in the lab after careful processing ththe chromosomes and the cells are examined and counted. When is this test done and what are you looking for?
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Can be done at 12-14 weeks gestation, Best done at 15-20, also can be done in 3rd semester. You're looking for chromosome abnormalities such as Downs Syndrome (trisomy 21).
At 3rd trimester, you're looking at fetal lung maturity. |
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What is the L/S ratio?
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It is the ratio of licithin/ sphingomyelin (lipoproteins that together make surfactant) and is the best known test for estimating fetal lung maturity. P
roportion is equal until about the 30th week. After the 30th week, an L/S ratio of 2:1 indicates that surfactant is adequate and the fetal lungs are mature. |
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A procedure that is similar to amniocentesis but instead of sampling amniotic fluid that contains fetal cells, fetal blood is extracted from the fetal vein of the umbilical cord by inserting a fine needle through the pregnant woman's abdomen, guided by US. What is the name of this test?
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PUBS
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What does PUBS stand for and when is it done?
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Percutaneous Umbilical Blood Sampling.
Done at 18 weeks gestation of later (because fetal vein and umbilical cord are fragile in early pregnancy). |
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How long does PUBS test take? When are results available?
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45 min- 1 hour
results done in 48 h |
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What is the purpose of a PUBS test?
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inherited blood disorders
detect fetal infection acid base status of the fetus with IUGR treatment of isoimmunization & thrombocytopenia in the pregnant woman |
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When checking for chromosome analysis, which test gives faster results, amniocentesis or PUBS?
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PUBS
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What is CVS and when is it done?
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Chorionic Villus Sampling
10-13 weeks gestation |
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Which test gives earlier results, amniocentesis or CVS?
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CVS
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In chorionic villus sampling, a small tusse sample is taken from the ____ portion of the placenta using US.
It can be done transvaginally or transabdominally. It is used to detect fetal _____ or _____ abnormalities. |
fetal
chromosomal & metabolic |
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True or false: CVS detects neural tube defects.
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False, you need amniotic fluid to test AFP levels
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What are some complications r/t CVS?
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bleeding
spontaneous abortion ruptured membranes possible fetal/maternal hemmorhage Chorioamnionitis |
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What is MSAFP? When is it done?
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Maternal Serum Alfa-fetoprotein
usually done at 15-18 weeks (AFP is higher with advancing age and in multifetal pregnancies.) |
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What does MSAFP detect?
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elevated AFP levels may indicate open neural tube defects or fetal demise
Low levels may indicate chromosome trisomies such as Downs Syndrome Not all that accurate |
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True or False: AFP is main protein in fetal plasma. It can be measured via maternal blood and in amniotic fluid.
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True
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Triple Marker Screening is also known as _____ ______ screening is a more comprehensive maternal serum test. It looks for abnormal levels of 3 labs what are they?
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multiple marker
-HCG -AFP -estriols |
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Triple Marker Screenings look for...
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chromosomal abnormalities.
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What is EFM?
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External Fetal Monitoring
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What is a NST and when is it done? What is the purpose?
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Non Stress Test
3rd trimester It detects fetal wellbeing and adequacy of intrauterine environment. It identifies whether an increase in the FHR occurs when the fetus moves, indicating adequate oxygenation, a healthy neural pathway from the fetal CNS to the fetal heart, and the ability of the fetal heart to respond to stimuli. |
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What is the method for NST?
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EFM is placed on mom, given a button to push each time she feels movement.
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What do different results on NST indicate?
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reactive/reassuring: When there are 2 or more accelerations of 15 beats/ min that last 15 sec over a 20 min test.
nonreactive/nonreassuring: tracing does not demonstrate the required characteristics of reactive tracing within a 40 min or longer period. *If done before 32 weeks gestation, test is considered reactive if there is a 10 BPM acceleration for 10 sec. in a 30 min period. *In general, if NST is reactive 2x in a week, most high risk pregnancies can continue. |
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What is CST and when is CST done?
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Contraction Stress Test
When NST is nonreactive, although next step is usually an US for a BPP. |
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When would CST be contraindicated?
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preterm labor or women at risk of preterm labor
preterm ROM placenta previa history of extensive uterine surgery or classic uterine incision for C-section. |
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What is required for a CST ?
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3 contractions of at least 40 sec each and occurring within a 10 minute period are required to interpret results.
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True or False: On a CST, a negative result is reassuring and a positive result is nonreassuring.
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True
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Contractions are initiated in a CST by two methods, what are they?
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nipple self stimulation
IV infusion of low dose oxytocin PB (pitocin) |
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What is a positive and negative result of a CST?
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negative (reassuring)- no late or significant variable decelerations
positive (nonreassuring) late decelerations follow 50% or more of contractions even if < 3 contractions occur in 10 min |
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What are the 6 types of spontaneous abortions (miscarriages)?
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threatened
inevitable incomplete complete missed recurrent |
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What is a threatened abortion?
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1st sign: vaginal bleeding/spotting in early pregnancy
may have uterine cramping, persistent backache, pelvic pressure no passage of tissue upon examination, it is noted that cervix remains closed |
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Nursing implications for threatened abortion?
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Vaginal US is performed to determine whether fetus is present and if it is alive.
Advise patient no sexual activity until bleeding stops. Reduce activity and put on bedrest. Count saturated peri pads and note quantity & color. Foul odor suggests infection. |
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True or False: Vaginal bleeding in the 1st half of pregnancy must be considered a threatened abortion, and women should be advised to notify their physician if bleeding occurs.
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True.
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What is an inevitable abortion?
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Abortion is usually inevitable when the membranes rupture and the cervix dilates. Active bleeding is heavier than threatened abortion.
More severe cramping. No expulsion of tissue. |
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What is the treatment for inevitable abortion?
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Natural expulsion of uterine contents is common, no further treatment is needed.
If tissue remains or bleeding is excessive, dilation and vacuum curettage (D & C) is done with woman under anesthesia. |
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What is an incomplete abortion?
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Some but not all products of conception are expelled from uterus, usually placenta.
Cervix is open. Bleeding will persist until all products have passed. Treatment is D & C |
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What is the treatment for incomplete abortion.
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Initial treatment is to maintain woman's cardiovascular stabilization.
IV pitocin or methergine can be used to contract uterus/control bleeding. D & C Because of excessive bleeding, curretage may not be performed if pregnancy is beyond 14 weeks. |
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What is a complete abortion?
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All products of conception are expelled. Monitor mom for bleeding issues and s/s of infection.
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What is the treatment for complete abortion?
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None usually indicated.
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What is a missed abortion? What is the treatment?
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Fetus dies in utero in 1st half of pregnancy and is retained for weeks or months. May undergo fetus maceration (absorbed) or can become leathery/mummy like if it goes on.
Early s/s of pregnancy disappear. When fetal death is confirmed via US, the treatment is D & C. In 2nd trimester, may need contraction initiation with meds. |
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2 major complications of missed abortion are ____ and ____.
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infection and DIC
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What is a recurrent abortion?
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It is also known as habitual abortion, and is defined as 3 or more consecutive spontaneous abortions.
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What are some causes of recurrent abortion?
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endocrine imbalance (not enough progesterone)
immunologic factors genetic factors systemic problems (lupus) diabetes anomalies of woman's reproductive tract such as bicornuate uterus incompetent cervix |
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What is an incompetent cervix? What does it result in? How is it diagnosed?
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painless dilation of the cervical os without labor or uterine contractions. It is characterized by a sudden ROM and then painless expulsion of the products of conception.
It results in: preterm birth miscarriage It is usually diagnosed in 2nd trimester because of a 2nd trimester loss. |
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How is an incompetent cervix treated?
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Treated with a cerclage in an attempt to maintain viability of fetus.
A cerclage is the suturing of the cervix to prevent relaxation & dilation. It is done at 12-14 weeks (usually successful) Woman is watched for possible ROM, contractions, cramping, backache. The sutures are removes prior to vaginal delivery and left in until after a C Section delivery. |
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Any bleeding before 20 weeks gestation should be considered a possible _____.
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miscarriage
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What are some general nursing implications for the management of abortions?
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Ask woman if this has happened in the past, Ask about cramping, amount, color, duration of bleeding, whether activity helps or makes it worse, if there is any passage of tissue.
At home- restrict to bedrest, no sexual activity for 2 weeks after bleeding stops, report # of saturated pads. |
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What is usually done in hospital in managing abortions?
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CBC
may prepare for D & C Assess for shock. RhoGam is given to Rh negative moms often before baby's blood type is known to protect the next pregnancy. |
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S/S Shock
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tachycardia
cold, clammy skin pallor confusion Later: drop in BP |
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What is the name of a pregnancy where implantation is anywhere outside the uterine cavity?
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ectopic pregnancy
(It can be ovarian, abdominal, but usually in the ampulla of fallopian type) |
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What are some causes of an ectopic pregnancy?
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any abnormality that prevents the fertilized egg from moving down the fallopian tube to the uterus.
may be caused by: PID, endometriosis,or anything that obstructs the tube (infection/scar tissue), defects of fallopian tube |
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Who is at an increased risk of an ectopic pregnancy?
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smokers, women with IUDS, people with STD's, also people who douche
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What is the treatment of an ectopic pregnancy?
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may need surgery to remove fetal material or to correct problems so fertilization can occur, especially if endometriosis. Surgeries may be linear salpinostomy, laproscopy or microsurgery
Assess for hypovolemic shock. |
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What are some s/s of an ectopic pregnancy?
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amenorrhea
lower abdominal pain/tenderness vaginal bleeding (scant, dark brown continous or intermittent) |
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In an ectopic pregnancy, what are the s/s if the tube ruptures?
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severe abdominal pain
may be vaginal bleeding dizziness/fainting pale severe supraclavicular pain progressive HTN |
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What is the name of the developmental anomoly of the placenta where the placenta develops but the fetus does not?
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hydatiform mole
(Physiologically, there is proferation of the chorionic villi. They become edematis which results in a tumor mass of grape-like chorionic cells in the uterus that keep growing and growing) |
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What are the 2 types of hydatiform mole?
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Complete- fetus is absent
Incomplete- may have some fetal tissue or membrane |
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What are some clinical manifestations of hydatiform mole?
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mimic pregnancy symptoms
may have cramping, vaginal bleeeding enlarging uterus uterus is larger than should be No FHR , no movement mother will have hyperemesis gravidarum pregnancy test will show elevated HCG Early development (before 24 weeks) of preeclampsia |
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What is the treatment of hydatiform mole?
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usually they will abort spontaneously or do vacuum extraction and D & C of remaining tissue
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What is the name of the life threatening complication caused by hydatiform mole?
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choriocarcinoma
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What are some s/s of choriocarcinoma?
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cough
vaginal bleeding symptoms of ICP (h/a, nausea vomitting, LOC changes) spitting up blood |
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What is the term for spitting up blood?
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hematemesis
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It is important to continue to follow up after hydatiform mole for a year to prevent chroriocarcinoma. What is done at hospital ?
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Before evacuation, baseline labs, serum HCG, and chest x-ray for blood
After evacuation, HCG levels are done every 1-2 months, and follow up chest x-ray. |
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After hydatiform mole, how long should a woman wait to try to get pregnant again? She should be advised to report any s/s of _____.
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1 year
choriocarcinoma |
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What is the treatment of DIC?
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the priority is delivery of the fetus and placena to stop the production of thromboplastin, which is fueling the process. Blood replacement products are administered to maintain the circulating volume and to transport oxygen to body cells. (To get a better understanding of DIC in pregnancy refer to McKinney p. 609)
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Excessive vomitting furing pregnancy is known as ____ _____.
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hyperemesis gravidarum
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True or False: Hyperemesis gravidarum is caused by alcoholism.
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False. The cause is unknown. Many theories say there are physical and psychological implications.
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In assessing a patient with hyperemesis gravidarum, it is important to first rule out a severe condition known as ____ ______.
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hydatiform mole.
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Describe some S/S of hyperemesis gravidarum
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nausea & vomitting (especially in mornings/after meals)
heartburn, may be epigastric pain hiccups thirst marked weight loss (5+% of body weight) dehydration F & E imbalance withdrawn/depressed |
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A woman with hyperemesis gravidarum may be dehydrated, what are some signs of dehydration?
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concentrated urine, low urine output
elevated temp elevated HR decreased BP poor skin turgor dry mucous membranes |
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What is the treatment for hyperemesis gravidarum?
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Acute care: IV fluid replacement, electrolyte replacement
Monitor I & O Monitor VS q 4 h Antiemetics/sedatives private room (reduce stimuli) good oral hygeine Usually NPO, bedrest Transition to Convalescent care: small frequent meals mostly carbs BRAT small amts. of liquids 1 h after meals increase food/fluids as tolerated avoid high fat foods/strong odors |
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A hypertensive disorder of pregnancy developing after 20 weeks gestation is known as ____.
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PIH (Pregnancy Induced Hypertension)
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PIH is unique to pregnancy, and usually disappears soon after delivery. It is usually characterized by 3 things:
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hypertension
weight gain (in form of edema) proteinuria |
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PIH affects the body in many ways. Arterial vasospasm leads to HTN and _____ perfusion to all body systems and placenta. Kidneys become damaged which allows ____ to leak into urine. Fluid shifts (due to loss of protein) into interstitial spaces causing _____. Vasoconstriction of cerebral vessels are manifested as _____.
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decreased/poor
protein edema headaches |
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As PIH progresses, the patient may have visual distrubances such as blurred vision and seeing spots. What are some complications associated with PIH?
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preeclampsia--> eclampsia
poor placental perfusion abruptio placentae persistant fetal hypoxia liver problems |
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Mild preeclampsia is diagnosed by a BP range of ______________. There is usually weight gain greater than ____ in one week, and generalized ____ .
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BP:
Sys- greater than or equal to 140 but less than 160 , Diastolic greater than or equal to 90 but less than 110. (140-159 / 90-109)* 2 kg edema (in hands and face that is unresponsive to 12 h of bedrest) *must have 2 readings showing no improvement at least 6 h apart on bedrest to diagnose |
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In addition, diagnosing mild preeclampsia, you will use a urine dipstick. What are you looking for ?
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Proteinuria
1+ to 2+ (2 random samples at least 6 h apart) |
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In severe preeclampsia, what are the BP and proteinuria ranges?
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BP:
Sys greater than or equal to 160 Dias greater than or equal to 110 ( 160+ / 110+ )* Proteinuria 3+ to 4+ (2 random samples at least 6 h apart) *must have 2 readings showing no improvement at least 6 h apart on bedrest to diagnose |
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What are some s/s of severe preeclampsia?
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visual disturbance
photophobia epigastric pain oliguria CNS irritability clonus hyperreflexia (DTR 3+ or greater) pitting edema in lower extremities jawline often undefined |
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What is oliguria
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less than 500 ml voided in 24 h
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Women with preeclampsia may be irritable, especially if the CNS is involved. There may be involvement of the hepatic, pulmonary, and cardiac systems. A condition called _______, a persistent reduction in the number of platelets may also develop.
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thrombocytopenia
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What is a normal DTR?
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2+
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The specific cause of PIH is unknown. What are some risk factors?
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poor prenatal care
inadequate nutrition primagravida multi gravida (twins, etc) Preexisting problems: diabetes obesity chronic renal disease family hx of PIH immunologic disorders (i.e. lupus) |
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Women with preeclampsia may be irritable, especially if the CNS is involved. There may be involvement of the hepatic, pulmonary, and cardiac systems. A condition called _______, a persistent reduction in the number of platelets may also develop.
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thrombocytopenia
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Prenatal care is very important in addressing risk factors for PIH. A woman who is of race other than ____ is at higher risk and if she is younger than _____ or older then ____ she is also at a higher risk.
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white
19 35 |
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Preeclampsia is the result of generalized _______.
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vasospasm.
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What is a normal DTR?
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2+
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The specific cause of PIH is unknown. What are some risk factors?
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poor prenatal care
inadequate nutrition primagravida multi gravida (twins, etc) Preexisting problems: diametes obesity chronic renal disease family hx of PIH immunologic disorders (i.e. lupus) |
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Prenatal care is very important in addressing risk factors for PIH. A woman who is of race other than ____ is at higher risk and if she is younger than _____ or older then ____ she is also at a higher risk.
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white
19 35 |
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A life threatening condition of pregnancy that involves multi-system organ failure and a variant of preeclampsia is known as HELLP. It is named based on the main findings of the condition. What does HELLP stand for?
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Hemolysis
Elevated Liver enzymes Low Platelet count |
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A woman with HELLP usually has severe preeclampsia, but may have normal ____ _____.
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blood pressure
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What are some s/s of HELLP syndrome?
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pain in abdomen, upper quad
(very tender upon palpation, liver involvemnt) epigastric pain nausea, vomitting severe edema jaundice (liver involvement) |
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Complications of HELLP for mother and baby include
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DIC
lots of bleeding issues eclampsia Mom usually ends up in ICU. |
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What is the difference between eclampsia and preclampsia
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seizures
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What are some seizure precautions?
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padded side rails
decrease stimuli limit visitors limit noise, light Bed in low position O2 & suction ready loose, nonrestrictive clothing |
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What are some patient/family teaching for different levels of PIH?
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limit activity
(bedrest in lateral position for severe preclampsia) monitor daily weight monitor proteinuria do fetal kick counts office visits q 3-4 days Stress the importance of diligent record Report to HCP any visual disturbances, H/A, epigastric pain. |
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In treating PIH what is the main goal?
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delivery of baby.
Condition usually goes away postpartum, reassess 48 h after delivery if mom goes home. |
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What is the general cutoff time (gestational age) for viability of a fetus?
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24 weeks
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What medications do we give for PIH?
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sedatives (help rest, decrease CNS irritability)
antihypertensives- hydralazine (epresoline) Magnesium sulfate (CNS depressant to prevent seizures) |
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The classic medication to treat severe preeclampsia is _______ _________.
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magnesium sulfate
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Magnesium Sulfate has a vasodilation effect which temproarily decreases _____ _____ and increases uterine blood flow.
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blood pressure
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What are some nursing implications for the administration of magnesium sulfate?
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Infuse very slowly.
loading dose & regular dose (flushing/sweating normal in loading dose) Watch for s/s hypermagnesemia |
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A pregnant woman receiving magnesium sulfate may have labor difficulty because it can relax the effectiveness of contractions and it can interfere with progress. She needs to be monitored for ____ because the uterus might have trouble _____ after delivery.
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bleeding
contracting |
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What is the therapeutic level for magnesium? the toxic level?
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ther 4 - 8 mg /dl
toxic 9.6+ mg/ dl |
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Neuro checks need to be done q 1 h after administering magnesium sulfate. What are some s/s of magnesium toxicity?
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diminished LOC
diminished DTR's (1+ or none) RR less than 12 nausea muscle weakness slurred speech hypotension assess breath sounds for pulmonary edema warmth or flushing beyond loading dose |
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Always question a systolic BP of less than ____.
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100.
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A blood pressure of 140 over 90 prepregnancy or before 20 weeks gestation is classified as _____ ______.
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chronic hypertension
Or, BP persists indefinitely following delivery |
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Chronic hypertension with superimposed preeclampsia is .....
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chronic HTN that progresses quickly to higher blood pressure and development of proteinuria.
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What is the leading cause of life-threatening perinatal infection?
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Group B Streptococcus (GBS)
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Group B Streptococcus (GBS) normally exists in the vagina and doesn't create symptoms or problems. Why does it become a problem during pregnancy?
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It can cause premature delivery, premature ROM, chorioamnitis.
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Early onset newborn GBS infection occurs during the 1st week after birth, usually the first ___ h.
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48
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What are the primary infections GBS can cause to a newborn?
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sepsis, pneumonia
meningitis (most common) |
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A simple test can identify GBS and prevent problems. A vaginal culture is done at __ weeks. If positive, _____ is administered before delivery of baby and again afterward. Baby needs to be delivered as quickly as possible.
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35-37 weeks
Penicillin (IV piggyback) |
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What does TORCH stand for?
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Toxoplasmosis
Other (hepatitis A & B, HIV, syphilis) Rubella Cytomegalovirus (CMV) Herpes simplex virus |
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TORCH infections cross the placental barrier and can cause birth defects, miscarriages, or stillbirth. Moms may be asymptomatic. Some maternal symptoms include:
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enlarged lymph nodes
vague influenze-like symptoms rashes/legions jaundice- hepatic involvement |
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Severe congenital anomalies can be caused by TORCH infections such as ____ and ____.
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hydrocelphaly and microcephaly
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How can a mother get toxoplasmosis?
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Mother can be infected by improper handling od cat litter, handling or ingesting contaminated meat, eggs, unpasteurizzed milk, and improperly washed vegetables (contaminated soil)
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Hepatitis, HIV, and syphylis are associated with low ___ ___, fetal defects, and fetal deaths. HIV will be transmitted to fetus if no interventions are done.
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birth defects
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1st trimester exposure to rubella can cause ......
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spontaneous miscarriage, cardiac defects
IUGR congenital cataracts mental retardation deafness microcephaly |
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Pregnant women are screened for rubella titer to see if they have immunity so we can prevent problems. Ideally, she should have the immunization at least ___ weeks before conception if not immune. If she is not immune and is now pregnant, she can't get the immunization as it is too harmful for fetus. She needs to take infection precautions to protect her baby.
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4 weeks
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Which infection is the most prevalent of the TORCH group?
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Cytomegalovirus
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Describe Cyotmegalovirus (CMV). What are some s/s if pregnant woman is infected with CMV?
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CMV is a virus transmitted from person to person via close contact with an individual who is excreting the virus. It can be spread through the placenta, blood transfusions, organ transplantation, and breast milk. It can also be spread through sexual transmission. Usually immunocompromised are most susceptible (HIV, also organ/bone marrow transplants)
can cross placenta to fetus or during vaginal delivery can cause deafness, death, sometimes no effects. usually asymptomatic symptoms may include: enlarged spleen, liver |
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If a pregnant woman has active herpes, how is baby delivered?
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C section
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Herpes is usually not passed transplacentally, but can be passed in a vaginal birth. Exposure of herpes simplex virus to infant can cause...
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1st trimester- may cause spontaneous miscarriage
after 20 weeks- exposure may lead to preterm labor |
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If a vaginal birth is done during active lesions, there can be problems for infant such as
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vision problems
psychomotor problems intellectual development |
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Aclovir is the medication usually given for Herpes Simplex. There is a high risk of ___ ___ so it is important to stress the importance of regular pap smears.
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cervical cancer
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When is Rhogam given?
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to rh negative moms at 28 weeks and again after delivery within 72 h
also can be given after invasive tests or miscarriages |
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Rhogam destroys antigens in the mom's circulation so she won't develop antibodies that would harm a future pregnancy. The preferred site is the ______.
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deltoid
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Pregnant teens are at increased risk of what 2 complications?
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low birth weight, PIH
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Because she is pregnant, the teen mom is an ____ ____.
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emancipated minor
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Any vaginal bleeding that the pregnant woman experiences after ___ weeks gestation needs to be reported to HCP (health care provider).
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20
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_____ _______ is a complication of pregnancy in which the placenta grows in the lowest part of the uterus and covers all or part of the opening to the cervix.
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placenta previa
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The exact cause of placenta previa is unknown, what are some risk factors ?
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previous previa in the past
older women multiparas cocaine users smokers Women who had c-sections Women who have had suction curettage for induced/ spontaneous abortion |
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True or false: Placenta Previa is more common in a female fetus.
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False, more common with male fetus.
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A ____ placenta previa is when the placenta is implanted in the lower uterus but its lower border is more than 3cm from the cervical os.
It will usually migrate up as uterus enlarges and it's usually ok to do a vaginal delivery. |
Marginal or low lying
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A _____ placenta previa is when the lower border of the placenta is within 3cm of the internal cervical os. In this case, the placenta might migrate up but a c-section may be necessary. This patient needs to be monitored closely.
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Partial
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_______ placenta previa is when the placenta completely covers the internal cervical os. Because the placenta would come out before the baby, a c-section has to be done.
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Total
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What is the classic sign of placenta previa? What are some other S/S?
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Classic sign: sudden onset of Classic sign: painless uterine bleeding in latter 1/2 of pregnancy
Intermittent or constant flow Uterus palpation- soft/relaxed |
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What are some diagnostic tests used in detecting and monitoring placenta previa?
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Ultrasound to look at placenta placement
NST- to monitor fetus |
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If a woman has placenta previa, the fetus may be in distress. Hyperactivity or tachycardia due to low blood volume may eventually lead to bradycardia and even absence of fetal heart rate. What would be important to assess for the pregnant woman?
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It is important to assess the amount of bleeding, and assess for maternal shock.
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What are some nursing implications for the management of placenta previa?
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Monitor amt. of bleeding
Daily Weights High Fowlers w/pillow propped or lateral position Lots of bedrest Monitor VS q 4h Monitor FHR Watch for postpartum hemorrhage due to lack of muscle tone in lower uterine segment. |
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What are some ways to monitor the amount of bleeding in placenta previa?
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# of saturated pads
1ml = 1 g (zero out scale w/chuck to measure amt. of blood) |
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If the pregnant woman's condition is severe and she is hospitalized for placenta previa, she will usually get IV fluids and if severe blood loss will need a _______. If the woman is __ weeks gestation and lungs are mature, a c-section will usually be scheduled.
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transfusion
36 |
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If bleeding is excessive and does not stop, the woman's cardiovascular status is unstable, or there are signs of fetal compromise, and the fetus is immature, what is usually necessary?
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the delivery of the immature fetus may be necessary.
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In teaching a pregnant woman with placenta previa about home care (if she is stable enough to go home), what should you include?
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Stay within reasonable distance from hospital.
No sexual intercourse or unnecessary vaginal exams. Assess vaginal discharge or bleeding after each urination or bowel movement Monitor fetal movements daily. |
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______ ______ is the premature separation of the placenta occuring before the 3rd stage of labor.
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abruptio placenta
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The exact cause of abruptio placenta is unknown. What are some risk factors?
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Poor nutrition
maternal HTN multigravida status short umbilical cord abdominal trauma (MVA) Hx of previous premature separation of the placenta Smoking Street drug use: cocaine esp. |
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What are the 5 classic signs of abruptio placentae
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-Vaginal bleeding, which may not reflect true amount of blood loss. (usually dark red)
-Abdominal and low back pain (described as achy or dull) -Uterine irritability with frequent low-intensity contractions. -High uterine resting tone identified by use of an intrauterine pressure catheter (also increase in fundal height) -Uterine tenderness that may be localized to the site of abruption (abdomen becomes boardlike/rigid- hypertonis) Additional signs include back pain, nonreassuring fetal heart rate patterns, signs of hypovolemic shock, and fetal death. |
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True or False: A woman who exhibits signs of abruptio placentae should be hospitalized and evaluated at once.
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True. Evaluation focuses on the condition of the fetus and cardiovascular status of the woman.
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If the abruption of the placenta is small and the fetus is preterm, the pregnant woman may be monitored until gestational age is more favorable for viability. If C section is indicated due to severity, what's the protocal?
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NPO
signed consent neonatal resusitation team on board Do VS q 5-10 min Monitor fetal heart tones have Labs done CBC, coagulation profile, Foley Catheter IV- usually 2 L of LR have transfusions ready |
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What is included in a coagulation profile?
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platelets, fibrinogen, PT, PTT
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At about 35 weeks, a fetus produces less _____ which increases the likelyhood of RDS.
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surfactant
(This is the biggest issue for preterm infant.) |
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What medication do we use to help stimulate surfactant production?
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betamethasone
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All pregnant women are screened for gestational diabetes. What are some reasons for suspecting gestational diabetes? A woman with gestational diabetes has a 50-60% chance of getting _____ later in life.
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previous big babies
unexplained stillborn family hx of diabetes, obesity Diabetes Type II |
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What are some risk factors associated with gestational diabetes?
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spontaneous miscarriage
fetal anomalies UTI & Yeast Infections need for C section (big baby) PIH even if no preexisting vascular disease fetal/neonatal death infant with RDS |
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In the management of gestational diabetes, _____ is used because it offers better tight glucose control.
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insulin
No oral meds! |
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True or False: Insulin needs increase with gestational age.
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True.
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If a woman has gestational diabetes, how is her fetus is assessed ?
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@ 28-32 weeks:
Fetal Kick Count NST BPP AFP Multiple Marker Screening US to look for growth, anomalies An infant may be delivered earlier (induced) because of gestational diabetes (big baby). |
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A pregnant woman with a cardiovascular disorder is high risk because...
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inadequate compensation
increased strain on heart due to increased volume already has compromised system S/S overlap: edema of legs may be more dramatic |
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What are some nursing implications for the management of a pregnant woman with a cardiovascular disorder?
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limit stress
limit activities as needed (less Oxygen, may be SOB easily) may need to be on bedrest elevate HOB Prevent anemia and URI may need C section due to the increased strain in pushing for vaginal delivery. |
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Thalassemias is a shorter erythrocyte life associated with _____ ______.
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fetal anemia
(Thalassemias is an inherited form of anemia occurring mostly among people of Mediterranean descent, caused by faulty synthesis of part of the hemoglobin molecule.) |
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Folic acid deficiency is often associated with _____ deficiency.
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iron
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An autosomal recessive disorder that involves destruction of erythrocytes
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sickle cell anemia
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Sickle cell anemia is often associated with IUGR and _____ _____.
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preterm birth
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Signs of recent cocaine use
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High BP
irregular RR elevated temp dilated pupils diaphoresis angry, paranoid fetus: tachycardia, excessive fetal activity |
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Maternal effects of substance abuse
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vasoconstriction
increased BP decreased placental perfusion high risk of miscarriage and abruptio placenta malnutrition low birth weight fetal demise fetal anomalies |
