Flashcards in High risk pregnancy & complications Deck (106):
What is high risk pregnancy?
Already sick, then pregnant
What are pregnancy complications?
Complications caused by pregnancy
Common factors of high risk pregnancy
Late prenatal care
Most common group to have premies?
1 in __ newborns has an inherited genetic disorder
Is left handed considered genetic?
Assessing genetic disorders
Diagnostic testing (blood test)
Genetic diagnostic testing types
-Maternal Serum Screening (MSAFP)
-Chronic villi sampling (CVS)
-Percutaneous umbilical blood sampling
Genetic diagnostic testing:
Look at chromosomes and genes
Genetic diagnostic testing:
Chronic villi sampling (CVS)
tissue under placenta-belongs to baby!
Genetic diagnostic testing:
Genetic study after 14 weeks
-bilirubin with baby
-relieve pressure from excess fluid (polyhydramnios)
needed for baby's lungs
Common chromosomal Disorders
#1 Down syndrome (trisomy 21)
#2-Fragile X syndrome
What are teratogens?
-Environmental (maternal stress),
-Infectious agents, or
-Therapeutic agents (Dilantin, live viruses)
causing malformation of an embryo.
What 3 factors determine the results of exposure?
-affinity (organ specific)
What is TORCH?
Toxoplasmosis-uncooked meat, cat litter
Others, to include-STDs, beta strep
Herpes-If active, C-section.
Which STIs (teratogens) have an effect on baby?
Chlamydia and gonorrhea-eyes
Titer is done when pregnant to check if immune or not.
If not immune, vaccine is given after delivery.
Can effect eyes, ears and heart of baby
Other important teratogens
DE5 (prevent miscarriage)-girl babies-vagina, ovary or breast cancer
Thylitamine-arms and legs
Most important treatment of STIs
Teach mode of transmission
What would we give to cardiac OB patient in labor?
Classifications of heart disease in pregnant woman
1 or 2: normal pregnancy and birth
3: complete pregnancy with complete bed rest
4: poor candidate, in cardiac failure even at rest
Most dangerous time for cardiac pregnant woman
Peak blood volume
What do you need to watch for a cardiac pregnant woman in labor?
Signs of ischemia
Check lung sounds-pulmonary edema
Assessment of cardiac pregnant patient?
Cap refill >5 sec
What size baby will cardiac patient have?
Nursing interventions during L&D for cardiac patient
Epidural with 400 mL bolus
IV-not running fast
Watch for water intoxication
Head of bed needs to be up!
What meds do you need on hand for cardiac patient?
Most common signs of anemia (below 10)
What to do for anemic patient?
Special diet-increase protein-meat and spinach
Take iron with OJ and food (GI upset)
Folic acid deficiency in pregnant patient
More volume due to enlarged RBCs
When is baby impacted by folic acid deficiency in mom?
first few weeks of pregnancy
What is folic acid deficiency associated with?
neural tube defects
What food should you eat to get folic acid?
-green, leafy veggies
Sickle cell anemia management
O2 and fluids to prevent hypoxia and dehydration to keep mom out of crisis
Sickling of blood in sickle cell mom can impact what?
What is a diabetes mellitus mom prone to having?
Preeclampsia (kidney) and polydramnios
What is important for diabetes mellitus mom to do?
-check CBG (goes back to normal after delivery)
The need for insulin goes ____ at first in pregnancy, then gradually _________.
Does baby or mom manufacture insulin?
Insulin is ____ effective due to placental lactogen
What would you do if baby's CBG is below 40?
What is the #1 and #2 cause for abdominal trauma in pregnant mom?
#1 car accident
#2 physical abuse
What is the first and last vital signs to go when in shock?
Rhogam needs to be given after what?
How many hours after?
Delivery, car wreck, miscarriage, amniocentesis
CPR in pregnant woman
Higher on chest.
*Call for help
When does a spontaneous abortion usually happen?
Within first 12-16 weeks
Types of abortions
-complete (everything comes out)
-habitual (constant-incompetent cervix/endocrine)
-septic (unclean abortion)
S/S of spontaneous abortions
-little spotting (bleeding will continue if something was left in there)
IV started with big gauge (18 or above)
-burning in belly and shoulder with pain=ruptured
surgery is needed
As a nurse, what will you ask woman with belly pain?
When was your last period?
Hyperemesis Gravidarium aka what?
Morning sickness gone wild
What are the main things to worry about with Hyperemesis Gravidarium?
Dehydration and screwed up electrolytes from vomiting.
What is the first thing to do when a patient with Hyperemesis Gravidarium comes in?
What is a molar pregnancy?
Abnormal rapid production of chorionic villi (Rapid and HIGH HCG)
Risk factors for molar pregnancies
-low protein diets
S/S molar pregnancy
Normal at first
-some bleeding early
-exaggerated uterine growth
What is premature cervical dilation?
-Cannot hold fetus until term
What is the procedure for a premature cervical dilation?
McDonalds or Schirodkar cervical cerclage
When is the cervical cerclage procedure done?
Approximately 12 weeks.
Removed at 37 weeks or if in labor (cut strings or csection)
What is the main goal for cervical cerclage?
To keep baby in until after 38 weeks
What is placenta previa?
When the placenta covers the cervix
-complete, partial or marginal
S/S of placenta previa
Painless bleeding-usually starts about 28 weeks.
What is placental abruption?
Premature separation of placenta from uterine wall
-Marginal, central, complete
Risk factors of abruption
Is abruption painful?
YES-uterus will grow within hours
What is DIC associated with?
-Intrauterine fetal demise
S/S of DIC
Treatment of DIC
Correct underlying issues, transfuse, heparin!
What is a pregnant patient always at risk for?
DVT and PE
S/S of Pre-eclampsia
-Rapid weight gain
(if <20 wks, probably molar pregnancy)
Where would you put patient with PIH?
at the end of the hall, because it's quiet.
Pad side rails and place fetal monitors in case of seizures.
What must you check for protein?
What medication must you have on hand?
If on mag drip, how often should you check pt?
What should you assess with PIH?
Signs of Mag sulfate toxicity
Slurred speech, muscle weakness, reflex decrease
If pt has seizure, what would you check because what could happen?
Mom and baby for injury-could abrupt
What does HELLP stand for?
Hemolysis (destruction of RBCs)
What would you do for HELLP?
Give platelets and glucose
What would you check on a pt with HELLP?
Stool, IV and urine for blood
When can you give an epidural to a pt with HELLP?
ONLY AFTER platelets are given
Toxic level of Mag sulfate
Antidote for mag sulfate
Mag sulfate doses
4 gram loading dose
First trimester bleeding
Second trimester bleeding
Premature cervical dilation
Third trimester bleeding
Complications in 3rd trimester
Preterm labor-20-37 weeks
Post term pregnancy-beyond 42 weeks
What med is given to try to stop preterm labor?
Terbutaline (beta blocker)-it helps to prevent and slow contractions
Side effects of Terbutaline
What to do when mom has contractions due to dehydration?
Give 1000mL fluids via IV, send home
If 6cm with contractions every 10 minutes, give steroids (hopefully 2 doses)
Could do amniocentesis to check baby's condition, especially lung
What to do if PROM?
keep in hospital
Check temp q2hr, risk for infection
What is post term baby at risk for?
Hypoxic ischemic encephalopathy
What is common for post term moms?
Daily kick counts
Extra OB visits
Post term baby
Minimal fat-long, skinny
No vernix-peeling skin
Long nails, lots of hair, low glucose, wide eyed, temp regulation problems
possible molar pregnancy
-Fluid discharge from vagina
Possible placenta previa or miscarriage
-decrease in fetal movement
What is isoimmunization given for?
Rh-negative carrying Rh-positive baby
(Rh, ABO incompatibility)
What to do when coomb's test is negative?