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high risk pregnancy Flashcards

(48 cards)

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1
Q

what do we expect blood sugars to look like in early vs later in pregnancy?

A

early: low

later: hyperglycemia and resistance to insulin

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2
Q

normal 1 hr GTT results (50gm oral glucose)

A

135-140 mg/dL

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3
Q

3 hr GTT (100gm oral glucose)

A

1 hr: > 180 mg/dL
2 hr: > 155 mg/dL
3 hr: 140 mg/dL

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4
Q

how is gestational diabetes diagnosed?

A

1 hr GTT –> 3 hr GTT –> 2 values must meet or exceed the value = diagnosis

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5
Q

maternal implications od diabetes

A
  • ketoacidosis
  • vascular disease
  • nephropathy
  • retinopathy
  • hydramnios
  • HTN
  • dystocia
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6
Q

fetal implications of diabetes

A
  • higher risk for fetal death
  • congenital anomalies
  • LGA
  • IUGR
  • RDS
  • hyperbilirubinemia
  • hypocalcemia
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7
Q

what are the insulin requirements early in pregnancy?

A

insulin needs typically decrease

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8
Q

what are the insulin requirements later in pregnancy?

A

insulin needs greatly increase

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9
Q

what are the insulin requirements postpartum?

A

insulin needs decrease

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10
Q

insufficient hemoglobin production

A

r/t nutritional deficiency

ex: iron deficiency, folate deficiency

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11
Q

hemoglobin destruction

A

r/t inherited disorders

ex: sickle cell anemia

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12
Q

possible maternal complications in iron deficiency anemia

A
  • infections
  • fatigue bc they have less ability to carry O2
  • preeclampsia
  • tolerate blood loss poorly
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13
Q

possible fetal complications in iron deficiency anemia

A
  • low birth weight
  • preterm delivery
  • fetal demise
  • neonatal death
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14
Q

prevention of iron deficiency anemia in pregnancy

A
  • prenatal vitamins
  • 60-120 mg of iron/day
  • iron rich diet
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15
Q

possible fetal complication of megaloblastic anemia (folate deficiency)

A

neural tube defects

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16
Q

prevention of megaloblastic anemia (folate deficiency)

A
  • 0.4 mg folate/day
  • 1 mg folate + iron supplement
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17
Q

possible fetal complications of sickle cell anemia

A
  • fetal death
  • prematurity
  • IUGR
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18
Q

pre-existing heart disease (repaired or not) is associated with…

A

cyanosis = greater maternal/fetal risk

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19
Q

peripartum cardiomyopathy

A
  • no previous hx of heart disease prior to pregnancy
  • left ventricle dysfunction
  • occurs during second half of pregnancy
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20
Q

management of labor in a patient with heart disease

Study These Flashcards
A
  • may labor naturally w/ close observation
  • may limit pushing (may use forceps, vacuum)
  • limit pain and anxiety
21
Q

threatened abortion

Study These Flashcards
A
  • unexplained bleeding, cramping
  • cervix is still closed
22
Q

imminent abortion

Study These Flashcards
A
  • imminently going to have a miscarriage
  • increased bleeding and cramping
  • cervix may start to dilate, and membranes will rupture
23
Q

incomplete abortion

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A
  • parts of products of conception are retained
  • delivers or miscarries some of the pregnancy but some is still retained
24
Q

complete abortion

Study These Flashcards
A

all products of conception are expelled

25
missed abortion
- fetus dies in utero but is not expelled at all - note decrease in uterine size and changes in pregnancy begin to regress
26
nursing considerations for spontaneous abortions
- physiologically stable (bleeding) - pain r/t cramping - grief r/t loss
27
preeclampsia
- increase in BP after 20 weeks gestation - positive proteinuria
28
eclampsia
presence of a seizure in the preeclamptic woman
29
what labs would we expect in a preeclamptic patient?
- elevations in ALT/AST - elevated BUN/creatinine - low PLT count
30
assessment of eclamptic patient
- body involvement - duration - fetal status - prevent injury - maintain respiratory ability
31
HELLP syndrome associated with preeclampsia
H: hemolysis E: elevated L: liver enzymes L: low P: platelets (< 100,000)
32
symptoms of HELLP syndrome
- N/V - malaise - flu like symptoms - epigastric pain
33
goal of management of severe preeclampsia
prevent seizures, prevention of liver and kidney disease, maintain pregnancy
34
direct coomb's test
testing newborn for sensitization to antibody that mom produced against fetus blood
35
indirect coomb's test
testing the mother for sensitization
36
what does a negative coomb's test indicate?
no sensitization = her antibodies haven't become active
37
kleihauer-betke test
estimates the extent of bleeding for administration of the appropriate amount of Rh immune globulin
38
maternal medical risks with advanced maternal age
- diabetes - HTN - placenta previa - dystocia
39
fetal/newborn risks with advanced maternal age
- miscarriage - genetic issues (down syndrome) - preterm birth - low birth weight
40
fetal kick counts
same time everyday, one hour after meals count the number of fetal movements in 30 min, 3x/day there should be at least 3 movements in 30 min
41
when should we be concerned with fetal kick counts?
if there's < 10 movements in 3 hrs anytime through the day
42
non stress test
observation of accelerations with fetal movement - FHR monitored for 20 min
43
reactive NST
(normal) 2 accelerations at least 15 bpm above baseline, lasting at least 15 seconds in duration
44
nonreactive NST
(abnormal) lacks sufficient accelerations
45
contraction stress test
- assessing response of FHR to contractions - 3 cx that last at least 40 seconds w/in 10 min
46
negative contraction stress test
reassuring!! no significant decelerations
47
positive contraction stress test
presence of late decels w/ at least 50% of cxs
48
biophysical profile
- includes NST and US (up to 30 min) - considers accelerations, breathing, movements of extremities, tone, amniotic fluid volume (2 pts for each) - lower scores are associated w/ higher perinatal mortality and may indicate moving toward delivery

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