Exam 4 Flashcards
(35 cards)
Non Stress Testing
EFM is completed in office for at risk pregnancies.
Heart rate acceleration should match mom’s indication of fetal movement.
Reactive test is when an acceleration of at least 15 bpm for at least 15 seconds occurs within a 20 minute period.
If negative you can do vibroacoustic stimulation to make the fetus mad after 20 minutes.
Non reactive is no acceleration after 40 minutes, at which point you do more testing
Amniocentesis
Needle, guided by ultrasound withdraws placental fluid.
Done after week 14 when there is concern for genetic disorders.
Can also test for pulmonary maturity and hemolytic disease.
If being done for genetic testing be sure to ask mom if the results would change her decision to carry a child to term. If not, the risks of amniocentesis should be avoided.
Fetal Kick Counts
Mom sits quietly and counts kicks for an hour.
You want at least ten, many provider have mom stop counting after ten because the fetus will move an average of 30 times an hour.
Gestation hypertension
Hypertension, without proteinuria after week 20 of pregnancy in a woman with previously normal blood pressure.
Goals: Ensure maternal safety and deliver as close to term as possible.
Chronic hypertension
Hypertension before pregnancy
Ensure you are taking an accurate measurement: use the right cuff size, don’t use an electronic blood pressure reader, and focus on blood pressure readings over time instead of just during office visits.
preeclampsia without severe features
BP between 140/90 and 160/110
Proteinuria greater than 300mg but less than 5000 (no longer used for diagnostic)
No pulmonary edema
No cerebral or visual disturbances
Both Severe and non-severe forms share: thrombocytopenia, impaired liver function, renal insufficiency
Preeclampsia with severe features
Massive proteinuria (greater than 5000mg per dL)
epigastric or RUQ pain
pulmonary edema
new onset cerebral or visual disturbances
HELLP Syndrome
Variant of preeclampsia
Hemolysis
Elevated Liver Enzymes
Low Platelet levels
Can develop in women hypertension or preeclampsia
Patients are at severe risk for hemorrhage and DIC
Magnesium Sulfate
Used in preeclampsia to increase the seizure threshold, also helps with blood pressure
Be sure to monitor reflexes, keep the room quiet, and dark.
Monitor mag levels in urine since renal insufficiency is a part of most disorders that mag would be used to treat. If the kidneys are not clearing it fast enough levels can become toxic really quickly.
Side effects: warmth, flushing, burning at IV site.
Hydatiform Mole
Abnormal fertilization leads to overgrowth of trophoblasts into white, grapelike sacs.
Complete: no embryonic or fetal parts present.
Partial: embryonic or fetal parts present.
Because no placenta is present to receive blood risk for bleeding is increased.
Diagnosed by ultrasound or HCG levels (levels are much higher than with normal pregnancy)
Mom is at a much higher risk for cancer for the next year and should not get pregnant again during this time.
Ectopic pregnancy
pregnancy occurring outside of the uterus
Treated via methotrexate
Placenta previa
Placenta obstructs the cervical os
Complete: covers all of the cervical os
marginal: only partially covers
low lying: less than 20mm away from cervix
S/S: painless bright red bleeding.
Risk factors: previous cesarean, older maternal age, high altitude living, cigarette smoking
Care: typically an initial hospital stay for testing / obs, then discharge home for bedrest is stable and prior to 36 weeks. Planned cesarean as close to term as possible so long as mom and baby are stable.
Placental abruption
placenta partially or completely detaches too early
Hard to detect via ultrasound, clinically diagnosed.
S/S: vaginal bleeding, abdominal pain, uterine tenderness, contractions, abdominal stiffening.
Risks: maternal hypertension (chronic or gestational), cocaine use, cigarette smoking, trauma, or hx of abruption.
Hemorrhage definition
10% decrease in HCT from admission
1000mL blood loss after delivery
Significant blood loss such that RBC transfusion necessary
Significant blood loss with S/S of hypovolemia
4 T’s of hemorrhage
Tone - boggy uterine tone. Firm uterine tone applies pressure to the vessels/arteries associated with placenta and promotes hemostasis.
Trauma - pregnant people get in car accidents too
Tissue - retained placental fragments, acreta, increta, or percreta
Thrombin - clotting disorders like hemophilia, HELLP, or von willebrands
Threatened miscarriage
Placenta, amniotic sac, and fetus are still within uterus
Slight spotting, mild uterine cramping
Testing done to determine whether or not fetus is still alive, no evidence based treatment is available to prevent progression from threatened to actual.
Inevitable miscarriage
Moderate bleeding, mild to severe uterine cramping, cervical dilation present.
No passage of tissue yet, but miscarriage is inevitable.
Incomplete miscarriage
Heavy, profuse bleeding, severe cramping, tissue passage is incomplete, cervical dilation with tissue stuck in cervix.
May require further cervical dilation before D/C.
Complete miscarriage
Slight bleeding, mild cramping, complete passing of fetus, placenta, and amniotic sac. Cervix closes after the passage of tissue.
No further intervention may be needed if uterine contractions are sufficient to stop bleeding.
Missed miscarriage
No bleeding, cramping, tissue passage, or cervical dilation.
Fetal heartbeat is absent in utero.
Expectant management can allow for passage on its own.
D/C or misoprostol can medically terminate pregnancy.
Disseminated Intravascular Coagulopathy (DIC)
Large numbers of clots form in blood vessels all over the body exhausting the body’s clotting factors.
The rest of the blood supply, absent clotting factors, is especially prone to hemorrhage.
Quantitative vs Estimated Blood Loss
Quantitative involves collecting blood and recording in mL.
Estimated blood loss can be off by up to 50%.
Weighing pads and other absorbent materials and recording blood absorbed in ccs.
Remember grams weighed = mL lost = cc lost
Gestational diabetes
Diabetes that develops in a mother who previously did not have diabetes.
Glucose tolerance test done between weeks 24 and 28
Increases risk for IUGR or LGA babies.
Increase risk of hydramnios (too much amniotic fluid).
Fetal monitoring with non stress tests unless the woman/fetus is extremely low risk.
Hyperemesis gravidarum
When N/V is excessive enough to cause weight loss, electrolyte imbalance, nutritional deficiencies, and ketonuria
First priority treatment: If patient is unable to retain clear fluids by mouth they must have IV therapy to correct imbalances.
Vitamin B6 and unisom are first line medications.
Diclegis, and dopamine antagonists (like phenergan) can be used.
