OB Exam 2 Flashcards
(136 cards)
1
Q
What is the function of progesterone?
A
It decreases uterine motility and contractility.
2
Q
What is the function of prostaglandins?
A
It promotes smooth muscle relaxation.
3
Q
What hormones are secreted by the Hypothalamus?
A
Gonadotropin-releasing hormone (GnRH)
- -> which causes anterior pituitary gland to release:
- FHS = maturation of follicle
- LH = ⬆ production of progesterone - release of mature follicle
4
Q
During the ovarian cycle, when does the follicular phase occur?
A
Days 1-14 (controlled by FHS and LH)
–> body temp ⬆ after ovulation
5
Q
During the ovarian cycle, when does the luteal phase start?
A
Days 15-28
–> begins when ovum leaves follicle
6
Q
What are the 4 stages of the endometrial cycle?
A
1) Menstrual phase = shedding of endometrium due to ⬇ levels of estrogen and progesterone
2) Proliferative phase = ⬆ estrogen levels
3) Secretory phase = ⬆ progesterone levels
4) Ischemic phase = starts if fertilization does not occur
7
Q
After ovulation, how long does the ovum remain viable?
A
24 hours
8
Q
What are the main causes known for infertility?
A
- Ovulatory dysfunction (20-40%)
- Tubal and peritoneal pathology (30-40%)
- Male factors (30-40%)
- Uterine pathology is relatively uncommon
9
Q
What is another cause of ovarian dysfunction?
A
Polycystic ovarian syndrome = most prevalent ovarian disorder.
10
Q
What are 3 tubal and pelvic potential problems?
A
1) Endometriosis = uterine cells grow in other areas of the body
2) Tubal Scaring from PID (Pelvic Inflammatory Disease) = Gonorrhea, Chlamydia
3) Asherman’s syndrome = uterine adhesions resulting from trauma
11
Q
What are gametes and what do they become when united?
A
Gametes are the combination of a sperm and ovum together forming a zygote.
12
Q
What are the different developmental steps occurring during the pre-embryonic (or germinal) stage?
A
1) Morula is formed (12-16 cells)
2) Blastocyst (100 cells)
3) The inner cell mass develops into fetus
4) Trophoblast = develops into placenta and fetal membranes
13
Q
How long is the pre-embryonic stage?
A
First 14 days of human development
14
Q
When does the implantation of conceptus (zygote)?
A
Between the 6th and 10th days
15
Q
How is the corpus luteum maintained after conception?
A
It is maintained by the hormone HCG secreted by the zygote
–> in turn, the corpus luteum will continue to secrete estrogen and progesterone.
16
Q
What is the difference between monozygotic and dizygotic twins?
A
Dizygotic twins have 2 ova fertilized by 2 different sperms.
17
Q
When does the embryonic stage start?
A
From third to eighth week.
18
Q
During the embryonic stage, what happens at week 3 through 8?
A
Week 3 = Early ❤development
Week 4 = neural tube closes, beginning of internal ear and eye, upper extremities bud - lung and GI tract start development
Week 5 = rapid brain growth, ❤ is developing 4 chambers, embryo is about 0.4 cm long.
Week 6 = ❤ reaches final 4 chambers form - facial and digits development (yolk sac earliest source of nutrients)
Week 7 = eyelids and internal organs form (liver, intestines, kidneys)
Week 8 = EVERY SYSTEM IS FORMED
19
Q
What are the main potential teratogens to avoid during pregnancy?
A
Toxoplasmosis Other = Syphillis, Gonorrhea, Chlamydia, Condyloma, Trichoniasis Rubella Cytomegalovirus Herpes Genitalis
20
Q
What symptoms can be caused by congenital toxoplasmosis on the newborn?
A
- Mental retardation
- microcephaly
- Hydrocephalus
- Anemia
- Jaundice
- Deafness
- Seizures
21
Q
What symptoms can be caused by Syphilis?
A
- Chancre sores in different areas such as external genitals, vagina, anus and rectum.
- -> Can be passed to the fetus = high risk of death
22
Q
What are the consequences of Rubella on pregnancy or the fetus?
A
- Miscarriages
- Stillbirths
- Fetal anomalies
- If infected in first trimester = high risk of infant having congenital rubella syndrome (CRS –> cataracts, ❤ defects, and deafness)
- Vaccinated women should not get pregnant for 1 month after the immunization
23
Q
What is the consequence on the fetus if mom is infected with CMV (herpes-virus group)?
A
The fetus has a 30-40% chance of getting infected in utero.
- -> S x S =
- hearing loss
- vision impairment
- seizures
- developmental delay
- mental retardation
24
Q
When does the fetal stage start?
A
Weeks 9-40
–> All systems in place = refinement during this phase
- Teratogens less likely to damage already formed structures
25
What happens between week 9 and 12 of the fetal phase?
- body proportions change
- eyes close
- blood formation
- urine production
- -> by end of 12th week fetal ❤can be heard by Doppler
26
What happens between week 13 and 16 of fetal phase?
"Quickening" (sometimes not felt until 20th week)
27
What happens between weeks 17 and 20 during the fetal phase?
- Vernix covers fetus
- Lanugo grows on body
- Brown fat starts to develop
- Eyebrows and hair appear
28
What happens between week 21 and 24 during the fetal phase?
- Skin translucent
- Lungs begin surfactant formation
- Alveoli capillary exchange poor
- -> if born = poor chance of survival
29
What happens between weeks 25 and 28 during the fetal phase?
- SQ fat develops
- Eyes open now
- Fetus may assume head down position
- -> better chance for survival
30
What happens between weeks 29 and 32 during the fetal phase?
- Skin thickens
- Nails present
- -> good survival chance if born now
31
What happens between weeks 33 and 40 during the fetal phase?
- Mainly gain of weight
- Lungs mature
- Vernix and lanugo disappear by term
- Breast tissue palpable
- Testes are descending
32
During what week and phase, is the placenta formed?
By the 10th week during the fetal phase.
33
What is the consequence on the infant in contact w/ HSV (Herpes Simplex Virus)?
If left untreated, survival rate is 50%.
34
What are the implications on an infant of an HIV + mother?
- The infant will have a 25-45% risk of developing the disease
- Mother has to abstain from breastfeeding
- Mother will receive antiretrovirals (AZT or ZDV) during pregnancy (after the 14th week not to harm fetus during 1st trimester)
- Short course of antiretrovirals for baby for 6 weeks
* To avoid contamination at birth = Cesarian is preferred method of birth
35
What are the implications on the infant of a mother w/ Group B Streptococcus (GBS)?
The infant can get:
- pneumonia
- meningitis
- overwhelming sepsis
Prenatal treatment = PCN/Ampicillin to prevent this cross-infection from occurring.
36
For OTC and prescribed drugs, what are the significance of the different categories?
- Category A = no risk
- Category B = animal studies no risk - no human studies
- Category C = no adequate studies
- Category D = evidence of risk - but benefits can outweigh risks
- Category X = SEVERE fetal risk
37
What are the implications of tobacco use on pregnancy?
1) Fetal hypoxia
2) Low birth weight
3) ⬆ risk for miscarriage, premature birth and stillbirths
4) ⬆ risk for SIDS
5) Neuro and intellectual developmental problems later in school
38
What are the implications of alcohol use on pregnancy?
Can cause Fetal Alcohol Syndrome (FAS)
- -> potential mental retardation (low IQ, microencephaly)
- -> prenatal and postnatal growth restriction
- -> flat midface, small chin, thin upper lip
39
What are some maternal disorders and their implications?
1) Diabetes (most common) = ❤ diseases, anencephaly, macrosomia
2) Heart diseases = stress the cardiovascular system
3) Phenylketonuria = microcephaly, ❤ disease
4) Sickle cell, Thalassemia
40
What are the main 4 problems in early pregnancy?
1) Spontaneous Abortion
2) Ectopic Pregnancy
3) Hydatidiform Mole (Molar pregnancy)
4) Hyperemesis Gravidum
41
What are the S x S of a Spontaneous Abortion?
* Occur in 20% of all pregnancies
- Cramping
- Backache
- Bleeding
* Vaginal bleeding can be significant and life-threatening
- -> emergency IV fluids and meds
42
What is the definition of an Ectopic pregnancy?
An implantation of a fertilized ovum in an area outside the uterine cavity - 98% of time in Fallopian tube (Ampulla area)
43
What are the S x S of an Ectopic pregnancy?
- Missed menstrual period
- Abdominal pain (one sided)
- Vaginal spotting
* Caution if tube ruptures --> Hypovolemic shock symptoms (shoulder or neck pain w/ minimal or no external bleeding)
44
What are the risk factors to an Ectopic pregnancy?
- Hx of STDs
- Hx of Pelvic Inflammatory Disease (PID)
- Hx of previous Ectopic pregnancies
- Failed tubal ligation
- Use of an IUD
- Multiple induced abortions
- Maternal age > 35
45
What are some complications with a diabetic woman during pregnancy?
1st Trimester = insulin levels ⬆ (estrogen ⬇ progesterone ⬆)
--> Risk for Hypoglycemia
2nd + 3rd Trimesters = insulin levels ⬇ ( HPL + HgH ⬆)
--> Risk for Hyperglycemia
46
What is the definition of Hydatidiform Mole?
Rare condition in which tissue around a fertilized egg (normally would develop into placenta) develops into an abnormal cluster of grape-like cells.
47
What are the 2 types of Hydatidiform Mole (Aka Gestational Trophoblastic Disease)?
1) Complete - empty egg fertilized by normal sperm, HIGHLY associated w/ cancer :(
2) Partial - too many chromosomes
48
What are the clinical implications of a Hydatidiform Mole?
1) If not removed, 15% of moles will become cancerous
2) Can cause serious bleeding
3) Another 5% will develop into fast-growing cancer called choriocarcinomas
* It is highly recommended to NOT get pregnant for at least 1 year afterwards.
49
What is Hyperemesis Gravidarum?
A persistent, uncontrollable vomiting that can continue throughout pregnancy but is usually more prominent during the first trimester.
50
What are the implications of Hyperemesis Gravidarum
- Weight loss
- Dehydration
- Ketosis
- Electrolyte imbalance (K+)
51
What are the risk factors for Hyperemesis Gravidarum?
- Young age
- First pregnancy
- Problem w/ nausea + vomiting in previous pregnancy
- Hx of intolerance to oral contraceptives
- Previous gallbladder disease
52
What therapeutic management can be implemented w/ Hyperemesis Gravidarum?
- Drug therapy
- IV fluids w/ K+ (possibly TPN)
- Offer small, frequent meals, blend but high in K+ and Mag (simple carbs)
53
In concerns to the breasts, what physiological changes can the pregnant woman experience?
1) Estrogen stimulates growth of ductal tissues
2) Progesterone stimulates lobule growth
3) Secreted HPL (human placental lactogen) also stimulates breast growth
4) By 12-16 weeks production of some colostrum
5) Darkened areolae, superficial veins prominent
6) Striae may develop
54
In concerns to the cardiovascular system, what physiological changes can the pregnant woman experience?
1) Heart sounds - splitting of the first ❤ sound and murmur common in 90%
2) BP remains stable even w/ ⬆ of blood volume
3) ⬆ cardiac output - 500 mL/min required to perfuse the placenta
4) Supine hypotensive syndrome
5) Plasma fibrinogen ⬆ = Risk for loos clot
6) Physiologic anemia of pregnancy --> Blood volume ⬆ and RBCs production can't keep up (diluted blood) Hct is lower
7) Hgb may need iron therapy
55
What teaching tip should be shared w/ the pregnant patient in concerns to iron therapy?
- Do not take iron w/ milk products
| - Take vitamin C to help iron absorption
56
What is the Vena Cava Syndrome?
The gravid uterus compresses on the vena cava in supine position
--> reduces blood flow returning to the ❤
As a result = Maternal hypotension
* If baby pressing on spine --> ⬇ blood flow --> change mom's position to side.
57
What is an expected amount of blood loss at birth?
1) Vaginal = < 500 mL
| 2) C-section = < 1000 mL
58
In concerns to the Respiratory system, what physiological changes can the pregnant woman experience?
1) ⬆ in O2 consumption by 15-20%
2) Progesterone causes relaxation of smooth muscle --> can result in dyspnea and fainting
3) Vascular congestion of nasal mucosa can cause nasal stuffiness + epistaxis
59
In concerns to the GI system, what physiological changes can the pregnant woman experience?
1) Estrogen causes gums to bleed + excessive salivation (Ptyalism)
2) Progesterone causes relaxation of esophageal sphincter --> Heartburn + longer emptying of stomach
3) Constipation + hemorrhoids more common
4) Nausea + vomiting (1st trimester)
5) "Pica" = cravings for dirt, starch
60
In concerns to the Integumentary system, what physiological changes can the pregnant woman experience?
1) Hyperpigmentation (Melonocyte-stimulating hormone) =
- chloasma (beauty marks on face)
- linea nigra (vertical line along belly)
2) Stretch marks
- striae gravidarum
3) Spider nevi
4) Hyperactive sweat + sebaceous glands
61
In concerns to the Musculoskeletal system, what physiological changes can the pregnant woman experience?
1) Relaxin causes relaxation of pelvic joints --> waddling gait + change of gravity center (⬆ risk for falls)
2) "Lordosis" (lower curvature of spine) later in pregnancy
3) Calcium + phosphorous needs ⬆
4) Separation of rectus abdominis
62
In concerns to the CNS system, what physiological changes can the pregnant woman experience?
1) Reports of ⬇ attention, concentration, and memory
| 2) Sleep problems
63
In concerns to the Endocrine system, what physiological changes can the pregnant woman experience?
1) Estrogen produced by placenta stimulates:
- uterine growth
- breast ductal system
- hyperpigmentation + vascular changes in skin
2) Progesterone (MOST important hormone in pregnancy) produced by CL then placenta:
- maintains endometrial layer
- prevents miscarriage by relaxing smooth muscle
- stimulates breast lobes and lobules
- facilitates fat storage for energy
3) HPL (Human placental lactogen) promotes:
- fetal growth by ⬆ availability of glucose to the fetus
- -> ⬇ maternal insulin sensitivity and glucose use = ⬆ maternal blood sugar
- breast development for lactation
64
What are some objective signs of pregnancy?
1) Changes in cervix:
- Chadwick's sign = bluish discoloration of cervix, vagina and labia
- Goodell's sign = softening of vaginal portion of cervix
2) Changes in uterus:
- ballottement = fetus rebounds (@ 24 weeks)
- Hegar's sign = softening of isthmus of uterus
- Braxton Hick's contractions = similar to real contractions
- Uterine soufflé
65
What are some assessments or tests that can confirm a pregnancy?
1) Palpation of fetal outline:
- Leopold's Maneuver = assess baby's position
2) Blood test = assess HCG presence
3) Auscultation of fetal ❤ sounds = Doppler @ 10-12 weeks
4) Fetal movements = after 20 weeks
5) Visualization of fetus = x-ray, ultrasound @ 4-5 weeks
66
What are some important antepartum assessments performed during the physical exam?
1) Pelvic adequacy
2) Deep Tendon Reflexes (DTRs)
3) External + internal genitalia
4) Labs = h & h or CBC, blood type + Rh, urine, VDRL and HIV
5) Fundal height w/ McDonald's method
- -> * could be higher w/ twins = ⬆ risk of hemorrhage
67
What is the recommended weight gain for a pregnant woman?
1) Normal weight = Total 25-35 lbs
2) If underweight = Total 28-40 lbs
3) If overweight = Total 15-25 lbs
4) Twins = Total 35-45 lbs
68
What is the formula of weight gain during pregnancy?
3 1/2 lbs first trimester, then 0.9 lb. per week
69
What are some factors that can influence good nutrition during pregnancy?
- Age = young and AMA
- Nutrition knowledge
- Culture
- Vegetarianism
- "Pica"
- N/V
70
What are the nutritional requirements during pregnancy?
1) Calories = additional 350 (2nd tri) 450 (3rd tri) kcal/day
2) Proteins = 71 g/day
3) Iron = 27 mg/day
4) Vitamins:
- Prenatal
- Folic acid = 600 mcg or minimum of 400 mcg/day
- Calcium = 1000-1300 mg/day
71
What are some danger signs of pregnancy that would require to notify the MD right away?
1) Vaginal bleeding
2) Continuous headache
3) Rupture of membranes -------------------
4) Swelling of fingers, face + eyes ----------- > Pre-eclampsia
5) Visual disturbances ----------------------
6) Persistent or severe abdominal pain
7) Chills or fever
8) Painful urination
9) Persistent vomiting
10) Change in frequency or strength of fetal movements
72
What are the signs of Preterm labor
- Painful menstrual-like cramps
- Dull back ache
- Suprapubic pain or pressure
- Pelvic pressure or heaviness
- Change in appearance or amount of vaginal discharge
- Diarrhea
- Uterine contractions felt every 10 min for 1 hour
- Leaking of fluid from vagina
73
What are some psychosocial concerns during the 1st trimester of pregnancy?
- Uncertainty
- Ambivalence (conflicting emotions)
- Focus on self
74
What are some psychosocial concerns during the 2nd trimester of pregnancy?
- Focus on fetus
- Narcissism an introversion
- Body image changes
- Changes in sexuality
* Focused on their pregnancy
75
What are some psychosocial concerns during the 3rd trimester of pregnancy?
- Vulnerability
- Increasing dependence
- Preparation for birth
- "Nesting"
* Role playing, fantasy (of becoming a mom), and looking for a fit are experienced during the last trimester.
76
When the future dad experiences symptoms of the pregnancy, it is called...?
"Couvade" = ex: dad can gain weight w/ wife
77
What are the most "at risk" pregnancies?
- Single mother
- Adolescent mothers
- Alcohol or drug dependent mothers
- Physical abuse victims
- Older women
78
What are some statistics about adolescence pregnancy?
- 82% of pregnancies are unintended
- 43% will have a second child w/in 2 years of their first
- Babies of teen mothers are more likely to die in the first year of life
- 1 out of every 11 teen girls become pregnant before age 20
79
What are the risk factors for teen pregnancies?
1) Poor prenatal care = ⬆ risk for pre-eclampsia, LBW, preterms, cephalopelvic disproportions, iron deficiency (anemia)
2) Poor nutrition
3) ⬆ incidence of STDs + substance abuse
4) Interruption of psychological developmental tasks
5) Incompletion of academic scholarship
6) ⬆ risk of poverty
80
What nursing interventions can be implemented w/ teen moms?
- EDUCATION about pregnancy and motherhood
- Screening for drugs + STDs
- Assess nutritional status
- Family adaptation
81
What are the disadvantages of AMA pregnancy?
| >35 y
- ⬆ risk for complications
- Chromosomal abnormalities
- HTN
- Uterine fibroids ( Postpartum hemorrhage)
82
What are the advantages of AMA pregnancy?
- More mature
- Better financial resources
- Priorities in place
83
What are the 2 different types of Ultrasound Antepartum testing?
1) Ultrasonography:
- Transvaginal = confirmation/establishment of gestational age (best between 6 and 10 weeks)
- Transabdominal = @ 2nd and 3rd trimesters (full bladder to view)
2) Doppler Ultrasound Blood Flow Assessment
- -> Tracks blood through blood vessel
84
What other Antepartum testing can be performed?
1) Alpha-Fetrotein Screening (AFP) = chromosomal defects
- -> done between 16-18 weeks
2) Chorionic Villus Sampling (CVS) = fetal cells for genetic, metabolic and DNA abnormalities
- -> done during 1st trimester
* CVS to screen, not diagnose (cannot detect neural tube defects)
3) Amniocentesis = can detect genetic, metabolic, DNA abnormalities and neural tube defects!
- -> done between 14-21 weeks
85
What are the potential risks/side effects w/ performance of Amniocentesis?
- Transient vaginal spotting
- Cramping
- Amniotic fluid leakage
- Chorioamnionitis
- Rupture of membranes
86
What is the average of the Fetal Movement Assessment?
10 movements w/in 12 hours or
| 3 movements w/in 60 min
87
What is Lecithin Sphingomyelin (L/S) ratio?
To measure the lung maturation by amniocentesis
--> will indicate risks for RDS
< 2.0 = ⬆ risk for RDS
< 1.5 = Very ⬆ risk for RDS
88
What physical abnormalities will the Quad test detect and when will it be performed?
1) Spina Bifida (25-80% accurate)
2) Anencephaly (95%)
3) Trisomy (@ 21 and 18 chromosome)
4) Abdominal + ❤ defects
- -> Performed between 15 and 20 weeks
89
What 4 substances can the Quad test measure?
1) AFP ( ⬆ in open defects)
2) HCG
3) Estriol
4) Inhibin A
90
Why and when is the Non-stress Test performed (NST)?
- Accelerations of ❤ beats = intact CNS
- Accelerations need to be 15 beats/min above baseline and lasting 15 seconds
1) Reactive (or reassuring) = 2 or more accelerations w/in 20 min
2) Nonreactive (or nonreassuring) = insufficient accelerations over 40 min :(
- -> performed after 28 weeks
91
What does the Contraction Stress Test measure?
1) Uteroplacental function
2) ID intrauterine hypoxia
3) Fetal ❤ rate responses to contractions
As a result:
- Negative test = no late or significant decelerations
- Positive test = late decelerations following 50% or more contractions
92
What are the 2 possible outcomes w/ the NST and CST?
1) Negative CST w/ reactive NST :-)
| 2) Positive CST w/ nonreactive NST :-((
93
What is the Amniotic Fluid Index?
Measures the amniotic fluid volume
* AFI of 5 or less requires further evaluation
94
How is the Amniotic Fluid volume determined by?
- Fetal urine output
| - Fetal swallowing
95
What does the Biophysical Profile measure (BPP)?
1) Fetal ❤ rate acceleration
2) Fetal breathing
3) Fetal movements
4) Fetal tone
5) Amniotic fluid volume
--> by ultrasound
96
What are the 3 most common medical problems in pregnancy?
1) Diabetes Mellitus
2) Bleeding disorders
3) Hypertensive disorders
97
What is type 3 diabetes?
Gestational Diabetes = carbohydrate intolerance r/t ⬆ estrogen, progesterone, and HPL
98
What is a fasting blood sugar that would suggest Diabetes?
> 126 or non-fasting > 200
99
What are some clinical implications due to Diabetes during pregnancy?
- ⬆ risk for gestational HTN
- DKA (Diabetic ketoacidosis) mostly type 1
- Polyhydramnios = fetal hyperglycemia and consequent fetal diuresis
- ⬆ risk for difficult birth C/S due to macrosomia
100
What are the potential neonatal effects w/ Diabetes before birth?
- ⬆ risk for spontaneous abortion
- Congenital malformations
- Preterm labor/birth
101
What are the potential neonatal effects w/ Diabetes after birth?
- Hypoglycemia
- Hypocalcemia
- Hyperbilirubinemia
- Polycythemia
- RDS
- Birth trauma
102
What are the risk factors for GDM?
- Obesity
- Chronic HTN
- Family hx of DM
- Previous birth of large infants = > 4000 g
- Previous birth w/ congenital anomaly
- Previous unexplained fetal demise
- GDM in previous pregnancy
103
What is the definition of Abruptio Placentae?
Premature separation of a normally implanted placenta.
104
What are the 3 different types of Abruptio Placentae?
1) Marginal = placenta separates a edges
2) Central = placenta separates centrally and blood is trapped
3) Complete = total separation of placenta from uterine wall
105
What are the risk factors for the occurrence of Abruptio Placentae?
- Cocaine or amphetamines = vasoconstriction in endometrial arteries
- Maternal HTN
- Cigarette smoking
- Short umbilical cord
- Abdominal trauma
- Previous Hx
106
What are the S x S of Abruptio Placentae?
- Bleeding (potential signs of Hypovolemic shock
- Uterine tenderness + severe abdominal pain
- Excess uterine activity (no rest btw contractions)
- Fetal distress
- Back pain
107
How can Abruptio Placentae be treated?
- Assess cardiovascular status of mother and fetus
- If condition is mild = Bed rest + tocolytic meds (to suppress labor)
- If condition is severe = Intensive monitoring --> potential delivery, IV, blood products
108
What is the definition of Placenta Previa?
Implantation of the placenta in the lower part of the uterus.
109
What are the 3 types of Placenta Previa?
1) Low = placenta implanted in lower uterus but at least 3 cm away from internal cervical os
2) Partial = lower border of placenta is w/in 3 cm of internal cervical os but does not completely cover it
3) Total = placenta completely covers internal cervical os
110
What the risk factors for the occurrence of Placenta Previa?
- AMA
- Previous Hx of C/S and Placenta Previa
- Cigarette smoking
- Cocaine use
111
What are the S x S of Placenta Previa?
- Sudden onset of painless uterine bleeding (in last 1/2 of pregnancy)
112
What are the therapeutic interventions w/ Placenta Previa?
1) Conservative care
- Bed rest
- IV access
- Fetal monitoring
- Watching for signs of bleeding or preterm labor
2) Aggressive care:
- Delivery of infant if mom sows S x S of Hypovolemia and/or signs of fetal compromise
113
What is the definition of gestational hypertension?
A multi-organ disease process that develops as a consequence of pregnancy and regresses in the postpartum period.
114
What are the classifications of hypertensive disorders of pregnancy?
1) Pre-eclampsia (HTN + proteinuria):
- Mild
- Severe
2) Eclampsia
3) HELLP
4) Gestational HTN = ⬆ BP but NO proteinuria (25% of GHTN becomes pre-eclampsia)
5) Chronic HTN
115
What is the definition of Pre-eclampsia?
A condition in the last half of pregnancy in which a woman who previously had normal BP, experiences ⬆ BP, proteinuria, and generalized edema.
116
What is the incidence rate of Pre-eclampsia?
It occurs in 8% of all pregnancies.
* One of the 3 causes of perinatal morbidity and mortality
117
What are the S x S of Pre-eclampsia?
- Hypertension = sustained BP 140/90 or ⬆ of 30 mmHg systolic or 15 mmHg diastolic
- Generalized edema
- Proteinuria = 300 mg or more (24 hr sample)
118
What are the clinical implications of Pre-eclampsia on the kidneys?
- Glomerular damage = proteins leak through
- Loss of proteins causes fluid shift to interstitial space
- -> Edema (rapid weight gain, ⬇ urinary output = < 30 mL is concerning)
119
What are the clinical implications of Pre-eclampsia on the liver?
- ⬆ liver enzymes caused by impaired liver function
| - Epigastric pain (hepatic edema)
120
What are the clinical implications of Pre-eclampsia on the CNS?
- Headaches
- Visual disturbances
- -> due to arterial vasospasm (cerebral hemorrhage)
- Hyperactive DTRs
- Seizures
121
What are the clinical implications of Pre-eclampsia on the pulmonary system?
- Leaking of pulmonary capillaries
| - -> leading to pulmonary damage + dyspnea
122
What are the clinical implications of Pre-eclampsia on the placenta?
- ⬇ placental circulation + blood flow --> infant can have IUGR or fetal demise
- Maternal risks ⬆ for Abruptio Placentae and Disseminated Intravascular Coagulation (DIC)
123
What are the risk factors for the occurrence of Pre-eclampsia?
- Primigravida
- Age extremes
- Hx of Pre-eclampsia
- Multiple gestations
- ⬆ BMI
124
The only cure for Pre-eclampsia is delivery of the baby.
| T/F?
True
* Steroids can help the lung development
125
What is super-imposed Pre-eclampsia?
- Chronic HTN w/ development of new onset proteinuria after 20 weeks gestation
- Sudden ⬆ in proteinuria if already present
- Sudden ⬆ (worsening) in HTN
- Development of HELLP syndrome w/ pre-existing HTN
126
What is considered severe Pre-eclampsia?
- BP is 160/110 or higher
- Proteinuria is more than 500 mg/day (3+ or >)
- Oliguria occurs = 500 mL or < in 24 hr
- All other S x S
127
What are the medical recommendations for a pregnant woman suffering from severe Pre-eclampsia?
- Antihypertensive medications (Apresoline, Labetalol, Nifedipine)
- Anticonvulsant medications (MgSO4)
- Careful intrapartum monitoring
- Postpartum assessment for at least 48 hr
- Steroids
128
What are the clinical manifestations of Eclampsia?
- Generalized or grand mal seizures (last 1- 1 1/2 min)
- Maternal mortality is as high as 20%
- Respirations usually cease during seizures but resume afterwards
129
What are the nursing interventions for a patient w/ severe Pre-eclampsia that may progress to Eclampsia?
- Monitor for S x S of impending seizures (BP may drop, Temp may elevate dramatically
- Provide a quiet environment
- Ready the room for incidence of seizures (O2, padding around side rails, bed in low position...)
130
What are the proper interventions while a seizure occurs?
- Remain w/ patient and press emergency button
- Turn woman on side to prevent aspiration and ⬆ placental functioning
- Note time and sequence of seizure
- Insert airway following seizure and suction mouth and nose (O2 if necessary)
- Notify physician
- Administer meds as directed (Phenobarbital, MgSO2)
131
What are the proper nursing interventions following a seizure?
- Continue w/ MgSO4 or Phenobarbital
- Frequent assessment of pulmonary edema
- Urine output assessment (30 mL/hr minimum)
- DTRs monitor (fetal ❤ + vaginal bleeding)
- Assess for possibility of delivery
132
What are the S x S of MgSO2 toxicity?
CNS depression =
1) RR < 12/min
2) Absence of DTRs
3) Altered LOC
4) Hypotension
5) Serum MgSO4 level above 4-8 mg/dL
133
What are the nursing interventions when MgSO4 toxicity occurs?
- D/C MgSO4
- Contact physician right away
- Administer Calcium Gluconate = Antidote
134
What is HELLP syndrome?
Hemolysis Elevated Liver enzymes Low Platelets
| --> Life-threatening variation of Pre-eclampsia
135
What are the clinical manifestations of HELLP
Liver S x S =
- Right upper quadrant pain
- Nausea + vomiting
- Liver tenderness + swelling
- Malaise
Lab data =
- ⬇ Hct
- ⬆ liver enzymes (bilirubin, AST, ALT)
- Thrombocytopenia (plt count < 100,000/mm)
- Abnormal clotting studies (PT, INR)
* Risk for morbidity and mortality
136
What are the clinical interventions in the occurrence of HELLP?
- MgSO4
- Antihypertensive meds
- Induction of labor
- NO LIVER PALPATION
- IV fluids + platelets as needed
* Note: patient may or may not have DTRs (2+ is normal)
