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Module 6 (Labor And Delivery) > Pregnancy At Risk > Flashcards

Pregnancy At Risk Flashcards

1
Q

The US is the _____th largest in maternal deaths.
Why?

A

5th
healthcare workers do not listen to their patients
NO abnormal VS are noticed when critical and at telling dangerous levels. They believe they are fine and send them home regardless

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2
Q

What are the different hemorrhagic conditions r/t pregnancy?

A

Abortion
Cervical Insufficiency
Ectopic Pregnancy
Gestational Trophoblastic Disease
Placenta Previa
Abruptio Placentae
Disseminated Intravascular Coagulation (DIC)

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3
Q

What is the general definition of an abortion?

A

pregnancy loss before fetus is viable or capable of living outside the uterus
before 20 weeks or <500 g
-Spontaneous or induced

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4
Q

Spontaneous abortion incidence % in pregnancy

A

18-31%

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5
Q

During what trimester do 75% of women lose their children to an abortion?

A

1st trimester

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6
Q

Spontaneous abortion incidence increases with

A

parental age

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7
Q

What is the most common cause of spontaneous abortions?

A

chromosomal abnormalities

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8
Q

What are the clinical manifestations of a spontaneous or induced abortion?

A

uterine cramping, backache, and pelvic pressure
passing of products of conception
bright red vaginal bleeding (spotting)

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9
Q

Abortion subgroups
Threatened

A

spotting w/o cervical changes (pregnancy threatened)

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10
Q

Abortion subgroups
inevitable

A

cannot stop
open cervical os
moderate to heavy bleeding
passing tissue

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11
Q

Abortion subgroups
incomplete

A

not all products of conception are expelled

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12
Q

Incomplete abortions require

A

D&C to prevent infection of the remaining products

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13
Q

Abortion subgroups
complete

A

all products of conception are expelled

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14
Q

Complete abortion requires what treatment

A

no tx required

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15
Q

Abortion subgroups
septic s/s

A

fever
abdominal pain
tenderness
foul-smelling discharge
scant-heavy bleeding

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16
Q

Abortion subgroups
missed

A

fetus passed away but remains in the uterus
cause Dead Fetus Syndrome

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17
Q

In a missed abortion, what can develop as a result? and what can it be divulged into?

A

Dead Fetus Syndrome
- possible develop DIC

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18
Q

DIC requires what procedure

A

D&C

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19
Q

Abortion subgroups
recurrent/habitual spontaneous abortion

A

defined as 3+ spontaneous abortions

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20
Q

Cervical os is

A

the opening in the cervix at the end of the endocervical canal

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21
Q

For missed or incomplete abortion, what treatment needs to occur if the abortion is <13 weeks?

A

D&C

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22
Q

For missed or incomplete abortion, what treatment needs to occur if the abortion is >13 weeks?

A

D&E

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23
Q

D&C

A

Dilation of the cervical os and Cuttrage - scrap out

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24
Q

D&E

A

Dilation and suction out the remainging

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25
Q

What could be used in a missed or incomplete abortion to induce contractions and expel the uterus?

A

Prostaglandin E2 or Cytotec

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26
Q

What are the 2 major complications of a missed abortion?

A

Infection
Disseminated Intravascular Coagulation (DIC)

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27
Q

If the woman has recurrent spontaneous abortions, what will the doctor follow up on?

A

examination of reproductive organs
refer for genetic counseling
identify hormone/endocrine problems

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28
Q

If a Rh-negative woman has any abortion, what needs to be given

A

Rh - immune globulin (Rhogam)

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29
Q

If the pregnancy is 18-19 weeks, the treatment would use what to induce the abortion?

A

prostaglandin

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30
Q

What is the psychological impact of an abortion?

A

frightening (wait and watch is difficult)
acute sense of grief, anger, disappointment, and sadness
Guilt and speculation they could have prevented the loss

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31
Q

How long can grief last after an abortion?

A

up to 18 months
- fantasies of unseen, unborn baby

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32
Q

What should nurses do after their patient has an abortion?

A

convey acceptance of expressed feelings
-provide information and simple brief explanations of what has occured

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33
Q

Induced abortions can be what types

A

Therapeutic (when the baby passes away inside the mother)
Elective (not wanted)

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34
Q

When asking a pregnant mother about her GTPALM, the nurse notices A1. What should the nurse ask when assessing the score?

A

Ask when the mother is alone as it could be a sensitive situation

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35
Q

Cervical Incompetence/Insufficiency is the

A

mechanical defect in the cervix which causes premature cervical ripening

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36
Q

What could cause cervical insufficiency?

A

previous trauma (D&C or cauterization)
Congenital structural defect

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37
Q

What is a cervical cerclage?

A

sutures reinforce the cervix

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38
Q

The cervical cerclage is removed when

A

near term in preparation of labor

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39
Q

Can a cervical cerclage be used for prophylactic reasons?

A

yes, 12-16 weeks

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40
Q

Why would a cervical cerclage be used for prophylactic reasons at 12-16 weeks of gestation?

A

hx of loss or cervical insufficiency

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41
Q

Is Rhogam given to a Rh-negative patient with a cervical cerclage procedure?

A

yes

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42
Q

What are the post-op instructions for a cervical cerclage patient?

A

monitor and home instructions
- antibiotics to prevent infections
- tocolytics to relax the uterus
- modify activity for 1-2 weeks

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43
Q

What should a patient post-op from a cervical cerclage monitor for and report if found?

A

uterine activity
leaking fluid
infection

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44
Q

The cervical cerclage post-op patient needs to watch their activity by

A

modifying activity (bedrest and activity to a minimum)

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45
Q

When is a cervical stitch removed?

A

at 36 weeks around the estimated labor

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46
Q

What is ectopic pregnancy?

A

implantation of fertilized ovum in sites other than the endometrial lining of the uterus

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47
Q

Ectopic pregnancy is a medical

A

emergency

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48
Q

An ectopic pregnancy is usually found where?

A

fallopian tube due to a tubular obstruction or blockage (scarring)

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49
Q

Ectopic Pregnancy S/S

A

Full feeling/tenderness in lower abdominal quadrants
+ pregnancy test

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50
Q

When does a pregnancy test become detectable?

A

6-8 weeks

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51
Q

What are the signs of acute rupture of an ectopic pregnancy?

A

vaginal bleeding
adnexal/abdominal mass (fetus)
referred shoulder pain
syncope/shock

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52
Q

Adnexal pain

A

lower abdomen on the tube or involved ovary

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53
Q

What are the vital signs while a patient is bleeding?

A

low BP
high pulse

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54
Q

The symptoms of a ectopic pregnancy occur around

A

6-8 weeks

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55
Q

What are the nursing interventions for an ectopic pregnancy?

A

1st assess VS STAT - low BP and high pulse
check for vaginal bleeding
start large bore IV to start fluids
notify provider immediately for removal
assess for abd masses or adnexal tenderness

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56
Q

Ectopic Pregnancy Tx IF STABLE

A

prepare for an abdominal US
medical mgmt with methotrexate

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57
Q

Ectopic Pregnancy Tx IF UNSTABLE

A

rapid surgical tx for ruptured ectopic
- explain the procedure and sign consent
- pre and post-op instructions
- T&C for 2 units of packed RBCs
- future pregnancy is desired and the tube is not ruptured - attempt to preserve the tube
- observe for shock
- Rhogam for Rh (-)

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58
Q

In a OR tx for a ruptured ectopic pregnancy, if a future pregnancy is desired, what happens?

A

if tge tube is not ruptured, they will attempt to preserve the tube

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59
Q

What is Methotrexate?

A

chemotherapeutic agent

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60
Q

What are the precautionary measures for nurses when handling Methotrexate?

A
  • PPE with double-gloving
  • verify name, medication, and dosage with another nurse
    -air should not be expelled from the syringe so as not to aerosol the drug
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61
Q

T/F: You should expel the air in the syringe to prime the needle.

A

False, do not expel it as it could aerosolize the chemotherapeutic drug

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62
Q

What are the patient teachings for Methotrexate?

A

urine is considering toxic for 72 hours
avoid getting urine on the toilet seat, flush the toilet 2 times with the lid closing after voiding
- refrain from alcohol, vitamins with folic acid, NSAIDs, and avoid sunlight

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63
Q

What are the adverse effects of Methotrexate?

A

N/V with transient abdominal pain

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64
Q

Gestational Trophoblastic Disease aka

A

hydatidiform mole
molar pregnancy

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65
Q

Gestational Trophoblastic Disease Assessment

A

Hgh beta hCG than for gestational age
- Uterus larger than expected for gestational age
Hyperemesis- excess N/V
Vaginal bleeding(1st tri) varies from brown to profuse hemorrhage
absence of a fetal sac/heartbeat on US

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66
Q

Gestational Trophoblastic Disease can cause what in early development

A

preeclampsia before 24 weeks gestation

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67
Q

Gestational Trophoblastic Disease is characterized as what on a US?

A

snowstorm pattern with vesicles and absence of heartbeat and sac on US
gray-shaped nodules

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68
Q

Gestational Trophoblastic Disease malignant chnage leads to

A

choriocarcinoma and metastasis to the lung, vagina, liver, and brain

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69
Q

Gestational Trophoblastic Disease is

A

trophoblasts that attach the fertilized ovum to the uterine wall developing abnormally

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70
Q

In an anatomic view, what does a Gestational Trophoblastic Disease look like?

A

proliferation and edema of chorionic villi into a bunch of clear vesicles in grape-like clusters
- abnormal placenta
- embryo rare
- large enough to fill the uterus to advanced stages
- predispose to Choriocarcinoma

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71
Q

A patient comes in for a 20-week check-up and presents with their fundus at the xiphoid process. What do you suspect based on your findings?

A

The patient looks full-term when she is only half-term
- Gestational Trophoblastic Disease due to the advanced uterus compared to the actual gestation age

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72
Q

What are the tx for Gestational Trophoblastic Disease?

A

Evacuate the trophoblastic tissue (D&C)
Tx hyperemesis and preeclampsia
CBC, T&C, screen and coagulation status
Discharge instructions

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73
Q

Evacuate the trophoblastic tissue (D&C) for a molar pregnancy needs to avoid and get what test ran

A

Chext X-ray, CT, MRI for metastasis
avoid uterine stimulation (manual or chemical - Oxytocin)

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74
Q

What D/C instructions would you give a molar pregnancy after a D&C?

A

AVOID PREGNANCY FOR 1YEAR - birth control
obtain serum hCG monthly for 6 months then every 2 months for the next 6 months

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75
Q

If the hCG levels rise after the evacuation of the disease, what does this indicate?

A

malignancy

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76
Q

What do you treat the malignancy of Gestational Trophoblastic Disease with?

A

methotrexate

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77
Q

What s/s would you teach the patient to immediately report after the tx for Gestational Trophoblastic Disease?

A

bright red vaginal bleeding
temp >100.4
foul-smelling vaginal discharge

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78
Q

Placenta previa

A

implantation of the placenta in the lower uterus segment

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79
Q

Marginal/ Low-lying placenta classification

A

placenta implanted in the lower uterus but more than 3 cm from the internal cervical os

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80
Q

Partial placenta previa

A

lower placenta border is within 3 cm of the internal cervical os but does not completely cover the os

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81
Q

Total/Complete Previa

A

placenta completely covers the internal os

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82
Q

What are the s/s of placenta previa?

A

sudden onset of painless vaginal bleeding (bright red)
soft, relaxed uterus
no tenderness

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83
Q

When does the initial episode of placenta previa bleeding usually occur?

A

2-3rd trimester
- rarely life-threatening

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84
Q

How do you assess and dx placenta previa?

A

US to determine placental placement

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85
Q

The HCP orders a vaginal exam on a patient with sudden onset of vaginal bleeding but has no pain. What should the nurse do?
a) Continue with the exam
b) Question why the exam should be ordered and tell the charge nurse after performing the exam.
c) Tell the physician that a vaginal exam is contraindicated for a placenta previa suspected pt.
d) Tell the physician that a vaginal exam is contraindicated for an ectopic pregnancy suspected pt.

A

c) Tell the physician that a vaginal exam is contraindicated for a placenta previa suspected pt.

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86
Q

A vaginal exam on a placenta previa patient is ALWAYS
What could happen?

A

CONTRAINDICATED; can cause placental separation or tear placenta causing severe hemorrhage and death of the fetus

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87
Q

The management of a placenta previa patient is based on?

A

condition of the mother and fetus
- determine the amount of hemorrhage
- eval fetus using an electronic fetal monitor
- gestational age of the fetus

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88
Q

If the placenta previa patient is unstable or based on the fetal heart monitor the baby is not looking good. What would the doctor tell the patient?

A

Inpatient care in the Antepartum unit until delivery
monitored closely for compromise
immediate delivery

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88
Q

If the placenta previa patient is stable and based on the fetal heart monitor the baby has no fetal compromise. What would the doctor tell the patient?

A

Delay the birth to increase maturity and birth weight
Administer corticosteroids to speed up the maturation of fetal lungs
conservative mgmt may take place in the home or hospital

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89
Q

Why do you give a fetus corticosteroids?

A

speed up the maturation of fetal lungs

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90
Q

Why would you delay the birth of a stable placenta previa patient?

A

increase the maturation and birth weight

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91
Q

Placenta previa can be managed at home with the following criteria

A
  • no evidence of active bleeding is present
  • pt can maintain strict bed rest at home except for toileting and shower
  • pt verbalizes understanding of risks and how to manage care
  • can get to the hospital in a reasonable time if you start to bleed
  • home is close to the hospital
  • emergency systems available for immediate transport to the hospital
  • perform daily kick counts and recognize uterine activity
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92
Q

What is the treatment for total or partial previa, heavy bleeding, or deterioration of the condition?

A

CESAREAN SECTION
- additional personnel (NICU fr baby)
18 g IV and consider a second line
blood on standby or immediately available

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93
Q

Abruptio Placentae is the

A

partial or complete premature detachment of the placenta from implantation in the uterus

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94
Q

Abruptio Placentae usually occur in what trimester?

A

3rd

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95
Q

Abruptio Placentae is considered an OB

A

emergency
- cause 15% of maternal deaths

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96
Q

Abruptio placentae can be caused by

A

Hypertensive disorders
High gravida (10+ pregnancies)
Abdominal trauma (car accidents, falls, IPV)
Cocaine, Meth, Marijuana, or Tobacco use
Short umbilical cord (can not reach out in descent)
PROM
Previous abruptio

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97
Q

How can Cocaine, Meth, Marijuana, or Tobacco use cause abruptio placentae?

A

vasoconstrictor leads to vessels of the placenta to pull loose

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98
Q

What are the s/s of abruptio placentae?

A

Bleeding concealed or overt
uterine tenderness/pain locally over the abruption site
persistent abdominal pain - contraction never goes away
rigid, board -like abdomen
FHR abnormalities - Late decelerations
Shock s/s low BP and high pulse
IUPC reveals high resting tone

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99
Q

If the bleeding from the abruptio placentae is dark red, what does that mean?

A

overt bleeding

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100
Q

Abruptio Placentae Nursing Interventions

A

bed rest (no vaginal or rectal manipulation)
notify immediately AND prep for immediate C-section
Left lateral for placenta perfusion
EFM for contractions and FHR
IV infusion with large bore catheter
STAT CBC, clotting, Rh factor, and T&C
constant surveillance (signs of DIC)
assess for IPV ASKING WHEN ALONE
Quantify blood loss
emotional support, teach regarding mgmt and expected outcomes

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101
Q

Conservative mgmt of the Abruptio Placentae if

A

mild and the fetus is <34 weeks
- no signs of distress

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102
Q

What are the conservative mgmt for a mild abruptio placenta?

A

bed rest
tocolytic to reduce uterine activity
corticosteroids (accelerate fetal lung maturity)
Rhogam to Rh (-) women

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103
Q

If the abruptio placentae patient has fetal compromise or maternal deterioration in status, what needs to happen next?

A

immediate delivery with the NICU team at the delivery

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104
Q

DIC means

A

Disseminated Intravascular Coagulation
Consumptive Coagulopathy

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105
Q

DIC is a

A

defect in coagulation where the mother can not clot her excessive bleeding
- anticoagulation with excessive bleeding
- micro-circulation of inappropriate coagulation concurrently

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106
Q

DIC causes ischemia by

A

Formation of tiny clots in tiny blood vessels that block blood flow to organs
- excessive bleeding

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107
Q

Diseases that cause DIC

A

placental abruption
prolonged retention of a dead fetus
endothelial damage (severe preeclampsia and HELLP Syndrome)
maternal sepsis
amniotic fluid embolism

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108
Q

Anemia

A

decrease in the O2-carrying capacity of the blood

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109
Q

Anemia is caused by

A

iron deficiency
reduced dietary intake

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110
Q

Anemia is associated with increases of what complications?

A

miscarriage, preterm labor, preeclampsia, infection, PP hemorrhage, and IUGR

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111
Q

IUGR means

A

Intrauterine growth restriction

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112
Q

Pregnant women are considered anemic if their hemoglobin and hematocrit are what in the different trimesters?

A

Hgb <11g/dL, Hct <37% in first trimester
Hgb < 10.5g/dL, Hct < 35% in second trimester
Hgb < 10g/dL, Hct <32% in third trimester

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113
Q

Iron deficiency anemia s/s

A

pallor
fatigue
pronounced lethargy
HA
inflammation of the lips and tongue

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114
Q

What is the total iron requirement for a single fetus pregnancy in one day?

A

1000 mg/day

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115
Q

What are good sources of iron in food?

A

meat
fish
chicken
liver
green leafy veggies

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116
Q

What are the different infections possible in pregnancy?

A

UTI
Vaginal (Candiasis, bacterial vaginosis)
Viral (Rubella, COVID-19, Hep B, Cytomegalovirus, Varicella - Zoster)
Non-viral (Toxoplasmosis, Group B Strep)
STIs
Intrauterine Infection

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117
Q

UTIs in pregnancy can result in

A

pyelonephritis if untreated
- stay in the hospital

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118
Q

UTIs increase the risk of

A

preterm labor and premature delivery

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119
Q

Maternal complications from a UTI include

A

high fever
flank pain
septic shock
ARDs

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120
Q

Candidiasis in pregnancy can develop into

A

thrush in newborns (yeast infection)

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121
Q

Bacterial vaginosis can lead to

A

PROM, preterm labor and birth, intraamniotic infection, PP endometritis, neonatal sepsis and death

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122
Q

What is one of the first signs of pyelonephritis or a UTI?

A

pain with urination

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123
Q

What is the only protection for the fetus from Rubella?

A

prevention

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124
Q

If the mother has Rubella, what can result in the fetus?

A

fetal congenital heart defects
IUGR
congenital cataracts
hearing and vision problems

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125
Q

If a woman gets COVID-19 during pregnancy, the preliminary studies show that she is at an increased risk of?

A

preeclampsia
stillbirth
maternal death

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126
Q

Hepatitis B causes an increased risk for what in OB patients?

A

prematurity
LBW
neonatal death

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127
Q

If a mother is Hep B +, what should be given to the newborn?

A
  • clean thoroughly and carefully bathed before injections
  • receives Hep B immune globulin FOLLOWED by Hep B vaccine
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128
Q

Cytomegalovirus Tx

A

none for the mother or fetus

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129
Q

What can result if a mother gets infected with the cytomegalovirus?

A

stillbirth
congenital CMV
microcephaly
IUGR
cerebral palsy
mental retardation
rash
jaundice
hepatosplenomegaly

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130
Q

What precautions are taken for a mother infected with the Varicella-Zoster virus?

A

Airborne/Contact
Standard

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131
Q

What type of staff should take care of the Varicella-Zoster virus patient?

A

immune only staff

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132
Q

If the pregnant mother is infectedwith Chickpox at 13-20 weeks gestational age, what could occur to the fetus?

A

limb hypoplasia, cutaneous scars, chorioretinitis
cataracts
microcephaly
IUGR

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133
Q

If the pregnant woman gets infected 2-5 days before birth, what could happen to the fetus?

A

life-threatening varicella infection
- congenital varicella syndrome

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134
Q

Toxoplasmosis caused by

A

protozoa in raw uncooked meat
cat feces in the litter box

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135
Q

Toxoplasmosis can cause what in pregnancy

A

congenital toxoplasmosis
stillbirth
microcephaly
hydrocephalus
blindness
deafness

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136
Q

Group B Strep infection is the leading cause of

A

life-threatening perinatal infections

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137
Q

Group B Strep is tested with cultures at what weeks

A

35-37

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138
Q

If the mother is positive for Group B Strep, what will the nurses need to do?

A

administer PCN, cephalosporin, or clindamycin
for 2 minimum doses before delivery at least 4 hours to get to the baby

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139
Q

What STIs could infect the fetus in a pregnancy?

A

Syphilis
Gonorrhea
Chlamydia
Trichomoniasis
Human papillomavirus
Herpes Simplex Virus
Human Immunodeficiency Virus

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140
Q

Chorioamnionitis is

A

infection of the amnion/chorion/amniotic fluid

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141
Q

S/S of chorioamniotitis

A

maternal fever
fetal tachycardia >160 baseline for 10 minutes
maternal WBCs >15000 (w/o corticosteroids)
purulent fluid from the cervical os

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142
Q

Chorioamnionitis interventions

A

wash hands before and after touching pt
- Temp q2 hours after ROM and - q hour for a fever
keep pads under dry and limit vaginal exams - aseptic
inform neonatal staff if infection signs
Antibiotic therapy starts when identified
Assess maternal pulse, respiration, and BP hourly if fever is present

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143
Q

Chorioamnionitis can lead to what if untreated

A

sepsis
- high pulse and respirations
- low BP
high lactic acid

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144
Q

What do you give as an antipyretic for a maternal fever?

A

acetaminophen
- assess maternal fever, pulse, respirations, and BP hourly

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145
Q

PROM is the

A

Rupture of membranes before the onset of true labor regardless of gestational age

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146
Q

PPROM is the

A

rupture of membranes before 37 weeks gestation
- Associated with preterm labor and birth

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147
Q

When a baby is born with PPROM, the infection risk increases if not delivered within

A

24 hours

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148
Q

A newborn born before ___ -___ weeks is at the greatest risk of PPROM.

A

32-34 weeks

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149
Q

Conditions associated with PPROM

A

Infection of the vagina or cervix
Weak structure of the amniotic sac
Previous preterm birth, especially if preceded by PPROM
Fetal abnormalities or malpresentation
Incompetent or short cervix
Over distention of the uterus
Maternal hormonal changes
Maternal stress or low socioeconomic status
Maternal nutritional deficiencies and diabetes

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150
Q

PROM management depends on gestational age. What order should the nurse intervene and verify?

A

1st - verify ROM with nitrazine/fern/amnisure testing
2nd - If nearterm - induce labor if not
3rd - If preterm less than 36 weeks
= weight risks and benefits of fetal infection and risk of prematurity

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151
Q

PROM management if short-term

A

tocolytics to delay delivery and administer corticosteroids

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152
Q

What should be considered for management of PROM?

A

fetal age
lung maturity
amount of amniotic fluid
signs of fetal compromise

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153
Q

If there is no signs of infection of fetal lung immaturity after PROM,

A

admit and observe for infection or labor
- daily non-stress tests
- biophysical profile with amniotic fluid
- fetal lung maturity testing
- maternal antibiotics for 7 days

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154
Q

With a PROM patient what patient teachings does the nurse need to verify understanding completely?

A
  • avoid sex, orgasm, or inserting anything into the vagina
  • avoid breast stimulation with preterm gestation
  • Temp a least 4x/day minimum
  • Report 37.8C or 100F
  • Maintain activity restrictions (bedrest unless bath/toilet)
  • Note/report uterine contractions or foul odor or discharge
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155
Q

Preterm Labor begins

A

after the 20th gestational week but before 37 weeks
(21-36 weeks)

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156
Q

Preterm labor infants are not equipped for extrauterine life and may develop

A

cerebral palsy
developmental delay
vision or hearing impairment
significant emotional/financial burdens for the families

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157
Q

T/F: Racial disparities exist in preterm birth rates.

A

True - AA and Hispanics then caucasian

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158
Q

Risk factors for preterm labor

A

Uterine over-distention
Decidual (endometrium) activation
Premature activation of normal physiological initiation of labor
Inflammation and infection in decidua, fetal membranes, and amniotic fluid

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159
Q

What is the goal of preterm labor?

A

delay birth and promote fetal maturation

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160
Q

How can you predict preterm labor?

A

cervical length
infections
PPROM previously
Fetal fibronectin (fFN) test

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161
Q

Fetal fibronectin test

A

high negative predictive and low positive predictive value

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162
Q

Fetal fibronectin test - NEGATIVE

A

< 1% chance of delivering in the next 2 weeks

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163
Q

Fetal fibronectin test - POSITIVE

A

12-17% chance of delivering in the next 2 weeks

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164
Q

Fetal fibronectin test steps

A
  • collect specimens before any manipulation to avoid contamination
  • rotate the swab across the posterior fornix for 10 seconds to absorb cervicovaginal secretions
  • remove and immerse in buffer
  • secure and label
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165
Q

How do you stop preterm labor initially?

A
  • identify and tx infections and causes
  • limit activity - left lateral or semi-sitting positions
  • Hydrate: Oral and IV fluids
  • Tocolytics
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166
Q

Oral fluids can do what in stopping preterm labor?

A

reduce uterine irritability and risk of UTIs

167
Q

High IV infusion volumes of preterm labor can cause

A

maternal respiratory distress - PE

168
Q

Tocolytics can successfully

A

delay birth to provide time
- does not decrease the rate of preterm birth

169
Q

T/F: Tocolytics decrease the rate of preterm birth.

A

False, does not demonstrate a decrease in preterm birth

170
Q

Tocolytics can provide time for

A

Maternal corticosteroids
Antibiotics to prevent neonatal infection with GBS
Transfer to a tertiary facility
Give magnesium sulfate for neuroprotection

171
Q

What drugs can be given in preterm labor?

A

Magnesium Sulfate

172
Q

Mg Sulfate is used to

A

depress myometrium contractility
CNS depressant
PIH and suppress labor

173
Q

Mg Sulfate dosage and effectiveness

A

Load: 4g in 20-30 mins
THEN IV 2g/hr

174
Q

Mg Sulfate Therapeutic level

A

5/7-8

175
Q

Mg Sulfate antidote for toxicity

A

Calcium Gluconate

176
Q

Mg Sulfate maternal effects

A

Flushing, dry mouth, lethargy, headache, muscle weakness, pulmonary edema, cardiac arrest

177
Q

Mg Sulfate fetal effects

A

Lethargy, hypotonia, respiratory depression
- resuscitate possible and ready
May reduce risk of cerebral palsy in neonate; Shown to offer neuro-protection in preterm infant

178
Q

Mg Sulfate nursing interventions

A

Monitor lung sounds and FHR, contractions, and MgSO4 levels
Stop immediately and give an antidote for toxicity

179
Q

Mg Sulfate S/S Toxicity

A

Absent DTRs <12
Resp < 12
Severe hypotension
Decreased LOC
Pulmonary edema
Chest pain
Urine output <30ml/hr

180
Q

Prostaglandin Synthesis Inhibitors medication names

A

Indomethacin sodium; Naproxen sodium;
Fenoprofen

181
Q

Prostaglandin Synthesis Inhibitors are used to

A

stop the production of prostaglandin

182
Q

Prostaglandin Synthesis Inhibitors are effective in

A

delaying delivery 48+ hours
- used short-term due to fetal side effects
- used in < 32 week gestations

NSAID

183
Q

Indomethacin sodium dosage

A

50mg PO loading
25-50 mg PO every 6 hours

184
Q

Indomethacin sodium should not be used longer than

A

48 hours

185
Q

Indomethacin sodium maternal effects

A

Nausea, heartburn, GI upset; pulmonary edema, blurred vision, headache, nausea, post partum hemorrhage

186
Q

Indomethacin sodium fetal effects

A

Constriction of ductus arteriosus – not late, pulmonary hypertension, reversible decrease in renal function, with oligohydramnios, intra-ventricular hemorrhage,
hyper-bilirubinemia, NEC

187
Q

Indomethacin sodium nursing mgmt

A

Monitor FHR and uterine contractions;
Listen to lung sounds
Treat nausea and heartburn;
Monitor for manifestations of pulmonary edema; monitor for postpartum hemorrhage

188
Q

Nifedapine
Nicardipine
(procardia, adalat)
SHOULD NOT BE ADMINISTERED CONCURRENTLY WITH

A

Mg Sulfate

189
Q

Pts with Nifedapine or Nicardipine (Procardia, Adalat) should not be used with

A

terbutaline

190
Q

Nifedipine or Nicardipine (Procardia, Adalat)
is used for

A

block Calcium availability for muscle contraction

191
Q

Nifedipine or Nicardipine (Procardia, Adalat) is effective in delaying delivery for

A

49-72 hours
- Give corticosteroids for baby lungs now

192
Q

Nifedapine or Nicardipine (Procardia, Adalat)
maternal effects

A

Flushing, headache, dizziness, nausea, transient hypotension, pulmonary edema

193
Q

Nifedapine or Nicardipine (Procardia, Adalat)
fetal effects

A

May decrease utero-placental blood flow

194
Q

Nifedapine or Nicardipine (Procardia, Adalat)
nursing interventions

A

Monitor FHR and UCs
Monitor maternal blood pressure and heart rate

195
Q

Nifedipine or Nicardipine (Procardia, Adalat) should be cautioned in which patients

A

renal disease
hypotension

196
Q

Nifedipine or Nicardipine (Procardia, Adalat) should be HELD

A

for BP < 90/50 or HR >120

197
Q

Terbutaline / Ritodrine
are used to

A

Suppress uterine activity
Delay delivery by 3 days

198
Q

Terbutaline dosage

A

IV/ - max 0.08mg/min
SQ 0.25 mg q 3-4 hours

199
Q

Ritodrine dosage

A

max dose .35 mg/min IV

200
Q

Terbutaline / Ritodrine
maternal effects

A

Cardiac or cardio-pulmonary arrhythmias, pulmonary edema, myocardial ischemia, hypotension, tachycardia,
Elevation in maternal glucose, hypokalemia

201
Q

Terbutaline / Ritodrine
fetal effects

A

Fetal tachycardia,
Hyper-insulinemia, hyper-glycemia,
Myocardial and septal hypertrophy,
Myocardial ischemia

202
Q

Terbutaline / Ritodrine
nursing mgmt

A

Monitor FHR and UCs
Monitor I & O for overload
Auscultate lungs for pulmonary edema
Monitor maternal HR and may hold dose for heart rate >120
Monitor blood glucose

203
Q

Antenatal Corticosteroids medication types

A

Betamethasone or Dexamethasone

204
Q

Antenatal Corticosteroids are recommended to administer between

A

24-34 weeks
- risk for preterm birth within 7 days

205
Q

Antenatal Corticosteroids is used for

A

reducing Respiratory Distress Syndrome and intraventricular hemorrhage in preterm infants
- 2 doses 12-24 hours apart (Beta)
- 4 doses 12 hours apart (Dexta)

206
Q

What is contraindicated for the administering of Antenatal Corticosteroids?

A

active infection

207
Q

What is precautionary for the administering of Antenatal Corticosteroids?

A

complicated with diabetes

208
Q

If an infant is born sooner than 24 hours, is it okay to still give antenatal corticosteroids?

A

yes, still some benefits

209
Q

Post-term pregnancy lasts

A

longer than 42 weeks
- prolonged pregnancy can be due to miscalculation of EDD

210
Q

Risks to the fetus if a post-term pregnancy

A

Placental insufficiency - increases the risk for stillbirth longer the pregnancy lasts
Meconium aspiration syndrome
Large Baby
Fetus may continue to grow - complications dysfunctional labor, lacerations, or infections

211
Q

Mgmt for a Post-term Pregnancy

A

Accurate determination of due date – US in early pregnancy and ensure the gestation age at 20 weeks
Induction of labor at 39 weeks (earlier for HTN)

212
Q

Labor Dystocia

A

difficult birth resulting from any cause

213
Q

Labor Dystocia can result from one or all of

A

P’s
Power
Passage
Passenger
Position
Psyche

214
Q

Labor Dystocia
r/t Powers

A

ineffective uterine contractions and secondary bearing-down efforts

215
Q

Labor Dystocia
r/t Passage

A
  • maternal pelvis, uterus, cervix, vagina, perineum
216
Q

Labor Dystocia
r/t Passenger

A

fetal size, fetal position, placenta

217
Q

Labor Dystocia
r/t Position

A

position of the laboring woman – TURN (osteoposterior)

218
Q

Labor Dystocia
r/t Psyche

A

response to labor-anxiety

219
Q

Shoulder Dystocia is

A

shoulder becomes impacted above the maternal symphysis
OB emergency

220
Q

Shoulder Dystocia is usually due to a

A

large infant (IDM)

221
Q

What makes shoulder dystocia an emergency?

A

cord compression between the fetal body and maternal pelvis

222
Q

Initial s/s of the shoulder dystocia is

A

“turtle sign”
- the baby comes out and goes back in due to the shoulder stuck on the maternal pelvis

223
Q

Shoulder Dystocia Tx

A
  • prepare for STAT surgical delivery
  • call for help
  • McRoberts Maneuver
  • keep time
    -suprapubic pressure was applied to move the impacted shoulder past the symphysis
  • After delivery check the infant clavicle for fx
224
Q

What is the priority nursing action in Shoulder Dystocia?

A

McRoberts maneuver

225
Q

McRoberts Maneuver

A

pulls the legs as far as possible toward the chest
suprapubic pressure

226
Q

The McRoberts Maneuver opens up the pelvis to

A

15-30 degrees supine

227
Q

What is the abnormal presentation/position?

A

fetal occiput posterior
occiput transverse position
Brow, miliary, or face presentation
breech

228
Q

What are the initial sign of persistent OP?

A

low back pain
give counterpressure

229
Q

What maternal position changes will help abnormal presentation or positions from the fetus?

A

TURN side to side q 1-2 hours
Hands and Knees
Side-lying especially far side-lying with the use of peanut ball
Squatting (for the second stage)
Sitting, kneeling, or standing while leaning forward
The physician may assist with rotation using forceps

230
Q

Brow, military, or face presentation may require _________ delivery

A

Cesarean

231
Q

What breech presentations are dangerous?

A

frank
full
single footling

232
Q

In a breech presentation, the greatest fetal risk is

A

the head is the last to be born
- head can be entrapped if sevix clamps around the neck
- umbilical cord compressed

233
Q

What would the FHM show for a possible breach?

A

late decelerations to variables due to compressed umbilical cor
- low perfusion to the baby

234
Q

With prolonged labor, the infection rate for fetal and maternal are more likely with

A

prolonged ROM

235
Q

What is the “normal” length of labor?

A

Nullipara 1.2 cm/hr
Parous 1.5 cm/hr
Both = 6 hr to progress 4-5 hrs and 3 hrs from 5-6cm

236
Q

After 6 cm, multiparas progress

A

faster the nulliparas

237
Q

Nullipara 2nd stage labor
without epidural
with labor

A

w/o epidural 2.8 hours
with labor 3.6 hours

238
Q

Precipitous labor occurs within

A

3 hours on onset

239
Q

Precipitous labor can cause trauma to

A

genital tract of the mother, bruising, intracranial hemorrhage, or nerve damage
hyperbiliruibinemia

240
Q

Precipitous labor priority nursing care

A

promotion of fetal O2
maternal comfort

241
Q

Precipitous labor associated with

A

placental abruption, fetal meconium, infection, maternal cocaine use, postpartum hemorrhage, and low APGAR scores

242
Q

In a precipitous labor, staff should be

A

alerted to rapid labor progression and be prepared for delivery of the fetus
- mother supported

243
Q

What is the leading cause of maternal morbidity and mortality in pregnancy?

A

HTN disorders of pregnancy
- subsets
- progressive

244
Q

What is the only way for a road to recovery of the HTN in pregnancy?

A

delivery of the fetus

245
Q

What is the underlying mechanism of pregnancy HTN?

A

vasospasm leads to poor perfusion
- simultaneously with chronic HTN

246
Q

HTN in pregnancy is associated with

A

placental abruption, kidney failure, hepatic rupture, preterm birth, and fetal and maternal death

247
Q

Gestational HTN begins after

A

20th-week gestation

248
Q

For Gestational HTN let the HCP know if the BP

A

Elevated B/P ≥ 140/90 recorded on two different occasions at least 4 hours apart

249
Q

Gestational HTN proteinuria

A

NONE

250
Q

Preeclampsia S/S

A

GH with the addition of ≥ 1+ proteinuria
Possible transient headaches along with episodes of irritability
Edema may be present in finger and face (not in feet = normal)
Reflexes may be normal

251
Q

If HTN is before the 20th week, think

A

molar pregnancy

252
Q

Severe Preeclampsia S/S

A

B/P ≥ 160/110
Proteinuria > 2+ or 3+ = increase in edema
Oliguria (< 100 ml in 4 hours)
CNS symptoms: severe headache, visual disturbances - Black floaty spots
Extensive peripheral edema; Pulmonary edema or cyanosis
Impaired liver function
Hyperreflexia (3+) with possible ankle clonus
Thrombocytopenia, elevated serum creatinine, marked liver enzyme elevations
Epigastric and right upper quadrant pain (think it is indigestion)

253
Q

If the patient has severe preeclampsia, the rapid response should be ready to be called. Why?

A

seizure due to CNS irritation
black floaty spots - scotoma

254
Q

Clonus means

A

nervous system is affected
blood work elevated

255
Q

Normal DTR

A

2

256
Q

HELLP Syndrome stands for

A

Hemolysis = low iron and perfusion
Elevated Liver Enzymes (AST/ALT) = edema and no ciruclation
Low Platelets - PP Hemorrhage

257
Q

HELLP Syndrome
s/s subset for severe preeclampsia

A

Epigastric or RUQ pain, malaise, lower right chest or mid-epigastric area, nausea and vomiting

258
Q

HELLP Syndrome
If the patients are normotensive and with no proteinuria do you still give them Mg Sulfate?

A

yes

259
Q

HELLP Syndrome can cause

A

Hepatic rupture, renal failure, and preterm birth can lead to fetal and maternal death

260
Q

Eclampsia can cause what in pregnant women with preeclampsia or new onset 48-72 hours postpartum?

A

new onset grand mal seizures

261
Q

Eclampsia Warning signs of impending seizures

A

Severe headache, drowsiness or mental confusion
Severe epigastric pain is particularly ominous
Hyperreflexia or clonus
Nausea and vomiting
Decreased urinary output indicates poor renal perfusion
Visual disturbances such as blurred, double vision, or seeing spots
Hemoconcentration

262
Q

Seizure Mgmt

A

Priority is prevention of injury and stabilization of the maternal airway
Monitor fetal heart rate and for contractions (bradycardia and decals)
Keep patient on her side
Suction equipment readily available
Side rails padded and up

263
Q

Mgmt of Preeclampsia

A

do not restrict salt
ONLY CURE IS DELIVERY OF BABY AND PLACENTA
-based on severity and maturity
- 37 weeks gestation without severe fts

264
Q

If < 34 weeks gestation and delivery can be delayed 48 hours to administer

A

corticosteroids to mature fetal lungs

265
Q

Severe Preeclampsia Management

A

Requires inpatient hospitalization - Antepartum, OBICU, L&D
Bed rest and fetal monitoring
- no walking the halls

266
Q

May be possible if the woman does not have severe preeclampsia and no evidence of worsening fetal or maternal status

A

home care

267
Q

Patients should do what at-home care in HTN of pregnancy

A

Reduce activity (sedentary most of the day)
Home blood pressure monitoring
Follow-up with provider every 3-4 days
Fetal activity checks (kick counts)
Left Lateral position for perfusion

268
Q

Intrapartum Care of HTN pregnancy

A

1/2 of eclamptic seizures occur during labor or the first 48 hours after birth
Fetus and mother should be monitored continuously
Mother should be kept in a lateral position
Decrease stimulation/agitation - limit visitors and control pain
Large bore IV access – INT minimum for C section emergency
Urine protein every hour
Hourly I & O
B/Ps q 15 to 30 min

269
Q

Postpartum Care for HTN pregnancy

A

Careful assessment of blood loss and signs of shock are essential
V/S q 4 hours
Monitor for visual disturbances
Administration of magnesium for 24 hours after delivery or last seizure

270
Q

Signs of recovery in PP HTN in pregnancy

A

Diuresis
Decreased protein in urine
Return of B/P to normal
Resolution of abnormal labs

271
Q

Antihypertensive Medications indicated for

A
  • only if severe HTN
    Systolic > 160 mm/Hg
    Dystolic > 110 mm/Hg
    Decrease risk of stroke or congestion heart failure
272
Q

1st line antihypertensive -

A

preservation of uteroplacental blood flow

273
Q

1st Line Hypertensive medications for pregnancy

A

Labetalol
Hydralazine
Nifedipine

274
Q

Labetalol

A

less maternal tachycardia and fewer adverse effects

275
Q

Hydralazine

A

headaches, maternal hypotension, fetal distress

276
Q

Nifedipine

A
  • reflex tachycardia, headaches, and synergistic effect with magnesium sulfate may cause hypotension and neuromuscular blockade
277
Q

Magnesium Sulfate is used to

A

anticonvulsant
prevent seizures
CNS depressant

278
Q

Magnesium Sulfate as a CNS Depressant

A

depresses CNS irritability and relaxes smooth muscle
Prevents and controls seizures in severe preeclampsia
Prevents contractions in preterm labor
Offers neuroprotection of the preterm fetus

279
Q

Magnesium Sulfate should be given as a IVPB over

A

15-20 minutes

280
Q

Signs of Magnesium toxicity

A

Respiratory difficulty/depression RR <12
Chest pain
Mental confusion; Slurred speech
no deep tendon reflexes
Flushing, sweating, lethargy
Hypotension
Mg serum level >8
urine < 30 mL/HR

281
Q

Response to signs and symptoms of Magnesium toxicity

A

STOP the magnesium !!!!!
Notify the provider – STAT Mag
Be prepared to administer calcium gluconate and resuscitation equipment – at bedside and readily available STAT

282
Q

Calcium Gluconate can cause

A

fatal arrhythmia-cardiac monitoring advised

283
Q

DTR occur at

A

jaw jerk
supinator
biceps
triceps
knee
ankle

284
Q

Grading of DTR

A

0 - NONE
1 PRESENT
2 BRISK NORMAL
3 VERY BRISK
4 CLONUS

285
Q

Maternal Risk of obesity

A

Gestational diabetes
Preeclampsia
Thromboembolism
Cesarean delivery
Preterm birth
Birth trauma
Postpartum hemorrhage
Postpartum anemia

286
Q

Fetal Risk for obesity

A

Stillborn
NTDs
Hydrocephaly
Cardiovascular defects
Macrosomia
Hypoglycemia
Birth injury - shoulder dystocia
NICU admissions

287
Q

Pregnancy after bariatric surgery

A

postpone 12-24 months after surgery
assess vitamins and nutritional deficiency
signs of intestinal obstruction
edu on health, complications, and psychological support

288
Q

Cardiac Diseases that can occur in pregnancy

A

Rheumatic Heart Disease
Valvular Stenosis
Myocardial Infarction
Cardiomyopathy

289
Q

Hemodynamic changes in pregnancy have a profound effect on patients with

A

cardiac disease; management related to the disorder present and impact on cardiac function
Assess for cardiac decompensation

290
Q

Class I or II cardiac disease
mgmt

A

Limit physical activity
Avoid excessive weight gain
Prevent anemia
Prevent infection
Careful assessment for the development of CHF or pulmonary edema

291
Q

Class III or IV cardiac disease

A

Primary goal - prevent cardiac decompensation and development of CHF
May need to rest most of the day
Cardiac decompensation is likely with little or no activity

292
Q

Intrapartum mgmt for cardiac diseases

A

Prevent Valsalva maneuvers even during the second stage
Avoid the use of stirrups
Try to minimize the effects of labor on the cardiovascular system, may need operative assist
Manage IV fluid administration to prevent fluid overload
Position the woman on her side, with her head and shoulders elevated
Pulse oximetry to monitor O₂ saturation - use O₂ if saturation is < 95%
Administer pain medication/epidural earlier
Quiet and calm environment
Fetus monitored continuously
Signs of cardiac decompensation should be reported immediately

293
Q

PP Mgmt for Cardiac Disease

A

Fourth stage of labor associated with risks - monitor closely
After placenta delivery, 500-1000 ml of blood returns to intravascular volume
80% increase in cardiac output in 10 to 15 min
Avoid abrupt position changes

No evidence of distress in intrapartum, there may be cardiac decompensation postpartum
Observe closely for signs of infection, hemorrhage, and thromboembolism
Breastfeeding imposes extra demands on the heart - advised on an individual basis not to breastfeed
Lactation consultant - which drugs are safe for breastfeeding

294
Q

Hyperemesis Gravidarum

A

Persistent, uncontrollable vomiting that begins in the first weeks of pregnancy and may continue throughout pregnancy

295
Q

Hyperemesis Gravidarum can cause

A

Loss of 5% or more of pre-pregnancy weight
Dehydration - increased urine specific gravity and oliguria
Acidosis from starvation or alkalosis from loss of acid in gastric fluids
Elevated levels of blood and urine ketones
Fluid and electrolyte imbalance
Hypokalemia
Deficiency of vitamin thiamin, riboflavin, vitamin B₆, vitamin A, and retinol-binding proteins
Psychological stress

296
Q

Hyperemesis Gravidarum mgmt

A

rule-out other causes of persistent N/V
H&H and electrolytes - report abnormalities
Control with crackers in the morning, vitamins, and Rx antiemetics

297
Q

If the simpler methods of Hyperemesis Gravidarum are unsuccessful and wt loss, electrolyte imbalance persists then

A

Intene Antepartum unit
IV fluid and electrolytes replacement
TPN

298
Q

Hyperemesis Gravidarum nursing interventions

A

Record of elimination and observe for signs of dehydration
Daily weight in hospital
Food should be attractively presented in small portions; low fat, easily digested
Soups and other liquids in between meals
Use ginger
Sit upright after meals
Provide emotional support

299
Q

If the pregnant woman had T2 or T2DM before pregnancy, do you need to screen them

A

no need to screen

300
Q

With gestational DM, glucose intolerance is present/not present before pregnancy.

A

not present

301
Q

How do you test for glucose intolerance

A

24 weeks 1-hour test if abnormal then the 3 hour test is abnormal = gestation DM

302
Q

Pregnancy does what to insulin

A

progressive insulin resistance

303
Q

Glucose is transported across the placenta easily by

A

carrier-mediated facilitated diffusion
- maternal insulin does not cross the placenta

304
Q

The glucose levels in the placenta are ___________ _______________ to the maternal levels.

A

directly proportional

305
Q

At the 10th week of gestation, the fetus does what in gestational diabetes

A

begins secreting insulin at levels to use the maternal glucose

306
Q

In the 2-3 trimesters, pregnancy excretes a diabetic effect on the maternal

A

metabolic status

307
Q

Gestational DM Dx

A

1-hour glucose challenge > 140
3 hour Oral Glucose tolerance test
- fasting >95
- 1 hour > 180
- 2 hours > 155
- 3 hours > 140

308
Q

When do you do the glucose intolerance test in pregnancy?

A

24-28 weeks

309
Q

What is the gold standard for dx diabetes in gestation?

A

3 hour oral glucose tolerance test

310
Q

3 hour Oral Glucose tolerance test
women must fast from

A

midnight to the test

311
Q

What are the insulin requirements during the 1st trimester?

A

decreased need

312
Q

What are the insulin requirements during the 2nd trimester?

A

Increased need for insulin; Glucose use increases

313
Q

What are the insulin requirements during the 3rd trimester?

A

Increased need for insulin due to placental maturation and human Placental Lactogen (hPL) production

314
Q

What are the insulin requirements during labor?

A

Usually decreased need for insulin - diabetic women will have glucose level checked hourly and continuous infusion of insulin and glucose is started if needed

315
Q

What are the insulin requirements during the PP

A

Decreased need for insulin - Breastfeeding helps lower the amount of insulin needed

316
Q

Fetal effects from maternal hyperglycemia?

A

Fetal death
Macrosomia-LGA (blood sugar
IUGR if mother Type 1 with vascular changes
Respiratory Distress Syndrome
Hyperbilirubinemia

317
Q

Fetal effects of maternal hypoglycemia

A

Prematurity
Cardiomyopathy or cardiac anomaly
Congenital Defects
Psychiatric disorders

318
Q

Maternal complications from DM

A

Infections
Preeclampsia
Hydramnios
Ketoacidosis
Hypoglycemia
Hyperglycemia

319
Q

IUGR

A

baby is not growing inside the uterus = tiny

320
Q

When the baby grows big so does the maternal heart. Why?

A

activity decreases due to the low perfusion of the heart

321
Q

Self-mgmt of DM in gestation

A

Check blood glucose levels 4-8 times per day
Record blood glucose levels, food intake, activity, and insulin
Self-monitor of urine ketones
Provide an expected plan of prenatal care, tests, and fetal surveillance
Diet is individualized
Provide an expected plan for labor and delivery
Urine dipstick for glucose and protein each office visit
Exercise 3 times/week for at least 20 minutes unless contraindicated
Know symptoms of hypoglycemia: Always have fast-acting carbohydrate
Daily kick counts for 2nd trimester

322
Q

In the 2nd trimester a gestational Diabetic mother needs to monitor

A

daily kick counts

323
Q

Rh + antigen is

A

present

324
Q

Rh - antigen is

A

absent

325
Q

If a person with Rh (-) blood is exposed to Rh + blood, what happens?

A

antigen-antibody response occurs

326
Q

If antibodies form and Rh (-) person is considered

A

sensitized (alloimmunized, isoimmunized)

327
Q

Sensitization may occur in the antepartum via

A

small transplacental bleeds

328
Q

The risk of fetal of blood incompatibility is primarily for

A

subsequent pregnancies after isoimmunization

329
Q

What happens to the baby if the mother is not given Rhogam after/during her 1st baby?

A

hemolysis by maternal IgG antibodies attack the baby
= fetal anemia

330
Q

Fetal anemia

A

Fetus increases RBC production; the presence of nucleated RBCs (erythroblasts) - erythroblastosis fetalis
RBC destruction can lead to hyperbilirubinemia (Kernicterus)
Untreated anemia causes fetal edema called hydrops fetalis

331
Q

erythroblastosis fetalis

A

Fetus increases RBC production; the presence of nucleated RBCs (erythroblasts)

332
Q

(Kernicterus)

A

RBC destruction can lead to hyperbilirubinemia

333
Q

hydrops fetalis

A

Untreated anemia causes fetal edema

334
Q

Maternal Screening for Rh incompatibility

A

1st prenatal visit
- blood type, Rh factor, antibody screening

335
Q

What happens if the mother is Rh (-) with a negative antibody screening and no other complication arises?

A

Rhogam given at 28 weeks

336
Q

If there is an amniocentesis, CVS, abruptio placentae, trauma, or ECV, what needs to be assessed and given?

A

risk of fetal/maternal blood mixing
- Rhogam

337
Q

At delivery, the nurse needs to do a repeat antibody screening in Rh (-) women if the baby is Rh (+) within

A

72 hours

338
Q

T/F: If a test requires a possibility of an Rh (-) mother to pass blood to a Rh (+) fetus, you should wait until 28 weeks even if the test is before 28 weeks.

A

False at the test if before 28 weeks

339
Q

Indirect Coombs Test

A

detects antibodies against RBCs present unbound in the patient’s serum

340
Q

Rh immune globulin products: prevent

A

production of the anti-Rh (D) antibdoies

341
Q

When do you give the Rhogam in antepartum and PP?

A

Antepartum = 28 - 30 weeks gestation
PP = WITHIN 72 HOURS of delivery if the fetus is Rh +
given any risk of blood mixing (trauma, abortion)

342
Q

Do you Rhogam to an alloimmunized pregnant pt?

A

no as it is already too late and the antibodies against the + fetus are made

343
Q

What is done if they are sensitized and pregnant?

A

Anti-D antibody titers

344
Q

Anti-D antibody titers are evaluated every

A

2-4 weeks starting 16-18 weeks gestation

345
Q

If Anti-D antibody titers remain negative then the fetus is

A

not at risk

346
Q

If the Anti-D antibody titers are positive, then the fetus is

A

at risk

347
Q

Goal if the pregnant woman is sensitized

A

birth of a mature fetus who has not developed severe hemolysis/anemia in utero

348
Q

ABO Incompatibility usually involves

A

type o mother and type A or B fetus

349
Q

Anti A and Anti B antibides occur

A

naturally

350
Q

Once pregnant, maternal anti-A and anti-B antibodies

A

cross the placenta and cause hemolysis of fetal RBCs

351
Q

ABO incompatibility is not treated during

A

antepartum period

352
Q

How does the ABO incompatibility affect the babies?

A

mild anemia
hyperbilirubinemia = bili lights

353
Q

Placenta accreta

A

Invasion of the trophoblast is beyond the normal boundary (80%)

354
Q

Placenta increta

A

Invasion of trophoblast extends into uterine myometrium (15%)

355
Q

Placenta percreta

A

Invasion of trophoblast extends into uterine musculature; can adhere to other pelvic organs (5%)

356
Q

In a placenta accreta, increta, or perceta, what is required?

A

hysterectomy
watch for profuse hemorrhage

357
Q

Prolapsed umbilical cord is a

A

OB emergency

358
Q

A prolapsed umbilical cord usually occurs

A

slips under the presenting part
after ROM
- presenting part descends onto the cord, reduces or eliminates blood flow

359
Q

Prolapsed Umbilical Cord risk factors

A

Breech position
Polyhydramnios
High station (- stations) not engaged
Preterm Gestation
High Parity

360
Q

What is the 1st thing you assess when a prolapsed cord is noticed?

A

fetal heart rate monitoring

361
Q

What does the FHRM show with a prolapsed umbilical cord?

A

sustained bradycardia, variable decelerations, or prolonged decelerations

362
Q

When a prolapsed cord is detected what needs to happen to keep the cord from collapsing?-

A

Vaginal Exam with gloved fingers push upward lifting the fetal presenting part off of the cord
- call for assistance and notify anesthesiology and NICU
- stop Oxytocin infusion
- O2 10 L/min by Non-Rebreather
- IV 18 g
- Give Terbutaline to decrease contractions

363
Q

With a prolapsed cord, what can be done to keep the umbilical cord from being compressed?

A

Vaginal Exam with finger pressure until Cesarean birth
Insert catheter and fill with 500mL warmed, sterile normal saline
Left lateral, knee to chest, knee-chest, or Trendelenburg

364
Q

With a prolapsed cord, the baby needs to be born within

A

30 minutes

365
Q

What is essential for the nurse to do during the chaos of a prolapsed cord?

A

keep clam and keep the pt and family informed

366
Q

What is the priority in a prolapsed cord?

A

prompt delivery

367
Q

Trauma is the leading cause of

A

maternal death during pregnancy
due to abdominal injury from MVA
- uterine rupture
- penetrating trauma (GSW)

368
Q

Following trauma, placental abruption is monitored for up to

A

24 hours

369
Q

Unresolved bleeding can lead to

A

maternal exsanguination in 8-10 minutes

370
Q

Uterine Rupture is

A

Tear - wall of the uterus because the uterus cannot withstand the pressure

371
Q

Uterine Rupture is often associated with

A

previous uterine surgery, can occur on unscared uterus
- VBAC

372
Q

Complete Uterine Ruptures

A

direct communication between uterine and peritoneal cavities

373
Q

Incomplete Uterine Rupture

A

tear in the peritoneum lining of the uterus or broad ligament but not the peritoneal cavity

374
Q

Dehiscence Uterine Rupture

A

partial separation of an old uterine scar
- Little or no bleeding occurs, often no signs or symptoms

375
Q

S/S of uterine rupture

A

FHM - earliest signs - non-reassuring FHR, or absent FHR, and loss of contraction pattern
Constant abdominal pain or change in pain cessation of contractions
Loss of fetal station on abdominal palpation
Referred chest or shoulder pain
Hematuria
Hypovolemic shock

376
Q

Mgmt of uterine rupture

A

Emergency C-section - immediate blood products
Neonatal resuscitation should be anticipated

377
Q

Anaphylactoid Syndrome of Pregnancy/Amniotic Fluid Embolism is when

A

Amniotic fluid enters the maternal circulation and is carried to the lungs

378
Q

Amniotic fluid embolism patho

A

Fetal particulate matter in fluid obstructs pulmonary vessels
Failure of the right ventricle occurs early and leads to hypoxemia
Left ventricular failure follows

379
Q

S/S of amniotic fluid embolism

A

Abrupt respiratory distress, depressed cardiac function, and circulatory collapse occurs
DIC is likely

380
Q

Amniotic fluid embolism is often fatal and survivors may have

A

neurological defects

381
Q

Pregnant Substance Abuse can result in

A

poor pregnancy outcomes and early childhood behavioral and developmental problems

382
Q

Substance Abuse can happen with

A

alcohol
cigarette
illicit drugs

383
Q

When assessing the possibility of substance abuse, the nurse should

A

Ask directly about substance use with a nonjudgmental attitude

384
Q

Alcohol is a CNS

A

DEPRESSANT - most common teratogen

385
Q

Alcohol can cause what during pregnancy

A

cause physical and mental birth defects, preterm birth, and miscarriage
- Fetal Alcohol Syndrome Diseases

386
Q

_____ alcohol during pregnancy; passes swiftly to the fetus through the placenta

A

ZERO

387
Q

Smoking/Tobacco Use infants are more likely

A

preterm, wt 1/2 lb less
3x risk of SIDS

388
Q

Nicotine reduces

A

uterine blood flow

389
Q

Carbon monoxide binds to

A

hemoglobin, reducing oxygen-carrying capacity of blood

390
Q

What is a risk in utero of maternal tobacco use?

A

abruptio placentae

391
Q

What are the residual effects past the neonatal period?

A

Deficits in growth, intellectual and emotional development, and behavior
Increased risk for prematurity, bronchitis and pneumonia

392
Q

Methamphetamines AND Cocaine are a CNS

A

STIMULANT

393
Q

Meth from the mother can cause what effects in an OD

A

Seizures, heart attacks, strokes, and maternal deaths

394
Q

When the mother has Meth the fetus is at risk for

A

IUGR, preterm birth, microcephaly, and abruptio placentae

395
Q

What can happen to the mother when taking cocaine

A

vasoconstriction, seizures, abruptio placentae, hallucinations, pulmonary edema, cerebral hemorrhage, respiratory failure, and heart problems

396
Q

What can happen to the fetus when the mother takes cocaine?

A

IUGR, microcephaly, cerebral infarctions, shorter body length, altered brain development, increased incidence of PROM, meconium staining, and premature birth

397
Q

Marijuana maternal s/s

A
  • tachycardia, low blood pressure which can result in orthostatic hypotension
398
Q

Marijuana fetal s/s

A

crosses to placenta; increases carbon monoxide levels, reducing oxygen to fetus

399
Q

Marijuana alters the response of the neonates by

A
  • altered response to visual stimuli, increased tremulousness, high-pitched cry
400
Q

Marijuana fetal long-term effects

A
  • deficits in memory, attention, cognitive function or motor skills
401
Q

Marijuana can cause what to gestation

A

shortened and higher incidence of IUGR

402
Q

Heroin/opioid abuse is linked to

A

adverse consequences for the mother and fetus

403
Q

Heroin/opioid abuse fetal risks

A

fetal physiological dependence and maternal lifestyle associated with heroin use
- NAS

404
Q

What should be used for Heroin/opioid use when they are in labor?

A

Methadone

405
Q

What should be avoided in pregnant Heroin/opioid abuse?

A

Naloxone

406
Q

NAS

A

Neonatal Abstinence Syndrome
- withdrawal in NICU

407
Q

Perinatal Loss can occur in

A

Previous pregnancy, early or late pregnancy loss
Concurrent death and survival in multifetal pregnancy
Perinatal palliative or hospice care services

408
Q

Perinatal Loss Interventions

A

Allow expression of feelings
Acknowledging the infant (NAME IF HAVE ONE)
Presenting the infant to the parents – hold, See, pictures, and bond
Preparing a memory packet
Respect cultural practices
Assist with other needs – siblings
Provide follow-up care including referrals (counseling, support groups)

409
Q

Swanson’s Theory of Caring

A

knowing
being with
doing for
enabiling
maintaining beliefs

410
Q

Knowing -

A

understanding the event, avoiding prior assumptions about the meaning of the event, philosophy of personhood, willing to recognize others as a significant being

411
Q

Being with -

A

emotionally present, conveying ongoing availability, sharing feelings, one small step beyond knowing

412
Q

Doing for -

A

doing for one what they would do for themselves, comforting, anticipatory, protective of the other’s needs, preserving dignity

413
Q

Enabling

A

facilitating the passage through life transitions and unfamiliar events, using expert knowledge for the betterment of the other, to facilitate the capacity to grow in the other

414
Q

Maintaining belief

A

sustaining faith to get through the event, to face a future with meaning, believing in them and holding them in esteem, maintaining a hope-filled attitude while offering realistic optimism

415
Q

If the patient has a c-section before 28 weeks, do you need to give the Rhogam before the c-section?

A

no, but give it within 72 hours after the baby is born

Module 6 (Labor And Delivery) (7 decks)

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