Care of the High Risk Antepartum Patient (starting this not finishing yet) Flashcards
(33 cards)
What is preterm labor?
- labor (cervical change) between 20 and 36 6/7 weeks gestation
- leading cause of fetal/infant mortality and morbidity in US
Signs and symptoms of preterm labor
- more than 6 uterine contractions in an hour with or without pain
- cramping
- pressure
- leaking of fluid
- backache
- increased discharge esp pink tinged
- “just not feeling well”
Risk factors of preterm labor
- prior history of incompetent cervix or preterm delivery
- extremes of age
- infections: BV, STI, HPV
- multiple pregnancy
- abdominal trauma, surgery
- 3 or more elective abortions
- stress (physical or chronic psychological)
- Lifestyle factors:
– poor nutrition
– smoking
– substance use
– long work hours - short pregnancy intervals
- Non-Caucasian race, esp African-American
Self-care to prevent preterm labor and preterm birth
- obtain good prenatal care
- adequate rest, hydration, and nutrition
- smoking cessation, treatment for substance use
- avoid heavy lifting, shorten work hours
Diagnosis of preterm labor
- measurement of cervical length (transvaginal ultrasound)
- fetal fibronectin (testing presence; if positive - greater chance of delivery but not definite yes)
- cervical exam
- external fetal monitoring
- also palpating uterine contractions
Management of Preterm labor
- cervical insufficiency: cerclage (sewing cervix shut)
- IV hydration
- bedrest
- tocolysis
- administration of agents to improve neonatal outcomes
What medications are administered in tocolysis in management of preterm labor
- magnesium sulfate (helps with contractions)
- terbutaline
- nifedipine
What medications/agents are used to improve neonatal outcomes in the management of preterm labor?
- magnesium sulfate (neuroprotective agent)
- betamethasone (improves lungs)
What is the nursing care r/t preterm labor?
- education/prevention (warning signs, prevention)
- assessment (uterine activity and fetal wellbeing)
- monitoring for adverse effects of tocolysis
- preventing complications of bedrest
What is PPROM?
Preterm Premature Rupture of Membranes
Rupture of the amniotic sac prior to 37 weeks gestation
What are signs and symptoms of PPROM?
- leaking of fluid from the vagina (gush or trickle)
– can have ferning of the fluid on a slide - oligohydramnios (decreased amniotic fluid)
What is the management of PPROM?
Active vs expectant management: depends on gestation age and risk or presence of infection
- prevention of infection
- bedrest
- assessment of uterine activity, fetal wellbeing
– watch for cord prolapse - administration of agents to improve neonatal survival if fetus is viable (mag. sulfate, betamethasone)
What is the nursing care for PPROM?
- education:
– warning signs
– hygiene to prevent infection
– anticipatory guidance - external fetal monitoring
– minimize vaginal exam - communicate changes to provider
What are the types of hypertensive disorders in pregnancy?
- chronic hypertension
- gestational hypertension
- preeclampsia
When is chronic hypertension? Signs? Treatment?
Before 20 weeks
Asymptomatic; increased BP
Treated with:
- labetolol (beta blocker)
- nifedipine (calcium channel)
- methyldopa
What is gestational hypertension/when diagnosed? Sign? Treatment
After 20 weeks
Only symptom is increased BP (over 140/90)
Treatment:
- labetolol (beta blocker)
- nifedipine (calcium channel)
- methyldopa
When is preeclampsia diagnosed? Signs? Treatment?
It is an inflammatory response causing vasospasm
After 20 weeks
Multiple organ systems involved
Treatment depends on with or without severe features
What are risk factors of preeclampsia?
- pre-gestation hypertension or diabetes
- obesity
- extremes of age
- first pregnancy or new paternity
- multiple gestation
- history of preeclampsia
What is important with the assessment of women with preeclampsia?
- accuracy in BP measurement is essential
– check unexpected findings with manual - urine for proteins, platelets, liver enzymes, and creatinine
– platelets decreased, liver enzymes increased - assess for headaches, blurred vision, epigastric pain, severe N/V
- edema particularly hands, feet, face
- DTRs: hyperreflexia; scaled 1-4
- clonus (dorsiflex foot and it taps while moving out; usually done before seizing)
What is done in prevention of preeclampsia?
Control of pre-existing conditions:
- chronic HTN
- obesity
- diabetes
Low-dose aspiring in high risk women
- usually 81 mg/day around 12 weeks and up
What are the maternal risks of severe preeclampsia?
- HELLP syndrome (hemolysis, elevated liver enzymes, low platelets)
- renal failure
- placental abruption
- pulmonary edema (SOB, hypervolemia)
- eclampsia (seizures)
- stroke/MI
– stroke tends to be hemorrhagic - death
2nd leading cause of death globally for mothers
What are the fetal risks of severe preeclampsia?
- prematurity
- intrauterine growth restriction (IUGR: smaller baby)
- oligohydramnios (no BP, no peepee)
- death related to placental abruption [or poor blood flow]
What is Preeclampsia without Severe Features?
- elevated BP: 140/90
- proteinuria, other labs WNL
– CBC, LFT, creatinine - edema
Expectant management:
- education on danger signs (headache, blurred vision, pain on RUQ, N/V)
- increased maternal/fetal surveillance (NST 2x/wk, BPP, kick counts)
- delivery at 37 weeks
What is Preeclampsia with Severe Features?
- severe range hypertension: 160/110
- persistent headache or visual disturbance
- epigastric pain (RUQ)
- HELLP syndrome
- worsening renal function (elevated creatinine, oliguria)
– creatinine normally 0.6-1.0 (1.1-1.2 is sus)
– oliguria: less than 30mL urine/hr - non-reassuring fetal testing
