Additional PP Complications

Question 1

what does HELLP stand for?

Answer 1

Hemolysis, Elevated Liver enzymes, Low Platelets

Question 2

how is HELLP characterized?

Answer 2

Hemolysis/elevated liver enzymes: inflammation of the liver, characterized by pain under the right ribcage, which is caused by inflamed liver capsule

Low platelets: signals an impending disorder of clotting status that if left unchecked can progress to disseminated intravascular coagulopathy (must be less than 100 x10^9)

Question 3

how does hemolysis work in HELLP?

Answer 3

RBC’s are damaged as they pass through narrowed blood vessels and become hemolyzed,, resulting in a decreased RBC and platelet count and hyperbilirubinemia

Question 4

complications of HELLP?

Answer 4

Renal failure
Pulmonary edema
Ruptured liver hematoma
DIC
Placental abruption

Question 5

interventions for HELLP?

Answer 5

Protein or salt restriction
Zinc
Magnesium
Fish oil
Vitamins C and E
Use of diuretics or other anti-hypertensive medications
Use of heparin or low-dose aspirin

Question 6

nursing care for HELLP?

Answer 6

assess BP, deep tendon reflexes, fetal surveillance, recommend activity restriction

Question 7

what does magnesium sulphate prevent and treat?

Answer 7

convulsions (seizures) caused by pre-eclampsia or eclampsia

Question 8

how is magnesium sulphate administered?

Answer 8

via infusion

Question 9

what is bilirubin a by product of?

Answer 9

RBC hemolysis

Question 10

where do fetal RBC go at the time of birth?

Answer 10

mothers circlulation

Question 11

what is ABO coagulation?

Answer 11

antibodies in the plasma of one blood group produce agglutination (clumping) when mixed with antigens of a different blood group. In the ABO blood group system, the antibodies occur naturally

Question 12

does AB blood group contain antibodies?

Answer 12

no

Question 13

what is the most common blood group incompatibility in the newborn and mother?

Answer 13

mother is O blood group and an infant with A or B blood group

Question 14

how are Rh and ABO incompatibility different?

Answer 14

ABO incompatibility may occur in the first pregnancy

Question 15

when can Complications arise with Rh incompatibility (isoimmunization)?

Answer 15

mother is Rh negative and the newborn is Rh positive.

Question 16

When fetal RBCs enter maternal circulation during childbirth, the natural defense mechanism of the childbearing parent responds to these alien cells by:

Answer 16

producing anti-Rh antibodies

Question 17

isoimmunization has no effect during the first pregnancy with an Rh-positive fetus because:

Answer 17

the initial sensitization to Rh antigens rarely occurs before the onset of labor

Question 18

how does the fetus attempt to compensate for progressive hemolysis and anemia?

Answer 18

accelerating the rate of erythropoiesis (red blood cell production). As a result, immature RBCs (erythroblasts) appear in the fetal circulation. This is called erythroblastosis fetalis

Question 19

what is hydrops fetalis?

Answer 19

progressive hemolysis = fetal hypoxia

Question 20

is a prolapsed cord more of a complication in labour or post partum?

Answer 20

Labour

Question 21

what is a prolapsed cord?

Answer 21

occurs when the cord lies below the presenting part of the fetus.

Question 22

the prolapsed cord can be hidden during labour. T or F

Answer 22

T

Question 23

when would you typically see a prolapsed cord?

Answer 23

directly after rupture of membranes, when gravity washes the cord in front of the presenting part.

Question 24

what are contributing factors to a prolapsed cord?

Answer 24

long cord (longer than 100 cm), malpresentation (breech or transverse lie)

Question 25

what are risk factors of a prolapsed cord?

Answer 25

fetal hypoxia, newborn asphyxia, neurological brain injury, or death of the fetus.

Question 26

how can the nurse help with a prolapsed cord?

Answer 26

Pressure on relieved by putting a sterile gloved hand into the vagina, holding the presenting part off of the umbilical cord

Question 27

what positions can help gravity keep the presenting part off the prolapsed cord?

Answer 27

lateral recumbent, Trendelenburg, or knee–chest,

Question 28

when the pt has a prolapsed cord but is fully dilated that should be done?

Answer 28

vacuum-assisted birth can be performed for the fetus in a cephalic presentation; otherwise, emergent Cesarean surgery is likely to be performed

Question 29

signs of a prolapsed cord:

Answer 29

prolonged deceleration during uterine contraction Patient reports feeling the cord after membranes rupture Cord is seen or felt in or protruding from the vagina

Question 30

what is Dystocia?

Answer 30

abnormally slow progress of labor; it is caused by various conditions related to the five P’s of labor (passenger, passageway, powers, position of the labouring patient, and psychological response)

Question 31

causes of Dystocia:

Answer 31

- Ineffective uterine contractions (most common cause) - Alterations in the pelvic structure - Fetal causes (size, position) - position of pt during birth - Psychological responses

Question 32

when should dystocia be suspected?

Answer 32

when there is an alteration in the characteristics of uterine contractions, a lack of progress in the rate of cervical dilation, or a lack of progress in fetal descent and expulsion.

Question 33

what is the most common fetal malposition?

Answer 33

persistent occipitoposterior position

Question 34

when does fetal malposition usually occur?

Answer 34

during the latent phase of the first stage of labor - 2nd stage is usually prolonged (back pain from pressure)

Question 35

what is AROM?

Answer 35

Artificial rupture of membranes

Question 36

define AROM

Answer 36

when the doctor or health care provider intentionally breaks the pregnant woman's amniotic sac

Question 37

why is AROM done?

Answer 37

to progress labor and if the baby needs to be monitored more closely

Question 38

how is AROM performed?

Answer 38

physician takes a hook like device and inserts it into the woman's vaginal cavity, in through the cervix and reaches the amniotic sac

Question 39

causes of a C:

Answer 39

Fetal macrosomia Advanced maternal age Obesity Gestational diabetes Multifetal pregnancy Labour dystocia

Question 40

risks of a C:

Answer 40

- endometritis, blood transfusion and venous thrombosis - A longer hospital stay and recovery time - Increased risk for resp issues for baby - Greater complications in subsequent pregnancies

Question 41

C should not be perfumed unless they are at what gestational age?

Answer 41

39 weeks

Question 42

when are C's not recommended?

Answer 42

- pt who want more kids

Question 43

indications for a C (preg pt):

Answer 43

Specific cardiac disease Specific respiratory disease Conditions associated with increased intracranial pressure Mechanical obstruction of the lower uterine segment (tumours, fibroids) Mechanical vulvar obstruction History of two or more previous Csection births Elective csection birth

Question 44

indications for a C (infant:

Answer 44

Abnormal HR or pattern Malpresentation (breech or transverse lie) Active herpes lesions in labouring patient Maternal HIV Congenital anomalies

Question 45

complications of a C:

Answer 45

Anaesthesia events Hemorrhage Bowel or bladder injury Amniotic fluid embolism Air embolism

Question 46

postpartum complications of a C:

Answer 46

Atelectasis Endometritis UTI Abdominal wound hematoma formation Dehiscence Infection Necrotizing fasciitis Thromboembolic disease Bowel dysfunction

Question 47

when can Fetal asphyxia occur?

Answer 47

if the uterus and placenta are poorly perfused as a result of hypotension in the labouring patient caused by regional anaesthesia