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What are the two broad categories of pregnancy complications?
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What diagnostic test can guarantee the birth of a healthy baby?
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Introduction to Common Complications of Pregnancy
| Question | Answer |
|---|---|
| What are the two broad categories of pregnancy complications? | *Unique to pregnancy. *Can occur at any time, but are complications when in conjunction with pregnancy |
| What diagnostic test can guarantee the birth of a healthy baby? | NO diagnostic test can guarantee the birth of a healthy baby |
| What does an ultrasound require for proper visualization of the fetus? | A full bladder |
| List the uses of ultrasounds for pregnancy: | *Confirmation of pregnancy *Verification of the location of the pregnancy (uterine/ectopic) *Verification of fetal viability or death *Identification of multi-fetal gestations *Dx of fetal structural abnormalities *Gestational age of fetus |
| How long does an ultrasound take? | 10 - 30 minutes |
| How is the PT positioned during an ultrasound? | *Position on back with head and knees supported *Elevate head so that she can see the screen *Turn slightly to one side to prevent hypotension |
| What test makes use of high frequency sound waves to study the flow of blood through the umbilical artery and vessels, determining adequacy of blood flow? | Doppler Ultrasound Blood Flow Assessment |
| What is the predominate protein in fetal plasma? | Alpha-fetoprotein (AFP) |
| What screening determines the level of this fetal protein in the pregnant woman's serum or in a sample of amniotic fluid? | Alpha-Fetoprotein Screening |
| What are elevated levels of Alpha-fetoprotein (AFP) associated with? | neural tube defects, such as spina bifida (open spine), anencephaly (incomplete development of the skull and brain), or gastroschisis (open abdominal cavity) |
| What are low levels of Alpha-fetoprotein (AFP) associated with? | chromosome abnormalities such as Down Syndrome or trisomy 21 or gestational trophoblastic disease (hydatidiform mole) |
| What can influence AFP levels? | *Gestational age *Maternal weight *Multifetal pregnancy *Race *Maternal diabetes |
| What is a procedure by which fetal tissues are analyzed to reflect the chromosomal and genetic makeup of the fetus and is used to identify chromosomal, metabolic or DNA abnormalities? | Chorionic Villus Sampling |
| What are the types of chorionic villus sampling techniques? | *Transabdominal *Transcervical |
| What is an amniocentisis? | The insertion of a thin needle through the abdominal and uterine walls to obtain a sample of amniotic fluid, which contains cast-off fetal cells and various other fetal products |
| When is EARLY amniocentesis performed? | 11 to 14 weeks’ gestation. |
| When most amniocentesis' performed? | 15 to 20 weeks’ gestation |
| Why are mid-trimester amniocentesis' done? | *Identify chromosomal abnormalities *Fetal condition *Diagnose intrauterine infections *Investigate amniotic fluid AFP and acetylcholinesterase when there is a previously documented abnormality |
| Why are third trimester amniocentesis' done? | *Assess fetal lung maturity and whether the fetus is likely to have respiratory complications *help test for fetal hemolytic diseases when Rh incompatibility is suspected. |
| What does a non-stress test (NST) determine? | whether an increase in the fetal heart rate occurs when the fetus moves |
| How long does a non-stress test (NST) take? | 40 minutes |
| What is a non-stress test (NST) used to identify? | Identifies fetal compromise in conditions associated with poor placenta function, such as hypertension, diabetes mellitus, or post-term gestation |
| What is used to confirm a nonreactive non-stress test (NST) findings? | Vibroacoustic Stimulation Test |
| How is a vibroacoustic stimulation test performed? | An artificial larynx device is used to stimulate the fetus with sound; expected response is acceleration of the fetal heart rate, as in NST |
| What is an evaluation of the fetal heart rate response to mild uterine contractions by using an external fetal monitor? | Contraction Stress Test |
| When is Contraction Stress Testing conducted? | after 32 weeks of gestation |
| What test is used to determine how the fetal central nervous system reacts to hypoxemia and fetal acidosis? | Biophysical Profile |
| What test involves the aspiration of fetal blood from the umbilical cord for prenatal diagnosis or therapy? | Percutaneous Umbilical Blood Sampling |
| What is it called when the mother counts the number of fetal movements in a prescribed period of time? | Maternal Assessment of Fetal Movement (Kick Counts). |
| Define Hyperemesis Gravidarum: | Persistent, uncontrollable vomiting that begins before the 20th week of pregnancy |
| What is the most common cause of spontanious abortion? | *Severe congenital abnormalities incompatible with life *Chromosomal defects account for about 50-60% |
| What are the six spontanious abortion sub-groups? | *Threatened *Inevitable *Incomplete *Complete *Missed *Recurrent |
| What is threatened abortion? | *Vaginal bleeding occurs *May be followed by rhythmic uterine cramping, persistent backache, or feelings of pelvic pressure. |
| What is inevitable abortion? | Membranes rupture and cervix dilates |
| What is incomplete abortion? | Some products of conception have been expelled, but some remain |
| What should be stopped if a threatened abortion is present? | Sexual activity |
| What is missed abortion? | fetus dies during 1st half of pregnancy but is retained in the uterus |
| What is recurrent abortion? | defined as three or more spontaneous abortions, although some now use two or more pregnancy losses as the definition |
| What are some causes of ectopic pregnancy? | *Scarring/abnormality in tube *Inflammation *Surgery *IUD *Hx of ectopic pregnancy |
| What are some manifestations of ectopic pregnancy? | *Abdominal pain *Vaginal spotting *Missed period *Ruptured tube symptoms |
| What percentage of ectopic pregnancies occur in the fallopian tube? | Although implantation can occur in the abdomen or cervix, more than 98% occur in the fallopian tube. |
| What is the medical management of an ectopic pregnancy with an unruptured tube? | methotrexate (chemotherapeutic agent) is used to inhibit cell division in the embryo. Surgical management may involve linear salpingostomy to salvage the tube. |
| What is the medical management of an ectopic pregnancy with a ruptured tube? | goal is to control bleeding and prevent hypovolemic shock. Salpingectomy (tube removal) and ligation of bleeding vessels may be required |
| What is Disseminated Intravascular Coagulation (DIC)? | DIC is a life-threatening defect in coagulation that may occur with several complications of pregnancy |
| What is DIC associated with? | abruption placentae, incomplete abortion, hypertensive disease or infectious process. May occur if the fetus is retained for a prolonged period |
| What are the S/Sx of DIC (Disseminated Intravascular Coagulation) | *Chest pain or dyspnea *Restless and cyanotic, occasionally expectorating frothy, blood-tinged mucus |
| What is the medical management of DIC (Disseminated Intravascular Coagulation)? | *Correct cause *Administer blood products *Oxygen therapy (High flow) *Delivery ASAP |
| Define placenta previa: | implantation of the placenta in the lower uterus. As a result the placenta is closer to the internal cervical os than the presenting part of the fetus |
| What are the three types of placenta previa? | *Marginal/low lying *Partial *Total |
| What are the manifestations of placenta previa? | *Painless vaginal bleeding *Bleeding results from tearing of the placental villi *Bleeding may not occur until labor starts |
| Define abruptio placentae: | premature separation of a normally implanted placenta from the uterine wall. |
| What is the point of viability of the fetus (survive outside of mother)? | 20 weeks gestation |
| What are the predisposing factors for abruptio placentae? | *Chronic HTN or PIH *Cocaine *Premature rupture of membranes *Blunt abdominal trauma *Cigarretes *Prior Hx *Short umbilical cord |
| What is the nursing management of abruptio placentae? | *Side lying position with wedge under right hip for uterine placental perfusion. *Preparation for immediate cesarean delivery. *Blood/fluid replacement: two large-bore IV lines should be placed |
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