T4: High Risk Perinatal Care: Gestational Cond.

Question 1

gestational hypertension

Answer 1

mom is 20 weeks of gestation OR MORE and her blood pressure is elevated (140/90), NO PROTEIN IN URINE

Question 2

chronic hypertension

Answer 2

elevated BP BEFORE 20 weeks, NO PROTEIN IN URINE

Question 3

preeclampsia

Answer 3

BP is elevated WITH PROTEIN IN URINE

Question 4

s/s of preeclampsia

Answer 4

o Generalized edema, rapid weight gain (>5lbs in one week), vasoconstriction of cerebral vessels
o S/S; HA, blurred vison, abdominal pain, excessive weight gain, protein in urine

Question 5

what can happen if preeclampsia is left untreated

Answer 5

eclampsia or HELLP syndrome

Question 6

HELLP syndrome

Answer 6

• HEMOLYSIS (Burr cells on peripheral smear)
• ELEVATED LIVER ENZYMES (AST, ALT)
• LOW PLATELETS

Question 7

what do we need to diagnose HELLP

Answer 7

LAB RESULTS/TESTS

Question 8

What is the cure of preeclampsia?

Answer 8

delivery

Question 9

eclampsia

Answer 9

when preeclampsia progresses, and they HAVE A SEIZURE( If mom has seizure, baby will not be well oxygenated)

Question 10

preeclampsia or eclampsia superimposed on chronic hypertension

Answer 10

patient had chronic HTN before getting pregnant but now with pregnancy they have getting PROTEIN IN THE URINE or SEIZURES (depending on if its preeclampsia or eclampsia)

Question 11

physical exam of preeclampsia

Answer 11

Edema, reflexes (monitor DTR for the presence of hyper reflexia or clonus because it indicated increased CNS irritability), proteinuria

Question 12

s/s of eclampsia

Answer 12

o Headache
o Hyperreflexia
o Proteinuria
o Edema
o Clonus (indicated cerebral edema and patient can have a seizure)
o Visual changes (blurred vision)
o Epigastric pain (because liver enzymes are elevated and liver is swollen)
o Excessive weight gain (>5lbs in one week)

Question 13

immediate care for ecclampsia

Answer 13

o Maintain patient airway and safety during seizure
- Seizure precautions
o Stabilize mother after seizure
o Magnesium sulfate
o Fetal status

Question 14

education for eclampsia

Answer 14

EDUCATE about HA, blurred vision, and epigastric because mom can still have a seizure up to 6 weeks after delivery

Question 15

Labetalol IV

Answer 15

an antihypertensive is needed to lower the blood pressure (slows HR and reduced BP)

Question 16

other preeclampsia BP medications

Answer 16

Hydralazine IV
Nifedipine PO

Question 17

Mag sulfate is used for

Answer 17

an anticonvulsant to prevent seizures, preterm labor (slows uterine ctx), & neural protection (decrease preterm brain bleeds)

Question 18

administration of mag sulfate

Answer 18

MAG ALWAYS GOES ON A PUMP, administered as a secondary IV fluid

Question 19

In a mom with a premature baby and preeclampsia what steroid is given

Answer 19

betamethasone

Question 20

How is betamethasone administered?

Answer 20

2 injections (12mg IM, then 24 hours first dose it is repeated), now mother is in her steroid window

Question 21

dosage for mag sulfate

Answer 21

o 4-6 gram loading dose
o 2-3 grams per hour maintenance infusion

Question 22

Goal serum magnesium level

Answer 22

4-7 mEq/L

Question 23

Antidote for magnesium sulfate toxicity

Answer 23

CALCIUM GLUCONATE

Question 24

what do we monitor for when a patient is on mag sulfate

Answer 24

Respitatory rate!

Question 25

intervention if RR is low with mag sulfate

Answer 25

TURN THE MAG OFF THEN ADMINSTER CALCIUM GLUCONATE

Question 26

hyperemesis gravidarum

Answer 26

excessive vomiting during pregnancy

Question 27

clincal manifestation of hyperemesis gravidarum

Answer 27

o Excessive vomiting o Weight loss o Dehydration fluid and electrolyte imbalabces

Question 28

intervention for hyperemesis gravidarum

Answer 28

zofran

Question 29

first trimester

Answer 29

1-13 weeks

Question 30

third trimester

Answer 30

27-40 weeks

Question 31

first trimester hemorrhagic disorders

Answer 31

Miscarriage or ectopic pregnancy

Question 32

third trimester hemorrhagic disorders

Answer 32

Placenta previa and abruptio placentae

Question 33

miscarriage (spontaneous abortion)

Answer 33

: pregnancy ended before 20 weeks, < 500 gm, not viable

Question 34

When do most miscarriages occur?

Answer 34

before 8 weeks gestation

Question 35

threatened abortion

Answer 35

mom will present with slight spotting (bleeding), mild uterine contractions (cramping), and NO CERVICAL DILATION

Question 36

Inevitable abortion

Answer 36

they do not know why, but there is moderate to heavy bleeding and the CERVIX IS DILATED/OPEN so mom WILL abort (lose the baby)

Question 37

incomplete abortion

Answer 37

bleeding is moderate to heavy; the cervix is DILATED and the baby could be delivered but the placenta is retained

Question 38

complete abortion

Answer 38

BOTH placenta and fetus are completely expelled, may have slight bleeding and the cervix after the placenta and fetus are expelled, the cervix will start to close

Question 39

missed abortion

Answer 39

bleeding, then stops, and mom can go on to have a normal pregnancy, CERVIX is closed

Question 40

bicornuate uterus

Answer 40

women that have one uterus but has a septum in between (can be pregnant on one side but not the other)

Question 41

recurrent abortion

Answer 41

when mom gets to a certain week at each pregnancy, she aborts the baby

Question 42

Cervix insufficiency

Answer 42

- Painless cervical dilation - Cervical shortening

Question 43

cerclage

Answer 43

suture around the cervix and close it, the suture stays in until 36 weeks

Question 44

when is the recommended time for a cerclage placement

Answer 44

16 weeks or before

Question 45

ectopic pregnancy

Answer 45

fertilized ovum (egg) implants outside the uterine cavity (can get stuck in fallopian tube)

Question 46

Management of ectopic pregnancy

Answer 46

Stable (not ruptured): Methotrexate (baby will be aborted) Unstable (ruptured): Surgery

Question 47

hydatidiform mole

Answer 47

ONLY the placenta is developed without a fetus - No embryo, fetus, or amniotic sac

Question 48

management for hydatidiform mole

Answer 48

o Methotrexate will be used to expel placenta o Avoid pregnancy for 1 year

Question 49

s/s of hydatidiform mole

Answer 49

Vaginal blessing (prune juice color) Increase in hCG Rapid uterine growth Failure to detect fetal heart activity A distinct snowstorm pattern on ultrasound with no evidence of developing fetus

Question 50

diagnosis for hydatidiform mole

Answer 50

o Elevated hCG levels, no heartbeat and no growth, snow storm pattern on US

Question 51

placenta previa

Answer 51

occurs when placenta is before the baby (Usually, placenta is at the top of the fundus, but here it is in the lower uterine segment)

Question 52

marginal placenta previa

Answer 52

implanted in lower uterus but its lower border is >3cm from internal cervical os

Question 53

complete placenta previa

Answer 53

placenta completely covers internal cervical os

Question 54

partial (low lying) placenta previa

Answer 54

lower border of placenta is within 3dm of internal cervical os but does not fully cover it

Question 55

clinical manifestations for placenta prevus

Answer 55

BRIGHT RED BLOOD AND PAINLESS in the third trimester

Question 56

when a patient comes in with suspected placenta previa, what is done

Answer 56

o NEVER DO A VAGINAL EXAM, DO AN ULTRASOUND (level 2) - Want to know exactly where placenta is placed

Question 57

Maternal and fetal outcomes for placenta previa

Answer 57

MUST DO A C-SECTION -bed rest for as long as possible

Question 58

abruptio placentae

Answer 58

premature separation of placenta from lining of the uterus after 20 weeks' gestation OBSTECTRICAL EMERGENCY MUST DO A C-SECTION

Question 59

goal of abruptio placentae

Answer 59

deliver baby as soon as possible

Question 60

Types of abruptio placenta

Answer 60

o Grade I Mild separation: 10-20% o Grade II Moderate separation: 20-50% o Grade III Severe separation: > 50%

Question 61

clinical manifestations of abruptio placenta

Answer 61

o DARK RED BLEEDING AND PAINFUL o Bleeding can be seen vaginally or concealed (abdomen feels board-like)

Question 62

maternal/fetal outcome for abruptio placenta

Answer 62

o No O2 or blood supply to baby, must do a C SECTION

Question 63

Cholelithiasis and Cholecystitis

Answer 63

o Causes generalized itching, induction may be suggested so that a surgeon can take over to take out the gallbladder