Complications of Maternity Flashcards by Julie Hodgman

S/S Miscarriage

When do we worry?
What to do when it happens?

What if it’s REALLY bad?

Spotting + cramping

Worry when hCG levels are down
Pelvic rest (no sex), and bed rest

IV, blood, dilation & curettage (remove remains, may be sedate)

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What is a Hydatidiform mole?

NCLEX - is the fetus involved?

Benign neoplasm that can turn malignant
Grape-like clusters of vesicles

NCLEX - no

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Hydatiform Mole

How does the pregnancy start?
S/S
Dx?

Uterus enlarges too fast

S/S - Absence of FHT, vesicles may cause bleeding

Dx: Confirmed with US

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Hydatiform Mole–

Treatment
Make sure to avoid what? Why?

What if it becomes malignant? How do we know if it metastasis?

How often is hCG measured?

Dilation and Curretettage

Avoid getting pregnant during follow-up time because we won’t be able to tell if the hCG levels mean pregnancy or not

Malignant = Choriocarcinoma
Metastasis confirmed with CXR

hCG measured weekly until normal, then every 2-4 weeks, then every 1-2 months for up to a year

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Ectopic Pregnancy confirmed with what?

First sign? Other signs?
Where are they going to bleed?

Risk factor

PAIN, usually same signs as a normal pregnancy
Maybe bleed into peritoneum
If fallopian tube ruptures, vaginal bleeding may occur

Having 1 risks another

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How to treat Ectopic pregnancy–
Goal is to what?
Meds?
What if meds don’t work?

What if the tube has ruptured?

SAVE THE TUBE
Methotrexate to stop embryo growth
If not working, an incision is made to remove the embryo, or perhaps the whole tube

Laparotomy - WORRY ABOUT HEMORRHAGE, may need blood transfusion

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What is placenta Previa?

What does it commonly cause?
Confirmed with what?

What is a risk factor?

The placenta implants in a bad spot

Most common cause of bleeding in the later months (usually 7th)
Confirmed with US

RF: C-section

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How does Placenta Previa happen?

Where should the placenta normally be?
What it is called when it’s in other places?
Why do we worry about this?

Placenta separates early with the start of dilation, causing decreased oxygen to baby

Should normally be attached high up
Low lying placenta: side of uterus
Partial previa: Halfway over cervix
Complete Previa: Over cervix

Placenta comes out first!

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S/S Placenta previa

Painless bleeding in the 2nd half of pregnancy (spotting or perfuse)

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Placenta Previa Treatment –

Complete Previa
Not much bleeding?

what do we need to rule out?

Complete: Hospital as early as 32 weeks to prevent blood loss and fetal hypoxia if labor happens

Bedrest if not much bleeding

Rule out other sources of bleeding such as an abruption (placenta detaches)

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Placenta previa

What to we need to monitor?
What if contractions start?
What kind if delivery?

WHAT DO WE NOT PREFORM ON THESE PATIENTS

Pad counts
Blood count
Fetus closely*

Contractions: CALL DR
C-section

DO NOT PREFORM A VAGINAL EXAM

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Complications of placenta previa

Fetus
Mom

Fetus
Preterm delivery
Immature growth retardation
Fetal distress
Anemia

Mom
Hemorrhage
DIC risk

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Abruption previa (Abruption)

Where is the placenta?
Partial or complete?
When does the placenta separate? bleed where??
When is it seen?
Dx 
How is it treated?

NORMAL PLACEMENT!
May be either
Separated prematurely (bleeds ext or within uterus)
Seen in the last half of pregnancy
Dx US
Severity 1-3 (worst is 3)

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Causes of an abruption

Trauma
Previous C section
ROM rapidly (RAPID DECOMPRESSION OF THE UTERUS)
Cocaine, PIH, smoking

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S/S abruption

Abdomen?
Bleeding?
Pain?
Fetus?

Rigid, hard abdomen w or w/o vaginal bleeding (NO EXAM IF BLEEDING)

Abdominal pain w increased uterine tone

Hard to palpate the fetus

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NCLEX: UNEXPLAINED VAGINAL BLEEDING

DO NOT DO A VAGINAL EXAM

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Abruption

Delivery?
2 priorities

C section

Watch for Fetal status and maternal shock

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What happens with an incompetent cervix?
When does it occur?
What is a common history?

Premature dilation of the cervix
4th month of pregnancy
Hx of repeated, painless, 2nd trimester miscarriages

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When are miscarriages usually?

1st trimester

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Causes of incompetent cervix

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Baby weight causes pressure on cervix causing it to prematurely dilate

How to treat an incompetent cervix

Procedure?
Delivery?

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Purse-String suture / Cerclage at 14-18 weeks to reinforce the cervix (80-90% term)

MAY have c-section to preserve the suture or may clip it if a vaginal birth is wanted

Hyperemesis Gravidarum
How does it start? Then what?

Cause?

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Starts like regular morning sickness
THEN excessive vomiting, dehydration, starvation, then death

R/t high levels of hCG and estrogen

S/S hyperemesis gravidarum

BP
H&amp;H
UO
K
Weight
Urine

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BP - decreased
H&amp;H - decreased
UO - decreased
K - DECREASED - lots of K in vomit
Weight - decreased
Urine - ketones d/t fat breakdown

Treatment of Hyperemesis Gravadarum

Diet for how long?
Fluid
Meds
Environment
Hygiene

talk about food?
give puke bucket?

what kind of meals?
any food/liquid should be what?
room

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NPO 48 hours
IVF 3000mL first 24 hours
Anti-Emetic IV, vitamins
Quiet env, far from nurse station
Oral hygiene

VERY nauseous - no food talk
No basin - out of site, out of mind

Meals: 6-8 small, dry feedings followed by clear liquids

Food/liquid should be icy cold or hot

Well-ventilated room - fresh

Preeclampsia 3 main S/S that occur when? What mx could be a sign?

HTN (130/90 is high if baseline not known) Proteinuria Edema

S/S Preeclampsia ``` Weight Swollen Neuro things Reflexes Serious stuff ```

``` Sudden weight gain Swollen face/hands - losing protein and albumin HA, blurred vision, seeing spots Increased DTRs (hyperreflexia) Clonus (muscle spasm) --> SEIZURE ```

When do we especially worry about PIH?

Weight gain of 2 or more pounds in a week

BP in mild vs severe preeclampsia Documentation? Only cure for both?

Mild: up 30/15 from baseline Severe: 160/110 Both documented 6 hours apart Pregnancy is the only cure!

MILD preeclampsia treatment

Bedrest | Increased protein in diet

SEVERE preeclampsia treatment Drug of choice?

Sedate to delay seizures Mg Sulfate (VD, increase renal perfusion and placenta perfusion)

What is Mg Sulfate? Risk for what with impaired kidney function? What happens to labor? What is this good for?

Hypertonic solution - bring fluid into vascular space Risk for pulmonary edema Labor stopped unless used with oxytocin Use for preterm labor

What do we monitor for a patient on Mg sulfate?

Toxicity every 1-2 hours BP, RR, DTR, LOC UO, serum mag

What do we give for a diastolic greater that 110? SE?

Give Apresoline (Hydrazine) in combination with MG sulfate SE: ^HR

What do we watch for after preeclampsia delivery? Environment?

Seizure risk for 48 hours!!!! Single room Quiet Dim lights, no stimuli ^Promote a seizure!

What else might we give to help prevent immature lungs in the preeclampsia baby?

Steroids to stimulate surfactant production and cause less tension when the infant breathes

Eclampsia - what has changed Monitor what?

Mom HAS A SEIZURE! Monitor FHT Watch for labor Watch for HF

DIFFERENCES PIH Gestational HTN Chronic HTN Chronic HTN w superimposed PIH

PIH - after 20 weeks, proteinuria Gestational HTN - after 20 weeks Chronic HTN - HTN before Chronic HTN w superimposed PIH - HTN got worse after 20 weeks

Premature delivery Occurs when? Medication to stop the labor? What else may stop it?

20-37 weeks Terbutaline - may cause ^HR Mg Sulfate Bethamethasone - mature lungs, IM Hydrating mom and fixing UTI

Prolapsed cord Check what? How do you know compression is occurring? - Need what?

Cord through cervix Check FHT when ROM Compression: Decreased FHR, variable decel - Need IMMEDIATE C SECTION

What if a cord isn't pulsing?

Fetal death

Prolapsed cord Nursing action ``` Do what? Mom position? Give what? Monitor what? WHAT NOT TO DO ```

Lift head manually Mom: Trenhdeleberg or Knee chest Give O2 Monitor FHT DO NOT PUSH IT BACK IN

Shoulder Dystocia

Shoulders big and baby can't get out caution anterior should impaction

Shoulder Dystocia Risk to baby Causes? Can it resolve?

Hypoxia --> CP, asphyxia Brachial plexus injury --> Erb's Palsy Broken clavicle Bell's palsy Cause: forceps May resolve, but can lead to permanent damage

Shoulder Dystocia risk to mom

Permanent damage to birth canal Bruised bladder Rip episiotomy Torn cervix or uterus

What fuckin fat babies are gonna cause Shoulder Dystocia

LGA >4000g Gestational DM Previous Hx of it Post-delivery

Shoulder Dystocia Nursing care NEVER DO WHAT

McRoberts Maneuver - pull legs up and open Mazzanti technique: suprapubic pressure to assist in easing the shoulder out NEVER APPLY FUNDAL PRESSURE - doctor has to do this

Group B Strep ``` Leading cause of what? Culture when? Transmitted how? Risk for fetus when? Patient teaching ``` Risk factors Treatment

``` Neonatal mortality Culture 35-37 wk, admission From mom to baby through birth canal Risk after ROM Teach it's NOT an STD ``` RF: Preterm, + cultures, premature ROM (>18hr), fever, previous GBS Treatment: Prophylactic antibiotics; Penicillin

When do we never do a vaginal exam?

BLEEDING from vag | Placenta previa, abruption

WHEN DO THEY BLEED Ectopic Pregnancy Placenta previa Abruption HAPPENS WHEN Incompetent cervix when and common hx

Ectopic Pregnancy Placenta previa - 2nd half pregnancy, around month 7 Abruption - last months Incompetent cervix - month 4, 2ndT miscarriage

Complications of Maternity Flashcards

(49 cards)