Flashcards in Exam 2 Deck (54):
Complete molar pregnancy.
An egg with no genetic information is fertilized by a sperm. It does not develop into a fetus but continues to grow as a lump of abnormal tissue that looks a bit like a cluster of grapes and can fill the uterus.
Partial molar pregnancy.
An egg is fertilized by two sperm. The placenta becomes the molar growth. Any fetal tissue that forms is likely to have severe defects.
baseline CXR, follow hCG levels for six months, hormonal contraception (BCP's or IUD) is curable if recognized early and treated properly
severe n/v during pregnancy; suggest ginger root, saltine crackers (before you lift your head off pillow in the morning- acid from empty stomach goes up your throat and you puke). Meds if losing weight (Zofran, if that doesn't work, admit to hospital, worst case scenario, TPN nutrition)
elevated BP more than 140/90 after week 20, without the presence of proteinuria. one third of these women develop preeclampsia
development of hypertension WITH proteinura after week 20. Either mild or severe. Severe includes HA, blurry vision, epigastric pain. definitive cure is delivery
onset of seizures in a pregnant woman after week 20 when no other reasonable explanation is present
HTN before preggo, or before week 20. At risk for preeclampsia
elevated liver enzymes
can lead to DIC and death
Threatened abortion -
back pain, cramping, bleeding
back pain, cramping, bleeding, cervix is open
placenta remains, must go for a D&C, dilate the cervix, scrape out the uterus
Missed abortion -
baby died in utero, but mom’s body has not expelled it, can lead to infection so must perform a D&C
Complete abortion -
baby and everything is expelled
habitual abortion - 3 or more miscarriages r/t to hormonal imbalance or genetic probs b/w mom & dad
septic abortion - mom has become infected
Any bleeding episode during pregnancy and mom is Rh-,
mom will get rhogam
Etopic pregnancy -
most common place - fallopian tube, but it’s considered any pregnancy that occurs outside of the uterus; risk factors - smoking, old maternal age, previous infections r/t PID; treated w/ surgery or methotrexate ( folic acid maker)
Gestational trophoblastic disease (hydrops or molar pregnancy or hydatitaform) -
grossly elevated HCG levels, uterus larger than the date due to hydropic growth of cells; mom will have signs of hyperemesis graviderum due to high levels of HCG; “prune juice bleeding”, might be anemic due to blood loss; increases with age of mother; can cause coriocarcinoma - 20% are metastatic; will follow HCG levels for 6 months after
HA, blurry vision, hyperreflexia, epigastric pain
treatment for preeclampsia
give steriods if less than 34 weeks gestation (improve lung development in case we deliver early)
monitor baby's movement
Tx for preeclampsia
magnesium sulfate running via IV and take to the OR for c-section
carb intolerance during pregnancy
unidentified preexistent disease?
unmasking of compensated metabolism abnormality by stress of pregnancy
direct consequence of altered maternal metabolism as a result of hormonal changes
hPL and gestational diabetes
In the second half of pregnancy, the placental hormone hPL causes maternal peripheral resistance to insulin
This ensures that there is glucose for the developing fetus
Mother metabolizes fat (lipolysis) for energy and produces ketones as a results
This is why we screen at 24 – 28 weeks
first screen for gestational diabetes
All women of low to average risk are screened between 24 and 28 weeks gestation with 1-hr 50 gram GCT. If the result is greater 140 a 3-hour 100 gram GTT will be done to diagnose
diagnosis of gestational diabetes (2nd test)
If the result is greater 140 a 3-hour 100 gram GTT will be done to diagnose
Gestational diabetes is diagnosed if two or more of the following values are met or exceeded:
Fasting 95 mg/dl
1 hour 180 mg/dl
2 hour 155 mg/dl
3 hour 140 mg/dl
heart disease, predictors of poor maternal and fetal outcome
History of arrhythmia
Poor maternal functional class
heart disease, fetal risks
intrauterine fetal demise
small for gestational age
lacks antigen. If rh- mom makes a baby with Rh+ dad, then baby will most likely be Rh+. at 28 weeks of pregnancy, we give ALL Rh- pregnant women Rhogam. And then we give it again within 72 hours of delivery.
inhabits GI tract of many people. If colonized in vagina, baby can get infected during labor. Treat women with antiobiotics during labor. Most doctors won't break the bags until the antiobiotics have been started. Screen at 35-37 weeks via vaginal swab. PCN or Ancef or clinamycin. Sometimes Vanc
start mom on acyclovir to suppress the virus. watch for outbreaks around labor time. If there is an outbreak, must deliver via C-Section. A primary infection during pregnancy can be devasating for baby. First trimester-> miscarriage. Second, Third trimesters: ______
good fetal movement
indicates a good nervous system and a well-oxygenated baby.
two ultrasounds typically performed during pregnancy
first visit (to date it with CRL, and confirm fetal viability--heart beat)
19-20 weeks to measure growth and assess for anomalies
at least 2 accelerations in a 20 min period.
last at least 20 s?
an ultrasound with a non stress test. used to id fetuses that may be compromised. done regularly on women with insulin dependent diabetes, IUGR, post dates. perfect score is 10/10
what are the components of a biophysical profile (BPP)
6/10-asphyxia-if fluid is low, we will induce labor
fetal breathing mvmts
gross body measurements
Non stress test
Amniotic fluid volume
chorionic villus sampling
1-12 weeks of pregnancy
carries a 1.3 risk fo pregnancy loss
measuring nuchal width with along with serum markers can help detect Down's Syndrome 11w1d-13w6d.
neural tube defects, trisomy 21, trisomy 18
performed between 15-22 weeks
most reliable 15-16
high false positive rate
being replaced by MaterniT21
15-20 weeks, performed under UA guidance. screens for chromosomal abnormalities. Risk of pregnancy loss .2-.3% (less than CVS) but performed later in pregnancy. Harder for mom to make decision if results are not desirable. Leaky fluid and infection risks too
why dont we give steriods after 34 weeks?
fetus is making its own surfactant. Steriods are typically given 24-34 weeks if we are concerned about a premature labor.
what is the leading cause of neonatal mortality in the US?
risk factors for preterm labor
multiple gestation, infection, substance abuse, anemia, uterine anomalies (such as fibroids-crowd the baby inutero), foreign bodies (such as IUD-we will leave an IUD in if we discover it during the second trimester or beyond), violence, low socioencomic status, inadequate prenatal care
Preterm labor Nursing care
primary goal is to delay birth by 48 hours so that glucocorticoids may be administered. cath urine culture (for UTI), vaginal swab for bacterial vaginosis
why give mag sulfate during preterm labor?
it relaxes smooth muscle; dont give with CCB's (nifidipine/Procardia)--if you mix these two meds--> pulmonary edema and cardiovascular collapse.
why give terbutaline during preterm labor?
same thing we give to asthmatics-bronchodilators-relaxes smooth muscle (relaxes uterus). Tachycardia, shakey, irritable, and hold if HR >120.
prostaglandin inhibitor-relaxes preterm contractions
When don't we stop a preterm labor?
fetal demise, lethal fetal anomaly, severe preeclampsia/eclampsia, placental abruption, chorioamnionitis (infection of chorian and amnion), severe fetal growth restriction (IUGR-related to prob with placenta usually), fetal maturity, nonreassuring fetal status
>5 contractions in ten mins, or contractions lasting longer than 2 mins each. Contractions are more painful. Pictocin overuse/overdose. Placental abruption can also cause this. can lead to uterine rupture, placental abruption, c-section.
extremely rapid dilation and effacement of <3 hours
precipitous labor: caused by low resistance of maternal tissues, strong contractions, multiparous, large pelvis, previous precipitous labor, small fetus
amniotic fluid embolus
exposure of fetal tissue to maternal circulation-sets off inflammatory response-sudden onset of symptoms-DIC, ARDS, neurologic injury- prompt c-section, fluids of fluid and blood resuscitation (clues-sudden onset of symptoms-SOB-grasping, cyanosis)
abruptio placentae risk factors
htn, preeclampsia, abdominal trauma, cig smoking, cocaine use, sudden decompression of the uterus (bag of waters breaks causing a sudden decrease in size of the uterus)
low-lying, partial, or complete; placenta covers cervical os.