High Risk Pregnancy Flashcards
(24 cards)
High risk pregnancy
Occurs when a concurrent disorder, pregnancy related condition, or external factor jeopardizes the health of the mother or fetus
Type 1 Pre gestational Diabetes
Autoimmune
-insulin needs could change during pregnancy delivery, and post-partum
- continuous blood sugar monitoring and insulin pumps are recommended
- high risk for fetal malformations, miscarriage, and intrauterine fetal demise throughout pregnancy
- will likely be induced around 39 weeks
Type 1.5 Pregestational Diabetes
Genetic driven
- cystic fibrosis
- adult onset
- MODY: mature onset diabetes young
Type 2 pregestational diabetes
AIC > 6.5% prior to or at first prenatal visit
- insulin needs could change during pregnancy, delivery, and post-partum
- oral meds may not be enough
- may be induced around 39 weeks
- continuous glucose monitoring (CGM) - 65-140
Gestational Diabetes Mellitus (GDM)
- insulin resistance
- usually around 28 weeks
- caused be placental hormones
- oral meds or insulin may be required
- resolves after delivery
- does not require further blood sugar monitoring
- patient is at a higher risk for type 2 diabetes later in life
- does have increased risk of intrauterine demise
Intrapartum management of diabetes
Primary goals:
- to prevent neonatal hypoglycemia
- to prevent extreme highs and lows
- glucose assessment during active labor
- insulin needs vary based on control of maternal glusoce levels
- assess fetal tolerance during labor
Hypertension in Pregnancies
Complicates 5-10% of all pregnancies
HTN disorders of pregnancy are the most common medical complication reported during pregnancy
Significant contributor to maternal and perinatal morbidity and mortality
HTN Lab Tests
CBC
- hemoglobin and platelets
UA
- protein
Spot
- creatinine/protein ratio
24hr urine
- protein
BMP
- creatinine, AST, ALT, Uric Acid, LDH
Assessment for pre eclampsia
Elevated BP
Headache
Visual disturbances
Epigastric pain
Increased edema
Urine protein and urine output
Deep tendon reflexes (DTR)
Fetal assessment
Gestational HTN/ Pre eclampsia
Dark, quiet, low stimulation environment
IVF
Oral fluid restriction - prevent pulmonary edema
Magnesium sulfate - seizure precautions
Beta Methasone - lung maturity
Strict I/O - foley
Labetalol, procardia, hydralazine, baby aspirin
Seizure precautions
CURE = DELIVERY
Eclampsia
In addition to worsening S/S listed under preeclampsia the patient develops
- seizures/convulsions unrelated to other cerebral conditions
Heal Effects of HTN
Oligohydraminos
Intrauterine Growth Restriction (IUGR)
Abrupt in Placenta
Fetal distress in labor
Fetal demise
Preterm labor
Labor offering between 20-36 6/7th weeks
Regular contractions leading to cervical change
Signs and Symptoms of Preterm Labor
Increased vaginal discharge
Bloody discharge
Low backache
Pelvic pressure and/or aching in the thighs
“Menstrual like” cramping
Contractions
Diarrhea
Palpable uterine contractions
Feeling like “something is not right”
PPROM
Preterm Premature Rupture of Membranes
Spontaneous rupture of the amniotic membranes prior to 37 weeks
PPROM
Premature Rupture of Membranes
Spontaneous rupture of the amniotic membranes before the onset of labor at any gestational age
Preterm Labor treatment
Bed rest
IV oral fluids
Procardia, terbutaline, magnesium sulfate, beta -methasone
Antibiotics
Foley - possibly
Continuous fetal monitoring
Trendelenburg
Placental previa
Placenta grows partially or completely over vagina
Abruptio Placentae
The placenta separates from the cervix wall which leads to fetal hypoxia
Placental Previa (antepartum bleeding)
Quiet/sneaky onset
Visible external bleeding
Bright red bleeding
painless (except in labor)
Non-tender uterus
Soft/relaxed uterine tone
Abnormally located placenta
Abruptio Placentae (Antepartum bleeding)
Sudden/stromy onset
External or concealed
Vaginal bleeding
Abdominal pain
Uterine tenderness
Mild to severe uterine tonicity/rigidity
Fetal heart tones absent distress
Systemic signs of early hemorrhage
Chorioamnionitis
Infection in the amniotic cavity
Risks:
- longer duration of membrane rupture
- prolonged labor
- nulliparity
- African American ethnicity
- internal monitoring of labor
- multiple vaginal exams
- meconium stained amniotic fluid
- smoking
- alcohol
- immune compromised states
- epidural anesthesia
- colonization with group B streptococcus
- bacterial vaginosis
- sexually transmissible genital infections
- vaginal colonization with ureaplasma
Signs associated with intrapartum infection
Fetal/maternal tachycardia
Maternal fever
Foul smelling amniotic fluid
Cloudy or yellow amniotic fluids
Chorio treatment
- delivery
- antibiotics
- amnion/chorion cultures
- NICU team present at delivery
- IVF
- Antipyretics
