Common disorders in Antepartum- EXAM 1

Question 1

Anemia during pregnancy

Answer 1

Inadequate levels of hemoglobin in the blood
12g/dL in non pregnant woman
<11 g/dL in pregnant woman
Can be effected by ethnicity, smoking, nutrition or medications

Question 2

Iron deficiency anemia

Answer 2

Most common in pregnancy
May be asymptomatic but more susceptible to infection, high blood pressure and postpartum hemorrhage
Prevent: by iron supplements and vitamin c for better absorption
Treatment: Oral doses of elemental iron. Continue treatment for about 3 months after anemia has been corrected
Do not take iron with milk or antacids

Question 3

Folic acid deficiency anemia

Answer 3

Large immature RBC
Essential for normal growth and development
Prevent: daily supplement of 400 mcg per day
Treatment: 1 mg/day of folic acid supplement
Anticonvulsants, oral contraceptives, sulfa drugs and alcohol can decrease absorption

Question 4

Sickle Cell disease

Answer 4

Fetal death due to sickling attacks in placenta
Additional folic acid supplements requiresd
Maternal infection should be treated promptly
Make sure hydrated and increase fluids, water!
Dehydration, fever can trigger sickling crisis

Question 5

Diabetes

Answer 5

GDM
Can be caused from unidentified preexisting disease
Important to diagnose due to increased risk for perinatal morbidity, mortality
Consquences of changing hormone levels

Question 6

Effects of pregnancy on Cardiovascular system

Answer 6

Blood volume increased by 45%, provides for the exchange of nutrients, oxygen, and waste products in the placenta, reserves for blood loss at birth
Pulse rate increased by 10-15 beats/min ( 75-115 is new normal )

Question 7

Signs of CHF

Answer 7

persistent cough
moist lung sounds
difficulty breathing on exertion

fatigue or fainting
severe pitting edema of the lower extremities
palpations
changes in fetal heart rate

Question 8

CHF treatment

Answer 8

limit physical activity
drug therapy:
beta-adrenergic blockers, anticoagulants and diuretics
Vaginal birth is preferred bc it carries less risks for infection and respiratory complications

Question 9

Supine hypotension syndrome

Answer 9

vena cava syndrome
Occurs when women lies flat on her back and heavy uterus compresses vena cava
can lead to fetal hypoxia
Symptoms: faintness, lightheadedness, dizziness, agitation
Turning to side relieves pressure on the inferior vena cava, preferably the left side

Question 10

Pregnancy induced hypertension

Answer 10

Condition that affects woman’s kidneys, heart or blood circulation
Develops gradually during the second half of pregnancy
symptoms: abnormal rise in blood pressure, rapid weight gain, swollen face and fingers, headaches and blurred vision

Question 11

Hypertension DURING pregnancy

Answer 11

GH: preeclampsia and Eclampsia
Present after 20 week of gestation
30mm or more systolic increase over baseline
15 mm diastolic increasse

Question 12

Danger signs in pregnancy

Answer 12

sudden gush of fluid from vagina
vaginal bleeding
abdominal pain
epigastric pain
Edema of face and hands
chills with fever over 100.4
painful urination or reduced urine output

persistent vomiting
Severe persistent headache
Blurred vision or dizziness

Question 13

Ectopic pregnancy manifestations & Tx

Answer 13

Lower abdominal pain and light vaginal bleeding
Vaginal bleeding and signs of hypovolemic shock if tube ruptures
Treatment: pregnancy test, transvaginal ultrasound, priority is to control bleeding
Treat w/ Methotrexate or surgery to remove from tube

Question 14

Signs and symptoms of hypovolemic shock

Answer 14

fetal heart rate changes
rising weak pulse
rising respiratory rate
shallow, irregular respirations
falling blood pressure
decreased or absent urinary output
pale skin or mucous membrane
cold, clammy skin
faintness
thrist

Question 15

Hydatidiform mole manifestations & Tx

Answer 15

Bleeding, Higher then expected levels of hCG
“snowstorm: pattern on ultrasound with no sign of fetal development
Rapid uterine growth but failure to detect fetal heart activity
Treated through uterine evacuation or dilation and evacuation

Question 16

Rh incompatibility

Answer 16

mom is rh negative and fetus is rh positive
Her body will respond by making antibodies to destroy rh positive erythrocytes
RhoGAM is given at 28 weeks and within 72 hours of delivery to the mother

Question 17

TORCH

Answer 17

Infections that can be devastating to the fetus or newborn
Toxoplasmosis
Other
Rubella
CMV
Herpes

Question 18

CMV & Tx

Answer 18

Cytomegalovirus
infected infant may have seizure, blindness, deafness, dental abnormalities and petechiae
Treatment: none but therapeutic abortion may be offered if detected early in pregnancy

Question 19

Rubella

Answer 19

mild viral disease
low grade fever and rash
destructive to developing fetus
women shouldn’t get pregnant for a month if she receives vaccine before pregnancy!
Not given during pregnancy because vaccine is from a live virus!!

Question 20

Rubella effect on embryo/fetus

Answer 20

small head size
intellectual disability
congenital cataracts
deafness
cardiac effects
IUGR

Question 21

Herpesvirus

Answer 21

2 types; Type 1 and 2
1: likely to cause fever, blisters or cold sores
2:likley to cause genital herpes
Lies dormant in nerves, can reactivate at any time

Question 22

Hepatitis B & Tx

Answer 22

transmitted by blood, saliva, vaginal secretions, semen and breast milk; can also cross the placenta
Can be infected during delivery; will receive a single dose of hep b immune globulin, followed by hep b vaccine

Question 23

STI’s

Answer 23

syphallis, gonorrheam chlymydia, trichomoniasis, condylomata

Question 24

HIV

Answer 24

acquired through sexual contact, membrane/ perinatal exposure
Causes AIDS
Cripples the immune system

Question 25

Taxoplasmosis

Answer 25

acquired by contact of cat feces or raw meat
transmitted through placenta
causes: low birth rate, enlarged liver or spleen, jaundice, anemia, inflammation of eye structures, neurologic damage

Question 26

Strep

Answer 26

leading cause of perinatal infection with high mortality rate
Organism found in woman rectume, vagina, cervix, throat or skin
exposure is greater if the labor is long or the women experiences premature rupture of membranes

Question 27

TB

Answer 27

mother can be tested for PPD skin test or serum quantiferon gold
if mother is active, infant must be kept away from mother until she had been cleared by PHD

Question 28

UTI

Answer 28

Pressure on urinary structures alters self cleaning
Prevents bladder from emptying completely
Retained urine becomes more alkaline
May develop cystitis: burning urination, increased frequency, slightly elevated temperature

Question 29

Placenta Previa
abdomen & interventions

Answer 29

Attachment of the placenta is partially or fully covered in the cervical opening
Three types: marginal, partial, total
Baby is in abnormal position

Painless, bright red bleeding, episodes of bleeding, spontaneous bleeding after sex

Nontender abdomen, relaxed and soft uterus

No sex, no vaginal exam, no manipulation of vagina or optimum, bedrest you know strenuous activity. Continuously monitor mom and baby and pad count, left side lying, if bleeding persist C-section

Question 30

Abrupto placentae
abdomen & interventions & causes

Answer 30

Premature detachment of the placenta before childbirth. Baby is so stressed and there is decreased fetal movement. Mother is faint & nauseous

Concealed blood loss, blood is pulling, dark vaginal bleeding in extender fundal height

Abdominal pain, hard Abdomen, uterine contractions don’t relax

Monitor for concealed bleeding, no abdominal or vaginal exams, left side lying, prepare for delivery!!!

Caused due to trauma, previous history of it, chronic hypertension, preeclampsia, premature rupture of membranes, smoking/cocaine, having multiple babies at once