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antepartdum Flashcards

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1
Q

high-risk pregnancy

A

Coincidental (had disease before pregnancy) or unique to pregnancy (unique to pregnancy). visit dr every 4 weeks during 1st and 2nd, and 3rd every 2 weeks. 0-13 - 1st, 14-26 - 2nd, 27-40 3rd trimester.*****

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2
Q

Risk Factors

A

Biophysical - mostly due to diseases. multiple birth, genetic abnormalities, nutritional deficiencies.
Psychosocial - depression, smoking, caffeine, alcohol, substance abuse. crisis w/ domestic violence.
Socio-demographic - poverty, lack of nutrition, prenatal care, less than 15 years of age, parody (# of deliveries greater than 20 wks) access to health care.
Environmental - a little bit of all of them, not clean or healthy place to live, more infections. radiation, air and water polution, and 2nd hand smoke, stress.

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3
Q

Antepartum Testing

A

To detect potential fetal compromise (usually a lack of 02)
32-34 weeks until delivery - fetal fibernectincan predict when person is going to deliver
Used primarily for women at risk for disrupted fetal oxygenation

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4
Q

BIOPHYSICAL ASSESSMENTS

A

VVP - vital physical profile. Daily Fetal Movement Count (AKA Kick Count) - daily movement counts - should be performed same time every day. lay on left side, hand on stomach, and lay for an hour and count. should be around 10 kicks an hour. best time is after meals.
Ultrasound - used for many things - wellbeing - usually look at movement, heartbeat, and RR, can see baby move, can see diaphragm
Biophysical Profile (BPP) - measures health of fetus. HR, muscle tone, breathing action, and how much amniotic fluid. also a non-stress test.

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5
Q

ultrasound

A

Abdominal or transvaginal. usually abdominal. if looking for anomalies, will do transvaginal.

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6
Q

when is Transvaginal used? (trans is first)

A

Transvaginal used mainly in in the first trimester - provides greater detail and can dx IUP (intrauterine pregnancy) and establish Gestational age earlier. can tell if cervix is thin.

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7
Q

Levels of ultrasonography:
Standard

A

Levels of ultrasonography:
Standard – GA, AFI’s etc.
Limited – e.g., check for vertex presentation, fetal HR
Specialized- suspected anatomical or physiological abnormal fetus

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8
Q

get to know your baby’s movements

A

if she doesn’t feel that movement, call the provider.

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9
Q

Indications For Use

A

Fetal Heart Activity
Gestational Age
Fetal Growth
Fetal Anatomy
Fetal Genetic
Fetal Position
Disorders and Physical Anomalies
Placental Position and Function
Adjunct to other tests
Fetal Well Being

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10
Q

Ultrasound to Determine Gestational Age
Fetal Growth

A

Recommended method of dating.
Most accurate between 14-22 weeks. most common one is from last mentstural period and nagal’s rule.
Gestational Sac dimensions (8 weeks)
Crown/Rump length (7-12 weeks)
BPD (biparatal diameter - just transverse section of skull) (12 weeks) and Femur Length (12 weeks)
Serial evaluations of BPD, Limb length and abdominal circumference can determine Fetal Growth

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11
Q

Biparietal Diameter (BPD) to determine (gest bpg at 12)

A

Gestational age
After 12 weeks

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12
Q

fetal well being

A

doppler flood flow analysis (not as common), amniotic fluid (through umbelical cord), NST, biophsical profile, modified biophycial profile.

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13
Q

biophysical profile scoring

A

fetal breathing movements - 2 ,gross body movement - 2, fetal tone - 2, reactive HR - 2, qualatative amniotic fluid - 2`

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14
Q

missing slide

A

14 - prob don’t need this

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15
Q

biophysical profile scoring

A

8 - 10 normal, 4-6 suspected chronic asphysxia, 2 strong suspicion of asphysxia

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16
Q

Amniotic Fluid Index (AFI)
Amniotic Fluid Volume (AVI) (same thing as amniotic fluid test) - what is the normal amount?

A

Measures the vertical depths of the largest pocket of amniotic fluid in all four quadrants surrounding the maternal umbilicus and totaled. 5 - 25 cm is normal fluid amount.

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17
Q

Biochemical Assessment

A

Procedures to obtain specimens:
Amniocentesis - take some anmiotic fluid.
Chorionic Villus Sampling (CVS) (placenta side towards infant)
Maternal Assays - blood draws - looking for downs, etc.
Percutaneous Umbilical Blood Sampling

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18
Q

AMNIOCENTESIS

A

Genetic and chromosomal abnormalities (15- 20 weks), Fetal Lung Maturity, Rh isoimmunization status and severity of hemolytic anemia, AFP (Alpha Feto Protein) levels which indicate anatomic abnormalities

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19
Q

2 Ways of Measuring the Infant’s Lung Maturity

A
  1. Lecithin to sphingomyelin (L/S) ratio: a mixture of lipids, proteins, and glycoproteins that make up surfactant:

2 or more indicated fetal lung maturity and low risk of infant respiratory distress syndrome
1.5 or less is associated w/high risk

  1. Phosphatidylglycerol: is a glycerophospholipid found in pulmonary surfactant and an indicator o fetal lung maturity
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20
Q

If a patient needs to be delivered, they should be delivered

A

If a patient needs to be delivered, they should be delivered regardless of fetal lung maturity. If a patient doesn’t need to be delivered, then we should wait.

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21
Q

if the pt needs to be delivered- BMZ <34 weeks

A

BMZ (betamethazone) <34 weeks with imminent delivery before 7 days and have not received it BMZ in the last 14 days.

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22
Q

BMZ 34 to 36.6 weeks

A

BMZ (betamethazone) 34 to 36.6 weeks at risk of preterm birth within 7 days and have not received BMZ or prior course was > 14 days

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23
Q

Complications
Less than 1%. -mom

A

Infection
Hemorrhage
damage to bladder or intestines.
Miscarriage
PTL
leakage of AF
Rh Sensitization

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24
Q

Complications
Less than 1% - baby

A

Death
Hemorrhage
Infection

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25
nursing care
Report leaking fluid Abdominal pain Bleeding Decreased Fetal movement Fever Rhogham to RH- women educate informed consent fetal monitoring
26
chorionic villus sampling (chronic for 10 weeks)
10-12 weeks. ultrasound guided.
27
Fetal Assessment via Electronic Fetal Monitoring
non-stress test (NST), contraction stress test (OST)
28
Fetal Assessment via Electronic Fetal Monitoring
To determine the the timing of childbirth for women at risk for uteroplacental insufficiency (UPI), 32-34 weeks in high-risk patients, 1-2 times a week. main thing is to ensure baby has good O2 supply.
29
NON-STRESS TEST
evaluate FHR during movement. Reactive/Nonreactive Reactive = 2 Accelerations in 20 minutes. (if they are greater than 32 weeks) (less than 32 weeks, could be 15 and 10) Accelerations are FHR equal or greater than 15 BPM over baseline lasting 15 seconds or more.
30
CONTRACTION STRESS TEST (we don't want positive contractions with the stress test!)
Endogenous or Exogenous Oxytocin, Evaluate FHT with contractions, Negative: No decelerations with 3 UC’s lasting 40-60 seconds in 10 minutes, Positive: Decelerations with 50% or more of UC’s (we don't want a positive) (we want negative)
31
contractions start where?
at the top, the fundus, and then they move down.
32
Contraindications to contraction stress test
placenta previa (over cervix), PTL, cervical insufficiency, multiple gestations, previous C/S
33
slides 30-34
34
minimal variability
<5 bpm variation around baseline
35
moderate variability
6-25 bpm variation
36
absent variability
no detectable variation around baseline
37
marked variability
> 25 bpm
38
SPONTANEOUS ABORTION (I was spontaneous before 20)
***on test***Loss of a fetus before 20 weeks, threatened, inevitable, incompomplete, complete, missed, recurrent (habitual), sepsis. 15% of pregnancies will have spontaneous abortion) . these are due to abnormalities of the fetus.
39
SPONTANEOUS ABORTION
Signs and Symptoms
Dependent on duration of pregnancy. Vaginal bleeding*** Abdominal pain*** Cramping Pelvic Pressure Low back pain almost impossible to stop once it starts
40

SPONTANEOUS ABORTION
Risk Factors:
Congenital malformations (1st Trimester. 60-70%), maternal infection, maternal endocrine problems, AMA (advanced maternal age), previous loss, UTI, thyroid issues, diabetes, spontaneous abortions in the past.
41
SPONTANEOUS ABORTION
Management
Bedrest, Fluids (threatened) D & C or suction curettage D & E (evacuation - used with suction) (2nd Trimester) Antibiotics (missed, septic) Misoprostol Pain medications RhoGAM (RH-)
42
abortion after 20 weeks called
still birth or intrauterinie demise.
43
if a pregnant woman has bleeding,
she needs to be seen by the provider.
44
Induced Therapeutic Abortion
EAB (elective abortion) - Purposeful interruption of a pre-viable pregnancy. TAB (theraputic abortion) – Abortion for maternal/fetal disorder.
45
A 2012 study of more than 9,000 women found that
when women got no-cost birth control, the number of unplanned pregnancies and abortions fell by between 62 and 78 percent.
46
H&P
Assess for co-morbidities and possible contraindications to any procedure Confirm IUP (Intrauterine pregnancy) Confirm gestational age (LMP - last menstrual period) Rh status (Rhogam prophylaxis within 72 hours if needed)
47
LARC
long-acting reversible contraception
48
Medical Abortions
Available in the US up to nine weeks after the last menstrual period Methotrexate and miso (up to 7 weeks after LMP) Methotrexate – Blocks folic acid needed for cell reproduction Misoprostol – empties the uterus (up to 10 weeks after LMP) mifepristone (RU – 486) blocks progesterone (up to 10 weeks after LMP) Least amount of complications
49
Surgical Abortions :
 Dilation and Curettage (D&C)
used up to 14-16 weeks
50
side effects - abortion
N/V (call dr. bc it could be infection), bleeding, cramping
51
Cervical insufficiency or Recurrent Premature Dilation of the Cervix
Recurrent passive and painless dilation of the cervix during the 2nd Trimester. dx based on history.
52
Cervical insufficiency or Recurrent Premature Dilation of the Cervix
Risk Factors: Congenital (presence of bicornuate uterus; exposure to DES (birth control bill from the 70s), short cervix) Acquired (multiple gestation, infection, trauma ) Hormonal (relaxin)
53
Cervical insufficiency or Recurrent Premature Dilation of the Cervix - management
medical: Bedrest Pelvic Rest anti inflammatory meds Progesterone Surgical: Cerclage (36 weeks) Prophylactic (11-15 weeks) Risks PTL (preterm labor) PPROM (preterm, premature rupture of membranes) Chorioamnionitis
54
Cervical insufficiency or Recurrent Premature Dilation of the Cervix - management - Nursing Care:
Observe for CTX, PPROM, S&S of infection. Education: activity restrictions Tocolytics (slows contractions down) S&S to report
55
ECTOPIC PREGNANCY 
Risk Factors:
History of STI or Pelvic Inflammatory Disease, previous ectopic preg, endometrosis, IUDs, assisted reproductions.
56
ECTOPIC PREGNANCY 
Symptoms:
Missed Period Tenderness Pain Shoulder Pain (internal bleeding) Vaginal Bleeding Shock
57
GESTATIONAL TROPHOBLASTIC DISEASE
tumors that grow in the uterus. an egg w/ no dna in it. A group of rare cancers including: Hydatidiform Mole Invasive mole Choriocarcinoma Placental Site Trophoblastic Tumor Overgrowth of the trophoblast or outer layer of the embryonic cells.
58
ECTOPIC PREGNANCY 
Management:
Methotrexate Emergency Surgery (Salpingectomy) Attempt to preserve tube Serial hCG levels (3-6 weeks) (to check if they're still pregnant)
59
6% of maternal deaths due to
ectopic pregnancies - education is key.
60
main STDS
gonn and chlyamdia
61
silent killer
ectopic pregnancy
62

Hydatidiform Mole (the mole is empty)
Complete: An egg with no genetic information is fertilized by a sperm. Partial: An egg is fertilized by two sperm and the placenta becomes the molar growth
63
Hydatidiform Mole (the mole is dark red) SYMPTOMS:
Second Trimester Vaginal Bleeding (dark brown or red). Uterus larger than dates. Elevated HCG levels hyperemisis. cramping and preeclampsia.
64
Hydatidiform Mole CARE:
Most- SAB if not- D&C, D&E Risk- Choriocarcinoma Follow-up monthly Serial hCG every 1-2 week until hCG is undetectable on two separate blood levels Then hCG every 1-2 months for at least a year NO PREGNANCY. usually short of breath bc the tumor can move to the lungs.
65
HYPEREMESIS GRAVIDARUM
70% of women will experience n/v 3% will develop severe n/v 1-5% n/v will be so severe they will require hospitalization Etiology unclear. May be related to high levels of estrogen, progesterone and hcg
66
HYPEREMESIS GRAVIDARUM
Is a dx of exclusion. Persistent vomiting not related to other causes A measure of acute starvation (ketonuria) Excessive n/v and weight loss (>5% of pre-pregnant weight)
67
HYPEREMESIS GRAVIDARUM
Risk Factors:
Hyperthyroid disorders Molar pregnancy Multiple gestation DM GI disorders Previous Pregnancy
68
HYPEREMESIS GRAVIDARUM
Initial Assessment:
R/O other causes (especially when presenting with N&V for the 1st time after nine weeks) Gastroenteritis Pyelonephritis (uterus pushes on uteter) Pancreatitis Cholecystitis Hepatitis Thyroid
69
HYPEREMESIS GRAVIDARUM
Initial Assessment: Assess for dehydration
Hypotension Intake and Output U/A (specific gravity) Skin turgor, mucous membranes Electrolyte imbalance (labs, S&S of hypokalemia) Vit. B1, B6 and B12 deficiencies (Wernicke-Korsakoff syndrome) IV Fluids: electrolyte replacement. NPO
70
HYPEREMESIS GRAVIDARUM
Nursing Care: Anti-emetics:
(usually on multiple meds before it is under control) Pyridoxine (B6)/Doxylamine* Phenergan Reglan Compazine Zofran Chlorpromazine Steroids Small frequent meals
71
HYPERTENSIVE DISORDERS IN PREGNANCY
Occurs in 5-10% of all pregnancies Is a leading cause of maternal death.
72
20 weeks
Gestational Hypertension - comes into pregnancy w/ HTN Pre-eclampsia eclampsia (eclampsia means you've had a seizure) cHTN with superimposed pre-eclampsia cHTN with superimposed eclampsia HELLP Syndrome (Hemolysis, Elevated Liver Enzymes, Low Platelets) - bleeding issues. 4 types - chronic - comes into pregnancy w/ HTN, gestational HTN , preeclamsia - liver enzymes and bp greater than 140/90, can be either diastolic or systolic.
73
NORMAL FINDINGS IN PREGNANCY
high Blood high Plasma Volume (50%) high Cardiac Output low BP (until 3rd trimester) low Total Peripheral resistance
74
FINDINGS IN PRE-ECLAMPSIA (Yolanda as high BP and her blood is the same)
Little or no change in Blood and Plasma Volume Variable Cardiac Output high - BP high - Total Peripheral resistance
75
Risk Factors PRE-ECLAMPSIA
First pregnancy Family history Obesity Multiple gestations Hx of Pre-eclampsia Hx of poor pregnancy outcome: IUGR, placental abruption or IUFD Pre-existing diabetes, HTN, or renal disease Gestational diabetes
76
diagnosis - PRE-ECLAMPSIA
32 Weeks Gestation with no previous hypertension documented. Admission B/P – 142/94 Present B/P - 160/112 x 2 0.5 PCR Protein in urine headache 8 out of 10 Rates URQ pain “6” out of 10 Patient is a G2/P1 with previous diagnosis of Pre-eclampsia
77
PRE-ECLAMPSIA - how to treat
have right sized BP for patient.
78
slide 84
abdominal pain, esp upper right quadrant (liver), SOB, oliguria. 1st bp is high. serial bp readings every 20 min. crackles, lung sounds.
79
good drugs for pre-eclampsia
lobetalol and hydrolazine
80
Nursing Care with Magnesium Sulfate
Duo check of dosing before administration. Baseline, V.S.,  Severe features, & EFM 4-6 gms IV over 20 minutes (BMI >35 use 6 gms) V.S. every 5 minutes 
81
Magnesium Sulfate - maintanence infusion
Duo check of dosing before administration. 1 gm/hr. IV V.S. every 1 hour for 8 hours. DTR’s, clonus - holding and dropping foot, lung sounds, & LOC with V.S.
82
Magnesium Sulfate - other nursing care
Foley catheter for Strict I/O Continuous EFM Seizure precautions - pads on siderails Strict Bedrest Antidote for Mag toxicity - calcium gluconate Quiet & dim environment Cool wash cloth & emesis bag Education
83
lab draws before magnesium
Magnesium level Hepatic Panel CBC Magnesium level at 30 minutes Magnesium level every 6 hours CBC & Hepatic panel daily lab will call and say levels are high, but you want the high levels.
84
magnesium
Hypotonia - If labor is being induced or if it started on its own, hypotonia from the magnesium will interfere with the ability of the uterine muscle to contract. Prepare for Pitocin infusion. Flushing Diarrhea N/V
85
after mag is administered
The neonate will experience some side effects from the magnesium infusion. Magnesium does cross the placental barrier. The neonate will experience some respiratory depression and hypotonia, causing decreased APGAR scores also. These side effects subside within 24 hours.
86
preeclampsia w/out severe features (can take care of it at home)
Instruct in self monitoring: BP, urine dips, kick counts Signs and symptoms of worsening disease Importance of frequent visits and fetal assessments Regular diet Reinforce activity restrictions
87
HELLP SYNDROME
May or may not have pre-eclamptic symptoms or may have only mild pre-eclamptic symptoms. H – hemolysis. EL – elevated liver enzymes. LP – low platelets
88
Placenta Previa
One in 200 pregnancies will be affected.Chances with 1st pregnancy is one in 400. With each cesarean section a woman has her chance increase dramatically.
89
Placental Abruption
Early separation of a normally implanted placenta after 20 weeks gestation. occurs in 1%. 40% mortality rate for the fetus. 5% maternal mortality rate
90
Amniotic Fluid (1000ml normal) - Polyhydraminos (poly is 2000 years old)
>2,000ml 32-36 weeks 2% of pregnancies Associated with DM*** Fetal anomalies Risk for Preterm labor, PPROM, PROM
91
Amniotic Fluid (1000ml normal) - Polyhydraminos - Oligohydraminos
<500ml 32-36 weeks 4% of pregnancies Fetus unable to make urine or something blocks the urination Poor pregnancy outcomes
92
PPROM
Preterm Premature Rupture of Membranes
93
PROM
Premature Rupture of Membranes

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