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OB chapter 14
Health problems complicating pregnancy
| Question | Answer |
|---|---|
| leading cause of maternal death | hypertension, embolism, hemorrhage, and infection |
| frequent causes of bleeding in 1st trimester | spontaneous abortion, cervical polyps, uterine fibroids, ectopic pregnancy, hydatidiform mole |
| causes of spontaneous abortion | genetic defects, defective ovum or sperm, defective implantation, uterine fibroids, maternal factors |
| maternal factors affecting spontaneous abortion | chronic conditions, acute infections, nutritional deficiencies, abnormalities of maternal reproductive organs and endocrine deficiencies |
| signs of threatened abortion | bleeding and cramping, shock |
| signs of shock | pallor, cold clammy skin, restlessness, and perspiration |
| ectopic pregnancy | an abnormal implantation of the fertilized ovum outside the uterine cavity (can be in fallopian tube, ovary, abdominal cavity or cervix) |
| care following hydatidiform mole | critical because of the great risk of choriocarcinoma; continued assessment includes hCG levels and ultrasound scans of the abdomen, chemotherapy is used if hCG levels increase instead of decline |
| major causes of bleeding in the last trimester | placenta previa, abruption placentae, and DIC |
| reasons that digital vaginal exams are contraindicated with bleeding | severe hemorrhage may result from the examination |
| signs of placenta previa | painless bleeding occurring after 24 weeks’ gestatation; also may have breech or transverse presentation of infant |
| abruptio placentae | premature separation of the placenta; partial or total detachment that usually occurs in third trimester with bleeding accompanied by pain |
| Disseminated Intravascular Coagulation is a complication following | abruptio placentae, GH, retained dead fetus, hydatidiform mole, hemorrhagic shock, and septic abortion, also infection can activate the coagulation pathway |
| reasons for Rhogam | prevent the formation of anti-Rh antibodies of an Rh-negative woman having an Rh-positive newborn |
| signs of gestational hypertension | vasospasms cause hypertension and ultimately a decreased blood flow to the uterus and placenta; proteinuria, oliguria, headaches, visual disturbances, epigastric pain, seizures, stroke, acute renal failure, abruption placetae, DIC |
| teaching plan for mild gestational hypertension | restricted activity, rest on left side, daily blood pressure in same arm and position, daily weight, daily urine dipstick test for protein, fetal kicks and uterine activity monitored, diet with increased protein |
| symptoms that would make you hold magnesium sulfate | loss of deep tendon reflexes, respiratory rate less than 12 breaths/min, and a decrease in urinary output to less than 30 ml/hr |
| primary reason for magnesium administration | seizure prevention |
| difference between preeclampsia and eclampsia | preeclampsia: GH with proteinuria present; eclampsia: preeclampsia with related seizures |
| risks for thromboembolic disease | venous stasis, normal changes in the coagulability and fibrinolysis activity, vessel wall injury, oral contraceptive use, stationary jobs, older than 30, obesity |
| pulmonary embolism | collection of platelets and fibrin on the wall of a blood vessel that enlarges and then detaches and flows through the circulation and lands in the lung |
| effects of pregnancy on heart disease | uterine contraction can overload the heart and may trigger CHF, maternal pushing taxes the heart, after birth, sudden shift of blood to maternal circulation |
| precautions in pregnancy with heart disease | warfarin, propranolol, and some diuretics may be contraindicated, monitor sodium and potassium levels, needs lots of rest periods |
| education for a pt taking ferrous sulfate | vitamin C and zinc enhance absorption; side effects include: nausea; vomiting; epigastric pain; discomfort; abdominal cramping; black, tarry stools; and constipation |
| hyperemesis gravidarum | (excessive vomiting of pregnancy); when vomiting persists causing dehydration, starvation, and excessive weight loss before the twentieth week of pregnancy |
| Effect of pregnancy on glucose metabolism | periods of hyperglycemia may occur for which the diabetic mother will need an increased insulin supply. Hyperglycemia in the fetus results in macrosomia |
| Patient with pregestational diabetes requires? | less insulin |
| Diabetic control in pregnancy | avoid hypoglycemia; BP and BS levels must be maintained within normal ranges |
| Maternal complications from diabetes | spontaneous abortion, increased risk for infections, hydramnios, GH, ketoacidosis, hypoglycemia, hyperglycemia |
| Malformations of fetus from rubella | cardiac anomalies; deafness; microcephaly, cataracts; heart disorder; IUGR; psychomotor retardation if mother has rubella in first 4 weeks of pregnancy |
| abuse of substances | use of illegal drugs, tobacco and ETOH during pregnancy can seriously affect fetal development and pregnancy outcome |
| signs of withdrawal in newborn | irritability, tachycardia, fetal hyperactivity,poor feeding reflexes, difficulty consoling, hyperactivity, high-pitched cry, continuous need for sucking, tremors, seizures, disrupted sleep-wake cycles, lack of response to cuddling, sensitivity to light |
| heart disease and 2nd stage of labor and postpartum | decreased peripheral resistance and pulmonary embolism are two major problems that can occur |
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laotracuata
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