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high risk pregnancy Flashcards

1
Q

what do we expect blood sugars to look like in early vs later in pregnancy?

A

early: low

later: hyperglycemia and resistance to insulin

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2
Q

normal 1 hr GTT results (50gm oral glucose)

A

135-140 mg/dL

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3
Q

3 hr GTT (100gm oral glucose)

A

1 hr: > 180 mg/dL
2 hr: > 155 mg/dL
3 hr: 140 mg/dL

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4
Q

how is gestational diabetes diagnosed?

A

1 hr GTT –> 3 hr GTT –> 2 values must meet or exceed the value = diagnosis

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5
Q

maternal implications od diabetes

A
  • ketoacidosis
  • vascular disease
  • nephropathy
  • retinopathy
  • hydramnios
  • HTN
  • dystocia
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6
Q

fetal implications of diabetes

A
  • higher risk for fetal death
  • congenital anomalies
  • LGA
  • IUGR
  • RDS
  • hyperbilirubinemia
  • hypocalcemia
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7
Q

what are the insulin requirements early in pregnancy?

A

insulin needs typically decrease

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8
Q

what are the insulin requirements later in pregnancy?

A

insulin needs greatly increase

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9
Q

what are the insulin requirements postpartum?

A

insulin needs decrease

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10
Q

insufficient hemoglobin production

A

r/t nutritional deficiency

ex: iron deficiency, folate deficiency

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11
Q

hemoglobin destruction

A

r/t inherited disorders

ex: sickle cell anemia

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12
Q

possible maternal complications in iron deficiency anemia

A
  • infections
  • fatigue bc they have less ability to carry O2
  • preeclampsia
  • tolerate blood loss poorly
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13
Q

possible fetal complications in iron deficiency anemia

A
  • low birth weight
  • preterm delivery
  • fetal demise
  • neonatal death
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14
Q

prevention of iron deficiency anemia in pregnancy

A
  • prenatal vitamins
  • 60-120 mg of iron/day
  • iron rich diet
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15
Q

possible fetal complication of megaloblastic anemia (folate deficiency)

A

neural tube defects

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16
Q

prevention of megaloblastic anemia (folate deficiency)

A
  • 0.4 mg folate/day
  • 1 mg folate + iron supplement
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17
Q

possible fetal complications of sickle cell anemia

A
  • fetal death
  • prematurity
  • IUGR
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18
Q

pre-existing heart disease (repaired or not) is associated with…

A

cyanosis = greater maternal/fetal risk

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19
Q

peripartum cardiomyopathy

A
  • no previous hx of heart disease prior to pregnancy
  • left ventricle dysfunction
  • occurs during second half of pregnancy
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20
Q

management of labor in a patient with heart disease

A
  • may labor naturally w/ close observation
  • may limit pushing (may use forceps, vacuum)
  • limit pain and anxiety
21
Q

threatened abortion

A
  • unexplained bleeding, cramping
  • cervix is still closed
22
Q

imminent abortion

A
  • imminently going to have a miscarriage
  • increased bleeding and cramping
  • cervix may start to dilate, and membranes will rupture
23
Q

incomplete abortion

A
  • parts of products of conception are retained
  • delivers or miscarries some of the pregnancy but some is still retained
24
Q

complete abortion

A

all products of conception are expelled

25
Q

missed abortion

A
  • fetus dies in utero but is not expelled at all
  • note decrease in uterine size and changes in pregnancy begin to regress
26
Q

nursing considerations for spontaneous abortions

A
  • physiologically stable (bleeding)
  • pain r/t cramping
  • grief r/t loss
27
Q

preeclampsia

A
  • increase in BP after 20 weeks gestation
  • positive proteinuria
28
Q

eclampsia

A

presence of a seizure in the preeclamptic woman

29
Q

what labs would we expect in a preeclamptic patient?

A
  • elevations in ALT/AST
  • elevated BUN/creatinine
  • low PLT count
30
Q

assessment of eclamptic patient

A
  • body involvement
  • duration
  • fetal status
  • prevent injury
  • maintain respiratory ability
31
Q

HELLP syndrome associated with preeclampsia

A

H: hemolysis
E: elevated
L: liver enzymes
L: low
P: platelets (< 100,000)

32
Q

symptoms of HELLP syndrome

A
  • N/V
  • malaise
  • flu like symptoms
  • epigastric pain
33
Q

goal of management of severe preeclampsia

A

prevent seizures, prevention of liver and kidney disease, maintain pregnancy

34
Q

direct coomb’s test

A

testing newborn for sensitization to antibody that mom produced against fetus blood

35
Q

indirect coomb’s test

A

testing the mother for sensitization

36
Q

what does a negative coomb’s test indicate?

A

no sensitization = her antibodies haven’t become active

37
Q

kleihauer-betke test

A

estimates the extent of bleeding for administration of the appropriate amount of Rh immune globulin

38
Q

maternal medical risks with advanced maternal age

A
  • diabetes
  • HTN
  • placenta previa
  • dystocia
39
Q

fetal/newborn risks with advanced maternal age

A
  • miscarriage
  • genetic issues (down syndrome)
  • preterm birth
  • low birth weight
40
Q

fetal kick counts

A

same time everyday, one hour after meals

count the number of fetal movements in 30 min, 3x/day

there should be at least 3 movements in 30 min

41
Q

when should we be concerned with fetal kick counts?

A

if there’s < 10 movements in 3 hrs anytime through the day

42
Q

non stress test

A

observation of accelerations with fetal movement
- FHR monitored for 20 min

43
Q

reactive NST

A

(normal) 2 accelerations at least 15 bpm above baseline, lasting at least 15 seconds in duration

44
Q

nonreactive NST

A

(abnormal) lacks sufficient accelerations

45
Q

contraction stress test

A
  • assessing response of FHR to contractions
  • 3 cx that last at least 40 seconds w/in 10 min
46
Q

negative contraction stress test

A

reassuring!! no significant decelerations

47
Q

positive contraction stress test

A

presence of late decels w/ at least 50% of cxs

48
Q

biophysical profile

A
  • includes NST and US (up to 30 min)
  • considers accelerations, breathing, movements of extremities, tone, amniotic fluid volume (2 pts for each)
  • lower scores are associated w/ higher perinatal mortality and may indicate moving toward delivery

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