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NURS 4500 > Complications of Pregnancy > Flashcards

Complications of Pregnancy Flashcards

(62 cards)

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1
Q

Pregnancy complications can occur _______ throughout the pregnancy

A

at any time

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2
Q

Decisions about management generally involve _____ between gains in fetal maturity and maternal/ fetal consequences of continuing with the pregnancy

A

a balance

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3
Q

Pathway from triage to labour and birth unit can lead to:

A

Induction
Labour and birth
Operating Room
Monitoring

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4
Q

Worldwide major causes of maternal death

A

Infection
Hemorrhage
Hypertensive disorders
Complications from the birth
Unsafe abortion

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5
Q

In Canada, the main causes of maternal mortality include

A

Hypertensive disorders
Pulmonary and amniotic embolism
Hemorrhage
And other causes (such as mental illness)

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6
Q

Factors strongly related to maternal death

A

Age (<20, >35 years)
Lack of prenatal care
Low education level

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7
Q

_____ are leading causes of newborn morbidity and mortality

A

Preterm and multiple birth rates

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8
Q

Other causes of newborn death

A
  • Low birth weight
  • Respiratory distress syndrome
  • Sudden infant death
  • Effects of maternal complications
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9
Q

Infant death rate is higher if ______

A

mother is of a lower socioeconomic status

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10
Q

Newborn morbidity and mortality is strongly connected to ______

A

fetal well being

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11
Q

Hypertensive disorders in pregnancy incidence

A

Hypertensive disorders or pregnancy are increasingly common, involving approximately 7% of pregnancies

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12
Q

Hypertensive disorders in pregnancy morbidity

A

Acute renal failure, pulmonary oedema, HELLP syndrome syndrome (hemolysis, elevated liver enzymes, and low platelets), and cerebral edema with seizures

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13
Q

Hypertensive disorders in pregnancy mortality

A

Mortality is primarily from hepatic rupture, placental abruption, and eclampsia

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14
Q

The fetus of the pre-eclamptic is at increased risk ________

A

Placental abruption, preterm birth, intrauterine growth restriction (IUGR), and acute hypoxia

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15
Q

Hypertension in pregnancy non-severe

A
  • Systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg
  • At least 2 measurements
  • Taken at least 15 minutes apart, AFTER 5 minutes of rest
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16
Q

Severe hypertension

A

Severe hypertension is a systolic blood pressure of ≥ 160 mmHg or a diastolic blood pressure ≥ 1110 mmHg

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17
Q

Three categories of hypertensive disorders of pregnancy

A
  1. Chronic hypertension
  2. Gestational hypertension
  3. Pre-eclampsia
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18
Q

Chronic hypertension

A
  • Hypertension pre-pregnancy or evident before 20 weeks gestation
  • Pregnancy is usually uncomplicated
  • Increased risk of: poor fetal growth; fetal stillbirth
  • May develop superimposed pre-eclampsia/ eclampsia (~25%)
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19
Q

Chronic hypertension with superimposed pre-eclampsia - one or more of the following at ≥ 20 weeks gestation:

A
  • resistant hypertension
  • new onset proteinuria
  • one or more adverse condition
  • one or more severe complications
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20
Q

Chronic hypertension with superimposed pre-eclampsia

A

Development of 1 or more characteristics of preeclampsia (i.e., new-onset proteinuria or 1 or more adverse conditions) superimposed on chronic hypertension

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21
Q

Gestational hypertension

A

Detected at or after 20 weeks gestation
Hypertension without evidence of pre-eclampsia
Not usually associated with fetal growth restriction or pregnancy complications
May go on to develop pre-eclampsia (~25%)

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22
Q

What is pre-eclampsia?

A

It is a hypertensive disorder accompanied by new-onset proteinuria and, potentially, other end-organ dysfunction

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23
Q

What can pre-eclampsia occur?

A

After 20 weeks gestation

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24
Q

What occurs in pre-eclampsia?

A

It is a multi system, vasospastic disease process - main pathogenic factor is poor perfusion as a result of vasospasm, not an increase in BP
Results in reduced tissue perfusion to the major organs
Increases blood pressure

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25
Pre-eclampsia symptoms
Gestational hypertension with new-onset proteinuria or one/ more adverse conditions
26
How is proteinuria sampled?
A concentration of 0.03g/L or more in at least two random urine specimens collected at least 6 hours apart where there is no evidence UTI
27
Proteinuria is defined as...
30 mg/mmol urinary PCR in a spot (random) urine sample, or ACR 8 mg/mmol, or 0.3g/day in a complete 24-hour urine collection
28
Proteinuria testing does not need to be repeated...
Once proteinuria criteria for preeclampsia have been met
29
Pre-eclampsia in the central nervous system: adverse conditions that require close ongoing monitoring to determine the need for delivery
Headache Visual disturbance
30
Pre-eclampsia in the central nervous system: adverse conditions that require delivery (birth) regardless of gestational age
Eclampsia Posterior reversible encephalopathy syndrome (PRES) Cortical blindness or retinal detachment Stroke or TIA GCS <13
31
What is eclampsia?
Seizures in a woman diagnosed with preeclampsia, with no other history that would explain the seizures
32
Eclampsia seizures may happen suddenly or can be preceded by specific signs and symptoms:
Headache Severe epigastric pain Hyperreflexia
33
Eclampsia: During the convulsion, both the pregnant person and the fetus...
Are not receiving oxygen
34
Pre-eclampsia in cardiorespiratory system: Adverse conditions that require close ongoing monitoring to determine the need for delivery
Chest pain/ dyspnea Oxygen saturation <97%
35
Pre-eclampsia in cardiorespiratory system: Adverse conditions that require delivery (birth) regardless of gestational age
Uncontrolled severe hypertension >12 hours, despite use of three antihypertensive agents Oxygen saturation <90%, need for 50% oxygen for >1 hr, intubation (other than for cesarean section), pulmonary edema Positive inotropic support Myocardial ischemia or infarction
36
Pre-eclampsia in hematological system: adverse conditions that require close ongoing monitoring to determine need for delivery
Low platelet count
37
Pre-eclampsia in hematological system: adverse conditions that require delivery (birth) regardless of gestational age
Platelet count < 50x10^9/L Transfusion of any blood product
38
Pre-eclampsia in renal system: adverse conditions that require close ongoing monitoring to determine need for delivery
Elevated serum creatinine
39
Pre-eclampsia in renal system: adverse conditions that require delivery (birth) regardless of gestational age
Acute kidney injury New indication for dialysis
40
Pre-eclampsia in hepatic system: adverse conditions that require close ongoing monitoring to determine need for delivery
Nausea or vomiting RUQ or epigastric pain Elevated serum AST, ALT
41
Pre-eclampsia in hepatic system: adverse conditions that require delivery (birth) regardless of gestational age
Hepatic dysfunction Hepatic hematoma or rupture
42
Pre-eclampsia in uteroplacental dysfunction: adverse conditions that require close ongoing monitoring to determine need for delivery
Abnormal or atypical Fetal Heart Rate (FHR) - NST Fetal growth restriction Oligohydramnios Absent or reversed end diastolic flow by umbilical artery Doppler velocimetry Angiogenic imbalance
43
Pre-eclampsia in utter-placental dysfunction: adverse conditions that require delivery (birth) regardless of gestational age
Abruption with evidence of maternal or fetal compromise Absent or reversed ductus venous A wave by doppler velocimetry Intrauterine fetal death
44
HELLP Syndrome
Usually considered a variant or complication of pre-eclampsia Can occur during later stages of pregnancy or after childbirth Mortality rate of HELLP can be as high as 25% Hemolysis - destruction of red blood cells Elevated Liver Enzymes Low Platelets
45
Diagnosis of HELLP syndrome
Platelet count less than 100 x 10^9/L with elevated liver enzymes (AST and ALT)
46
Management of hypertensive disorders of pregnancy
Anti-hypertensive therapy for management of BP Activities for the prevention of pre-eclampsia and prevention of fetal and maternal adverse outcomes Monitoring for pre-eclampsia Planning for timing of delivery It is a balance of gains in fetal maturity vs. risks of fetal and maternal compromise
47
How do you monitor for pre-eclampsia in hypertensive disorders of pregnancy?
Proteinurea, adverse conditions (maternal and fetal) Formalize the risk of adverse maternal outcomes among hypertensive pregnant people by using predictive models
48
In gestational hypertension/ chronic hypertension, monitor for:
Visual disturbances: blurred vision, spots, stars Headaches Epigastric / RUQ pain Chest pain / dyspnea Vaginal bleeding with abdominal pain Blood pressure, O2 saturation (in clinic or if self monitoring at home) Proteinuria (in clinic, may also be self monitoring at home with urine dipstick) Deep Tendon Reflexes – Basso, 2022 Pre-eclampsia, monitor for (twice weekly) - Maternal testing should include, in addition to gestational age and the above (except proteinuria): -oxygen saturation -platelet count -serum creatinine -AST or ALT
49
Fetal health surveillance
Daily fetal movement Electronic fetal monitoring/ non-stress test Ultrasound for assessment of fetal growth and deepest amniotic fluid pocket (amniotic fluid volume), and umbilical artery doppler
50
Pharmacological control of hypertension in pregnancy
Labetolol - B-Blocking agent Hydralazine Nifedipine Methyldopa (Aldomet)
51
Recommended target for pharmacological control of hypertension in pregnancy
For pregnant people with chronic or gestational hypertension or preeclampsia is a diastolic pressure of 85 mm Hg
52
Important key things to manage pregnancy hypertension in hospital
Assist with arterial line placement as needed (could receive arterial line placement for ongoing BP assessment and lab work) Stabilization and likely planned delivery (by induction of labour) Administer Magnesium Sulphate as ordered for seizure prevention Continuous electronic fetal monitoring Calm, quiet environment
53
What things determine the timing of induction?
Chronic hypertension Gestational hypertension Preeclampsia
54
Eclampsia prevention and treatment
Magnesium sulfate IV for seizure prevention and treatment as ordered Usual dose: - 4g IV loading dose - piggyback infusion - Load dose is usually followed by 1g/hr IV maintenance dose Requires close monitoring
55
Signs of magnesium toxicity
Decreased or absent reflexes Low BP Lower heart rate or cardiac arrhythmia <12 breaths/minute for 15 minutes O2 saturation <94% for 15 minutes <30 mL/hr for 4 hours Excessive drowsiness, slurred speech
56
Antidote for magnesium toxicity
Calcium gluconate
57
Assessment timings for magnesium sulphate
Reflexes upon completion of loading dose, and every hour while on therapy BP, HR, RR, and O2 sat every 30 minutes Urine output every hour CNS and neuromuscular symptoms when noticed
58
Signs of tonic-clonic seizure
Stage of invasion Stage of contraction Stage of seizure
59
Management of eclampsia pre convulsion or seizure
Call bell easily accessible Oxygen is working and mask available Suction available and working Side rails raised IV site patent Room is organized Quiet environment Emergency med tray
60
Management of eclampsia during convulsion/ seizure
Maintain patent airway Call for help - do not leave bedside Protect from injury if possible Observe and record activity/ timing
61
Management of eclampsia post convulsion or eizure
O2 by face mask @10L/min Electronic fetal monitoring (FHR and uterine activity) Prepare for birth as needed (ROM, dilation, delivery is most definitive cure) Risk for placental abruption - monitor
62
Ongoing care considerations for preeclampsia patients
Delivery is most definitive cure Postpartum - higher risk for postpartum hemorrhage if magnesium sulphate was administered Ongoing monitoring throughout postpartum period, anti-hypertensive meds may continue

NURS 4500 (4 decks)

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