W3: Pregnancy at Risk Flashcards
Adolescent pregnancy
age 10-19yrs
increased of perinatal complications, maternal death
Adolescent friendly perinatal care
nonjudgmental care
forming connection
individualizing care
- ensure safety
- positive experience
Geriatic Pregnancy
> 35 yrs
increased risk of:
- maternal death
- miscarriage
- pre-term
-LBW
- perinatal mortality
- down syndrome
IPV is assoc w/
preterm labour
premature baby
LBW
neonatal/infant/maternal mortality
maternal depression
substance abuse
IPV screening tools
RADAR (routine, document, assess, review)
HITS
Role of nurse (IPV)
- report if child <16 in house
-reassure & believe
- don’t judge
not her fault
apologies don’t end abuse
explain effects on fetus
reinforce their safety
explore cocnerns + plan of care
referrals
documentation
Risk assoc. w/ substance abuse
bleeding complications
miscarriage
still birth
prematuritty
lbw
SIDS
congenital abnormalities
Is there a legal drug testing requirement during pregnancy in Canada?
No
legal considerations associated w/ substance use
non-jugemental person centred approach
harm reduction model
encourage prenatal care, counselling, tx
barriers to tx assoc. w/ substance use
guilt, fear, shame
tx programs don’t address pregnant women
lack of women-only spaces
long waitlists
NC: Substance Use
assess hx
confidentiality
trauma-informed
harm reduction
women more receptive to changes during pregnancy
OAT (opiod agnonist therapy), methadone or buprenorphine tx
cannabis use education
maternal-infant attachment
BF
Early Pregnancy Bleeding
miscarriage/spontaneous abortopn before 20w OR fetus <500g
early loss
before 12 w
chromosomal abnormalities
teratogenic drugs
faulty implantation
maternal abnormalities
infections
late loss
12-20w
advanced age
premature dilation of cervix
chronic infection
use of recreational drugs
Threatened Abortion
bleeding: slight, spotting
uterine cramping: mild
cx: closed
expulsion of products: no
bed rests, tests
Inevitable Abortion
bleeding: moderate
uterine cramping: mild-severe
cx: open
expulsion of products: yes
bed rest, dilation/cutterage
Incomplete abortion
bleeding: heavy, profuse
uterine cramping: severe
cx: open
expulsion of products: yes
dilation -> cutterage (suction)
complete abortion
bleeding: slight
uterine cramping: mild
cx: close
expulsion of products: yes
cutterage maybe
missed abortion
bleeding: none, spotting
uterine cramping: none
cx: close
expulsion of products: no
monitor
early pregnancy assessment:
confirmation of pregnancy
bleeding
pain
vaginal d/c
late pregnancy assessment
date of birth
bleeding
pain
vginal d/c
amniotic membrane status
uterine activity
fetal heart rate + movement
MGT of incomplete abortion
expectant: allow miscarriage to expel on its own
medical: 2 drug combo
- mifepristone - prepare uterus for miscarriage (blocks progesterone)
- misoprostol - given 24-48 hrs later, helps soften + dilate cervix
surgical: dilation & cutterage
D/C teaching after pregnancy loss
- report heavy, bright-red bleeding
- scant d/c for 1-2 weeks
- nothing in vagina for 2 weeks (until bleeding stops)
- take antibiotics
- report elevated temp + foul d/c
- foods high in Fe & protein
- post-pone pregnancy for at least 2mo
Ectopic pregnancy
fertilized ovum implanted outside uterine cavity (amupllar)
medical emergency!
clinical manifestations
- abdominal pain
- missed period
- abnormal vaginal bleeding (rupture)
-referred shoulder pain
-one-sided, deep lower quadrant pain
Ectopic pregnancy dx
ultrasound
serum progesterone
b-hCG
medical mangement of Ectopic pregnancy
methotrexate: antimetabolite & folic acid antagonist, destroys rapidly dividing cells
surgical: salpinostomy, salpingectomy to repair rupture
Patient Teaching for methotrexate
avoid folic acid
avoid gas-forming foods
avoid sun exposure
avoid sexual intercourse until b-hCG gone
keep all appointments
CONTACT DOC: severe abd pain (rupture)
Premature dilation of cervix
passive/painlexx dilation of the cervix
d/t trauma, collagen issues
Nursing care for premature cervical dilation
cervical cerclage (12-14weeks)
observation
report signs of pre-term labor, PROM, infection
HOSPITAL: contractions, pPROM, perineal pressure, urge to push
Placenta previa
placenta implented in lower uterine segment near/over internal cervical os
classifcation of placenta percia
complete placenta previa
marginal placenta previa
low-lying placenta
clinical signs of placenta previa
bright red bleeding
pain absent
uterine normal
normal fetal HR
complictions of placenta previa
bleeding (PAINLESS)
preterm birth
IUGR
Expectant Management of Placenta Previa
reduced activty + observation
patient <36w
no labor, minimal bleeding
no rectal/vaginal examinations
ultrasound q2w
NST, BPP 1-2 x weekly
antepartum steroids (betamethasone), fetal lung maturity
active mgt of placenta previa
c-section
- mature fetus
-excessive bleeding - active labor begins
Placenta Abruption
premature seperation of placenta
clinical signs ofplacenta abruption
vaginal bleeding (PAINFUL)
abd pain
uterine tenderness
contraction
placenta abruption is a major cause of ___
antepartum hemorrhage
Placenta Abruption: CLASS 1- mild seperation
bleeding: minimal
total blood loss: <500
colour: dark red
shock: rare, no
uterine tonicity: normal
pain: absent
fetal status: normal
DIC: rare
Placenta Abruption: CLASS 2- mod seperation
bleeding: 0-mod
total blood loss: 1000-1500
colour: dark red
shock: mild
uterine tonicity: increase
pain: mod-sev
fetal status: atypical
DIC: occasional