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OB > High Risk Pregnancy (1) > Flashcards

High Risk Pregnancy (1) Flashcards

1
Q

what is an endocrine disorder involving inadequate insulin

A

diabetes mellitus

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2
Q

describe diabetes in early and late pregnancy?

A
  • early = hormones stimulate insulin prod. and increase insulin response (low sugar)
  • late = hyperglycemia and resistance to insulin, may have ketones in urine d/t fat metabolism (high sugar)
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3
Q

what is diabetes diagnosed through preganacy

A

gestational DM

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4
Q

will a gestational diabetic be diabetic for the rest of her life?

A

no

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5
Q

what is the normal reading of a 1hr gluc tolerance test?

A

135-140

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6
Q

what happens if a 1hr GTT exceeds 140?

A

3hr GTT is ordered

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7
Q

what are suspicious 3hr GTT results by hour?

A
  • fasting= >95
  • 1hr= >180
  • 2hr= >155
  • 3hr= >140
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8
Q

what is hyperglycemia from low insulin, inc. ketones in blood when fatty acids metabolize

A

ketoacidosis

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9
Q

what is when blood settles in the vasculature, associated w/ high blood sugar

A

vascular disease

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10
Q

what is neuropathy implication of pregnancy

A

settling sugar inc. blood sugar

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11
Q

what is when sugar settles in microvasculature of eyes

A

retinopathy

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12
Q

what is an increased amniotic fluis

A

hydramnios

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13
Q

what is dystocia

A

cephalic dysproportion (difficult labor)

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14
Q

what are some fetal implications of diabetes?

A
  • inc. risk fetal death
  • congenital abnormalities
  • LGA/macrosomia
  • intrauterine growth restriction!!! (IUGR)
  • resp. distress syndrome
  • hyperbilirubinemia
  • hypocalcemia
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15
Q

if the baby is LGA and the mother has gestational diabetes, what can this mean for labor?

A

baby has low sugar! its not diabetic, lots of insulin

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16
Q

what are the insulin requirements in early and late pregnancy along with postpartum

A
  • early= insulin need decreases
  • late= insulin need greatly increases
  • PP= insulin need decreases
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17
Q

who is at risk for gestational diabetes?

A
  • women w/ hyperglycemia, glucosuria, obesity
  • fam history
  • prior LGA baby
  • previous fetal demise
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18
Q

what diet should be encouraged with GDM?

A

ADA diet, low in carbs and calorie counting

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19
Q

what 3 things should be assessed in GDM/DM

A
  • height/weight
  • preg dates and fundascopic exam
  • neuropathy and infection
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20
Q

what tests are used to assess the fetus of a diabetic mother?

A
  • presence of fetal mvmt
  • non stress test (NST)
  • bio physical profile (BPP)
  • ultrasound
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21
Q

what are the 2 types of anemia?

A
  • insufficient hemoglobin production
  • hemoglobin destruction
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22
Q

what are the types of insufficient hemoglobin production anemia and what is it r/t?

A
  • iron deficient and folate deficient
  • r/t nutritional deficiency
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23
Q

what is the main tyoe of hemoglobin desctruction anemia and what is it from

A
  • sickle cell anemia
  • r/t inherited disorders
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24
Q

what are possible complications from iron deficient anemia

A

-infection
-fatigue
-preeclampsia
tolerate blood loss poorly

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25
Q

what are possible fetal complications of iron deficient anemia

A
  • low birth weight
  • preterm delivery
  • fetal demise
  • neonatal death
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26
Q

prevention of iron deficienct anemia

A
  • prenatal vitamins
  • 60-120 mg iron/day
  • iron rich diet
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27
Q

what are maternal complications of folate deficient (megaloblastic) anemia?

A
  • n/v
  • anorexia
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28
Q

prevention of folate deficient anemia

A
  • 0.4 mg foalte/day
  • 1 mg folate+iron supplement
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29
Q

what are possible fetal complications of folate deficient anemia

A

neural tube defects

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30
Q

who is at risk for sickle cell

A

autosomal recessive disorder

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31
Q

symptoms/complications of sickle cell

A
  • abd/joint pain
  • infection, CHF, renal failure
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32
Q

treatment of sickle cell anemia?

A

folic acid, prompt infection treatment, hospitalization during crisis

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33
Q

what are possible fetal complications of sickle cell

A
  • fetal death
  • prematurity
  • IUGR
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34
Q

what is when abnormal hemoglobin is made and there is resulting excessive breakdown of blood cells. hepatosplenomegaly and bony formations may be present

A

thalassemia

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35
Q

who is at risk for thalassemia?

A

those from greece, italy, and china

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36
Q

what is treatment for thalassemia

A

folic acid, transfusion, chelation

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37
Q

what is the life expectancy of thalassemia without treatment

A

20-30 yr

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38
Q

describe mitral valve prolpase

A

mitral vlave leaflets prolapse into the left atrium
-regurgitation may result
-genrally asymptomatic

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39
Q

what is mitral valve prolapse treated with?

A

inderal

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40
Q

what is peripartum cardiomyopathy and when does it occur

A
  • left ventricle dysfunction w/ no previous hx of herat diease
  • occurs in second half of pregnancy
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41
Q

what are symptoms of peripartum cardiomyopathy

A

CP, dyspnea, orthopnea, weakness, edema

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42
Q

what is management of labor with heart disease

A
  • no/slight limitation= may labor normal
  • may limit pushing
  • limit pain/anxiety (can inc. stress to heart)
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43
Q

what are the criteria for spontaneous abortion?

A

miscarriage prior to 20w

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44
Q

what kind of abortion is unexplained bleeding, cramping, cervix closed, possible abortion

A

threatened abortion

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45
Q

what kinf of abortion is where she is going to miscarry, inc. bleeding/cramping, cervix dialted, membrane rupture

A

imminent abortion

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46
Q

what kind of abortion is where parts of products are retained

A

incomplete abortion

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47
Q

what kind of abortion is where all products of cenception are expelled

A

complete abortion

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48
Q

what kind of abortion is where fetus dies in utero and is not expelled

A

missed abortion

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49
Q

what is a preganncy that implants outosde of the uterus

A

ectopic pregnancy

50
Q

what is the most common site of an ectopic pregnancy

A

fallopian tube

51
Q

is an ectopic pregnancy viable?

A

no

52
Q

if an ectopic pregnancy is in the fallopian tube, does the tube have to be removed?

A

yes

53
Q

what does hydratiform molar pregnancy consist of?

A
  • gestational trophoblastic disease
  • trophoblastic cells abnormally proliferate
  • loss of pregnancy
  • possible choriocarcoma
54
Q

what is n/v so severe that it affects hydration and nutritional status

A

hyperemesis

55
Q

hyperemesis tx?

A
  • control n/v
  • correct fluid/electrolyte imbalance
  • adequate nutrition
  • meds (B6, phenergan, reglan, zofran)
  • TPN
  • BRAT diet (banana, rice, applesause, toast)
56
Q

what classifies as preeclampsia?

A
  • inc. BP after 20 wk
    • proteinuria
57
Q

what classifies eclampsia?

A

presence of seizure in preeclamptic woman

58
Q

what are maternal vasospasms result in decreased perfusion

A

preeclampsia

59
Q

what comes from dec. uteroplacental perfusion

A

IUGR

60
Q

what is from decreased hepatic perfusion

A
  • liver enzymes, RUQ pain
61
Q

what is from dec. renal perfusion

A

dec, urine output, proteinuria, BUN inc, creatinine inc., edema

62
Q

what are some assessment details for preeclampsia?

A
  • BP
  • fetal HR
  • bleeding
  • HA
  • DTRs!!
  • clonus (push feet back, they would flutter)!!!
  • edema
  • urinary output/protein
  • BUN/creatinine
  • LOC
63
Q

assessment parts of eclampsia?

A
  • body involvement
  • duration
  • fetal status
  • prevent injury
  • maintain resp ability
64
Q

what is HELLP syndrome

A
  • Hemolysis
  • Elevated (down)
  • Liver enzymes
  • Low
  • platelets (less than 100,000)
65
Q

what are some symptoms of HELLP syndrome

A

n/v, malaise, flu-like, epigastric

66
Q

what is the goal of severe preeclampsia

A

prevent seizures, prevention of liver disease, and maintain pregnancy

67
Q

what are some managemant of preeclampsia?

A
  • bedrest
  • mag sulfate (CNS depression)
  • corticosteroids
  • antihypertensives
68
Q

what is the only sure for preeclampsia?

A

birth

69
Q

what is the loading dose of mag sulfate?

A

6 gm bolus over 20-30 mins

70
Q

what is the maintenance dose of mag sulfate

A

2-3 gm/hr

71
Q

what is the antidote of mag sulfate?

A

calcium gluconate

72
Q

what are side effects of mag sulfate (toxic?)

A
  • flushing/warmth
  • HA
  • blurred vision
  • lethargy
  • pulmonary edema
73
Q

nursing assessment of mag sulfate?

A
  • HA
  • vision changes
  • DTRs
  • CP/SOB
  • arousal
74
Q

what blood type does Rh incompatibility effect?

A

Rh- mom, Rh+ baby

75
Q

what is erythroblastosis fetalis?

A

severe hemolytic disease of the fetus and newborn

76
Q

what is hydrops fetalis

A

edema r/t anemia

77
Q

what can come from Rh alloimmunization

A
  • erythroblastosis fetalis
  • hydrops fetalis
  • CHF
  • hyperbilirubinemia
  • kernicterus
78
Q

what test tests the newborn for Rh sensitization

A

direct coomb’s test

79
Q

what test tests the mother for Rh sensitization

A

indirect coomb’s test

80
Q

in a direct or indirect coomb’s test, ____ reult means no sensitization

A

negative (good result)

81
Q

what estimates the extent of bleeding for administration of the appropriate amount of Rh immune globulin

A

Kleihauer-Betke test

82
Q

hiw can an ABO blood incompatibility cause anemia in the newborn?

A

if mother in type o and baby is A or B, anti a and anti b are naturally occuring

83
Q

when does puberty occur in women

A

12-13

84
Q

what are the contributing factors of teen pregnancy

A
  • lack of foresight
  • peer pressure
  • sex is popular in music/tv
  • family dysfunction
  • r/o incest
85
Q

what are maternal physiologic risks of teen pregnancy

A
  • many dont follow through with prenatal care
  • smoking
  • greater STIs
  • greater preeclampsia risk
86
Q

what are newborn physiologic risks of teen pregnancy

A
  • preterm birth
  • low birth weight
  • cephalopelvic disproportion
87
Q

are the fathers of teen pregnancy usually older or younger than the mother?

A

older! most are older than 20

88
Q

what is defined as advanced age in pregnancy

A

35

89
Q

what are maternal medical risks of advanced age pregnancy?

A
  • higher incidence of chronic med conditions
  • diabetes
  • HTN
  • placenta previa
  • dystocia
90
Q

what are fetal/newborn medical risks of advanced age pregnancy?

A
  • miscarriage
  • genetic issues (downs)
  • preterm birth
  • low birth weight
91
Q

what maternal conditions are indications for fetal assessment?

A
  • HTN
  • diabetes
  • renal and heart diease
  • hyperthyroidism
  • hemolobinopathies
92
Q

what prenatal factors are indications for fetal assessment?

A
  • preeclampsia
  • dec. fetal mvmt
  • oligohydramnios (dec. amnio fluid)
  • hydramnios
  • IUGR
  • post-term preg
  • Rh incompat (isoimmunization)
  • previous demise
  • multiples
  • fetal anolamy
93
Q

what does presence of fetal mvmt indicate

A

fetal oxygenation and CNS integrity

94
Q

when should fetal kick counts be done

A

same time every day, one hour after meals

95
Q

how should fetal kick count be counted, and what is the minimum norm?

A
  • count # of fetal mvmts within 30 mins, 3 times per day
  • should be at least 3 mvmts in 30 mins
96
Q

what is a concerningly low fetal kick count

A

less than 10 mvmts in 3 hours or mvmt slowing in morning

97
Q

normal fetal HR?

A

110-160

98
Q

what is tachycardia in fetal monitoring?

A

greater than 160 for at least 10 mins

99
Q

what is bradycardia in fetal monitoring?

A

less than 110 for 10 mins (concerning!!)

100
Q

what causes late decels?

A

uteroplacental insufficiency

101
Q

what causes variable decelerations

A

cord compression

102
Q

what causes early decelerations

A

head compression

103
Q

what is the use of external fetal monitoring for observation of accelerations with fetal mvmt

A

nin stress test (NST)

104
Q

how long is fetal HR monitored in an NST?

A

20 mins

105
Q

what does a reactive NST show?

A
  • normal
  • 2 accelerations at least 15 bpm above base, lasting at least 15 secs
106
Q

what does a nonreactive NST show?

A
  • abnormal
  • lack sufficient acceleration
107
Q

what test assesses response of FHR to contractions

A

contraction stress test

108
Q

how many contractions and length are needed for contraction stress test?

A

3 contractions of 40 sec within 10 mins

109
Q

are contraction stress test contractions induced or spontaneous? what are risks?

A

could be either, risk is going inti labor

110
Q

what does a negative contraction stress test mean?

A

there are no signoficant decels (good!!!!!)

111
Q

what does a positive contraction stress test show?

A

presence of late decels with at least 50% of contractions

112
Q

what does a biophysical profile include?

A

NST and ultrasound

113
Q

what 5 factors are considered for a bio physical profie

A
  • FHR accelerations
  • fetal breathing
  • fetal mvmt
  • fetal tone
  • amniotic fluid volume
114
Q

what is the highest score of a BPP and how is it scored

A

max 10, each has 2 points

115
Q

what are lower BPP scores associated with?

A

perinatal mortality, may indicate moving toward delivery

116
Q

what is when a needle is inserted through the maternal abdomen and into the uterus to aspirate a small amnt of amniotic fluid

A

amniocentesis

117
Q

what is amniocentesis fluid tested for?

A

genetics or lung maturity

118
Q

what causes genetic testing to be done?

A
  • advanced maternal age
  • hx of birth defect
  • abnormal screening
119
Q

what are the rare risks of amniocentesis

A

cramping, fluid leakage, fetal injury, infection

120
Q

what is the process of obtaining a fetal blood sample percutaneously through the umbilical cord?

A

percutaneous umbilical cord sampling (PUBS)

121
Q

what is a percutaneous umbilical cord sampling usually done to test for?

A

Rh and blood type or genetics

OB (19 decks)

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