class 7 Flashcards
(26 cards)
what are presenting variances that can lead to high risk pregnancies
- vaginal bleeding
- diabetes
- changes in fetal movements (need 6 per hour)
- premature ruptures
- pregnancy induced hypertension
- abdominal pain
- persistent vomiting
- illness
risk factors for placenta abnormalities
- previous C/S, uterine surgery, multiple pregnancies, smoking
placenta previa risks to mother and baby
- bleeding during pregnancies
- risk for infection
- premature labor
- fetal hypoxia
signs and symptoms of placenta previa
- end of pregnancy - sudden painless vaginal bleeding (bright red)
- decreased fetal movement
- blood in amniotic fluid
risk factors for placenta abruption
- abdominal trauma, maternal age, hypertension, substance use, short cord, high amniotic fluid, infection, diabetes
signs and symptoms for placenta abruption
- sudden
- signs and symptoms for hemorrhage
- uterine tenderness and rigidity back pain
- blood is dark red
what to assess for the fetus during placenta abruption
- fetal heart ( decelerations)
- assess for shock
causes for perinatal bleeds
- early pregnancies - implantation, ectopic, or abortion
- uterus - overstimulated, fatigued, dystocia
4 Ts variance for hemorrhage: tone
- abnormal uterine contraction
- muscle fatigue, polyhydramnios
4 Ts variance for hemorrhage: trauma
- genital tract
- lacerations of cervix, vagina, perineum, C/S
- uterine rupture
4 Ts variance for hemorrhage: tissue
- retained tissue
- accreta, increta, precreta
4 Ts variance for hemorrhage: thrombin
- liver disease, DIC, von willebrands disease
- coagulation abnormalities
risk factors for gestational diabetes
- history, stillbirth, abortion, type 2
- increased BMI
- over 35
- multiple pregnancy
- hypertension
risk to baby with gestational diabetes
- macrosomia
- shoulder dystocia, nerve injury
- neonatal hypoglycemia
- preterm delivery
- hyperbili
- C/S
management for gestational diabetes
- insulin first line
- induction at 38-40 weeks
- monitor BG during labor (between 4-7)
- PP - glucose screen at 6 weeks and at 6 months
causes/risk factors for premature labor (9)
- substance use
- cervical insufficiency
- anemia
- hydramnios
- infection
- malnutrition
- hypertension
- diabetes
- stress
assessment of premature labor
- menstraul cramps, abdominal pain, diarrhea, change in discharge, pelvic pressure, malaise
how to start induction and why
- membrane sweep to release prostaglandins
- ARM - artificial rupture of membrane
- oxytocin IV infusion
concerns with oxytocin
- hypotensive drug
- antidiuretic effects
- fetal bradycardia
hypertension in pregnancy
- systolic BP greater then 140 and diastolic greater than 90
- affects organs
- starts 20 weeks
- increased proteinuria
pre-eclampsia
- presence or increase in proteinuria (2+)
- before 34 weeks
- need 24 hour urine samples to measure protein and creatinine levels
- severe before 34 weeks is obstetric emergency
signs and symptoms of pre-eclampsia
- edema in face, hands, weight gain
- increased hematocrit
- lung congestion
- liver - ischemic, increased ALT, AST, bili
- renal - decreased GFR, protein loss, increased uric acid
- CNS - cerebral edema, hypertension
eclampsia
- convulsion/seizures
- very high diastolic pressure (over 110)
- will see thrombocytopenia, oliguria, pulmonary edema
HELLP stands for
- hemolysis
- elevated liver enzymes
- low platelet count
