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maternal Newborn
Pregnancy Complications
| Question | Answer |
|---|---|
| maternal mortality can be caused from ectopic pregnancy or obstertric events such as | hemorrhage, pulmonary embolism and pregnancy-induced hypertension (PIH) |
| What is the major cause of perinatal (5 months before and 1 month after) mortality | prematurity |
| risk factors for pregnancy complications | age (especially younger than 17), socioeconomic status (urgan poor, lack of education), primipariety (first), and multiple pregnancies |
| What is the best prevention of pregnancy complications | prenatal care |
| Name two pregestational disorders | cardiovascular disease and endocrine disorder (diabetes) |
| Name the 4 pregestational cardiovascular diseases | rheumatic heart disease, congenital heart disease, mitral valve prolapse and peripartum cardiomyopathy (disease of the heart muscle between the last month of pregnancy and 5 months post partum) |
| Why is rheumatic heart disease decreased in pregnant women | better treatment of strep infections |
| Why is congenital heart disease seen more | better treatment of heart anomalies bc of survival rate |
| Why are we conserned with mitral valve prolapse in pregnant women | Prevention of any infection that could travel to the heart and weaken valves, usually caused by stress. Give prophylactic IV antibiotic during labor |
| Why is peripartum cardiomyopathy a concern | can be very severe, may go unnoticed until after delivery |
| pregnancy increases ____ on the heart causing symptoms and risks to increase | stress |
| T/F signs of cardiac decompression can be similar to normal responses to pregnancy | True (fatigue, dyspnea, palpitations, tachycardia, heart murmurs, edema and cough) Decompensation is the functional deterioration of a previously working structure or system |
| What causes murmurs and palpitations | blood volume increase |
| main sign of cardiac decompensation is due to ____ - b/c this is the only sign that is not a common change in pregnancy | cough - red flag b/c increasing heart alteration, heart failure, pulmonary edema (congestion) |
| Class I and II heart disease in pregnancy is the milder form of heart disease, are these women able to have a normal pregnancy | yes - but need to be watched very closely - coordinate care OB with CV doctor |
| Can a woman with class III & IV heart disease become pregnant | yes - but it is in their best interest not to try to have a baby |
| What is the primary goal of a pregnant woman with heart disease | adaquate rest - other goals include prevention of respiratory infection (adds stress to lung), monitoring for signs of cardiac decompensation and attempt a trial of labor avoiding valsalva (closed glottis) puts pressure on thoracic cavity |
| Why is diabetes worse with pregnancy | stress alters CHO metabolism (pregnancy is a diabetogenic state) |
| Gestational diabetes (type III) stops once pregnancy ends but are at higher risk for mature onset diabetes - why | because they have subclinical diabetes when not pregnant, they are often overweight so need to encourage to eat well and exercise. |
| what are the influences of pregnancy on diabetes (woaman already having diabetes) | changes in CHO metabolism and control of blood glucose as well as vascular disease may increase because blood gets sticky, picks up debris and at capillaries oxygenation decreases leading to ulcers, poor healing, infection and amputation |
| What are some maternal complications of diabetes on pregnancy | kidney problems, retinopathy, early pregnancy increased insulin production = hypoglycemia, later in pregnancy is lack of insulin production = hyperglycemia |
| How much does insulin demand increase in later pregnancy | 3-5X over non pregnant level |
| When is gestational diabetes picked up during pregnancy | after 26th week due to increased hyperglycemic effect, high rate of C-section |
| What are some fetal complications of maternal diabetes | by 36 weeks - aged placenta, later in pregnancy placenta releases an insulin-destroying enzyme to make more glucose avail to fetus so mother uses protein |
| Type I, II, or III diabetes have the most difficulty controlling blood glucose levels during pregnancy | Type 1 |
| Type I, II, and or III pregnant women are more likely able to control their diabetes with diet | Type II & III (these woman may go on insulin if needed), type II may use oral hypoglycemic agents, the newer ones dont have same tetratogenic effects |
| what other specialists may a pregnant woman with diabetes see | endocrinologist, ophthalmologist |
| Poor control of insulin can lead to oversized or undersized babies | undersized r/t placenta getting old too quickly and baby not getting adequate nutrition. Generally fetal obesity due to growth acceration (macrosomia) if insulin is under control. |
| Why is it important to assess newborn of a diabetic mother for hypoglycemia shortly after birth | blood sugar can plummet after birth because glucose source is cut off and they are used to producing lots of insulin which is still in their system |
| Why does a fetus of a diabetic mother have hydramnios (excess amniotic fluid) | fetus urinating higher glucose, hyperosmotic, pulls in more water |
| Nurses role of taking care of a diabetic mother | assessment of disease process, education (anticipatory guidance), physhological support, and assessment of fetal well being, placental function, fetal maturity |
| gestational disorders are health alterations associated with pregnancy and usually disappear when | after delivery |
| T/F Premature rupture of membranes is an onset of preterm labor | Can be true -but- premature ROM occures before onset of labor even if baby is full term |
| What is the primary concern for premature ROM | infection (chorioamnionitis inflammatory condition of pregnancy affecting the uterus) |
| what diagnostic measures are used to determine if there has been ROM | sample fluid - nitrazine paper (measures pH amniotic fluid will be alkaline and urine acidic - and ferning test |
| what is amniotic fluid | fetal urine - so if premature ROM, can be replinished and hope it seals itself off, if no infection, pregnancy can continue |
| between which weeks is preterm labor | 20-37 |
| risk factors for preterm labor | previous preterm labor, durg use (especially stimulants), genital tract infections such as bacterial vaginosis and group B streptococcus (GBS) |
| ____ is the term for excessive N/V | hyperemesis gravidarum - the worst morning sickness, proglonged |
| Results of hyperemesis gravidarum | F&E imbalance (can affect fetus), weakness & fatigue (due to dehydration), and scant, dark urine (identification of severe problem) |
| Management of hyperemesis gravidarum | dry CHO (then wait 1 hr for fluids b/c fluids trigger vomiting), antiemetics (start with smallest therapeutic dose), IV therapy (correct F&E and acid-base imbalance), potential TPN (last resort), psychological (difficulty adjusting to pregnancy) |
| What is the difference between threatened abortion and imminent abortion | In an imminent abortion, the cervix had dilated, can't do anything about it, placenta starts to seperate from uterine wall. |
| what is the percentage of spontaneous abortions (miscarriage) | 10-30%, some women don't know they are pregnant before they miscarry |
| What is the main concern of imcomplete abortion | risk of hemorrhage increased because uterus can't contract, may be a risk of infection - if cervix is open a D&C is done to expell everything and if closed then there will be an attempt to save the pregnancy |
| what are some causes of incompetent cervix | multiple abortions, D&C (dilation of the cervix and curettage or scraping the uterus), possible previous large baby delivery |
| What is the procedure done for an incompetent cervix | cerclage procuedure - go around cervix and drawstring it closed, remove after 37 weeks unless signs of labor b4 |
| What is the main cause of implantation in a site other than the endometrium (ectopic pregancy) | pelvic inflammatory disease (PID) narrowing of tube (sperm gets through but not the fertilized egg - may be caused from gonorrhea, chlamydia |
| Manifestations of ectopic pregnancy | shock from internal bleeding, pain in lower left or right quandrant, pregnancy test is not a sign, may be negative |
| Diagnosis of ectopic pregnancy | sonogram - if high WBC count it is probably appendicitis |
| Management of ectopic pregnancy | laparascopic - removal of that poriton of the tube |
| What is the early sign of hemorrhagic shock | thirst - later signs are pale, sweaty, clammy, BP drop and elevated pulse also soaking more than one pad an hour |
| ____ benign proliferation of trophoblastic tissue. Developing embryo implants somewhere, and the tissue surrounding it (trophoblastic tissue) starts growing uncontrollably, cutting off nutrition and necrosis occures so body calcifies to prevent infection | gestational trophoblastic disease (molar pregnancy) generally not a viable pregnancy |
| Manifestations of gestational trophoblastic disease (molar pregnancy) | Bleeding. scant dark to copious full blown bright red. Fundal height bigger, N/V extreme |
| treatment of gestational trophoblastic disease (molar pregnancy) | D&C or methotexate an antineoplastic which attacks fast growing tissue |
| Why should women be cancelled for one year after gestational trophoblastic disease to not become pregnant | Need to monitor for tissue that may not have been removed and continue to grow for a year, this tissue can be diagnosed via hCG levels. If a woman becomes pregnant hCG levels increase and can not differenciate between tissue and fetus |
| ____ is a potential after gestational trophoblastic disease (molar pregnancy) and can be fatal | Choriocarcinoma - a malignant and aggressive cancer, usually of the placenta. It is characterized by early hematogenous spread to the lungs |
| ____ is pregnancy-induced hypertension (PIH) used to be called toxemia 5% of all pregnancies and diagnosed after 20-24 weeks gestation | preeclampsia/eclampsia |
| There are three signs to pregnancy induced hypertension. Pre-eclmpsia has two and eclampsia will have all three | hypertension (>140/90), edema (>2lbs/week), and proteinuria (albumin in the urine) |
| although >140/90 is diagnostic of gestational hypertension an increase of ____ systole or ____ diastole over baseline is considered | increase 30 systole or 15 diastole - especially diastole b/c indicated heart rest is stressed too (so if normal is 120/80, a pregnant 145/96 indicates hypertension due to diastole more than 15 over - not systole) |
| why should blood pressure be checked if more than 2lb per week is gained | risk for pre-eclampsia, should gain 1lb per week in later pregnancy, edema follows and it is a sign if seen when awakenging in the morning |
| other signs of pregnancy induced hypertension (PIH) | clonus (muscular contractions due to sudden stretching of the muscle), HA (prolonged/severe), blurred vision, and scotoma (spots in front of the eyes) |
| What is the difference between mild and severe PIH (pregnancy induced hypertension) | mild - BP 140/90 - 160/110, proteinuria and edma are both 1+ or 2+, occasional HA. Severe - BP >160/110, proteinuria and edema both 3+ to 4+ and may have oliguria (kidney's shutting down), pulmonary edema and RUQ pain r/t liver congestion |
| increased incidence of pregnancy induced hypertension (PIH) r/t | primigravidas, teens and over 35, hx of pre-eclampsia, multiple gestation,GTD (genetic trophoblastic disease), Rh incompatibility, and diabetes |
| maternal risks of pregnancy induced hypertension (PIH) | convulsions...coma, renal failure, abruptio placentae, DIC, ruptured liver, and pulmonary embolism |
| fetal-neonatal risks from pregnancy induced hypertension (PIH) | SGA related to IUGR, 10% mortality with pre and 20% with eclampsia |
| What happens to blood volume in pregnancy induced hypertension (PIH) | volume doesn't change with mild but will decrease with severe, normal pregnancy will increase blood volume 30-50% |
| What happens to peripheral resistance, blood pressure and hematocrit in pregnancy induced hypertension (PIH) | peripheral resistance increases where normal pregnancy it decreases, BP rises, and hematocrit rises where normal pregnancy it falls due to more fluid |
| Why does BP remain unchanged in a normal pregnancy when there is a 30-50% increase in blood volume | vessles diolate in normal pregnancy - with pre-eclampsia you have vasospasm so extra fluid is pushed out and get edema - don't treat with diuretics unless have pulmonary or cerebral edema, also do not use Ace-Inhibitors |
| Tx of pregnancy induced hypertension | bed rest left side (off of vena cava) decreased blood pressure and promotes diuresis due to fluid back to organs, consume extra protein and push fluids due to loss of both |
| What do you assess with pregnancy induced hypertension (PIH) | BP, daily weight, proteinuria, reflexes, urine output |
| After the baby is born, the mother with pregnancy induced hypertension is given what | apresoline - during pregnancy can take MgSO4 |
| Why is MgSO4 the drug of choice for a pregnant woman with eclampsia (Eclampsia is pregnancy-related seizure activity that is usually caused by high blood pressure) | lowers blood pressure, makes woman seizure proof |
| side effects of MgSO4 - used to treat pre-eclampsia | Flushing, Muscle weakness, lack of energy, HA, N/V, fluid in lungs, chest pain slurred speech and blurry vision. Hypotension hypocalcemia, arrhythmia and asystole |
| What is the antidote for MgSO4 | Calcium |
| What does HELLP syndrome stand for and when is it seen | people with pre-eclampsia are at risk. H=hemolysis. EL= Elevated Liver enzymes. LP = Low Platelets |
| Elevated Liver enzymes in HELLP sndrome cause | intra-arterial lesions, platelet aggregation, fibrin accumulation, microemboli in hepatic vasculature and eschemia |
Created by:
cgwayland
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