OB Exam 2 > Gestational Condition > Flashcards

Gestational Condition Flashcards

(49 cards)

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1
Q

Hypertension in Pregnancy: Significance & Incidence

A
  • Preeclampsia complicates approx. 5-10% of all pregnancies
  • HTN disorders of preg are the most common medical complication reported during preg
    > hemorrhagic/SI are 2nd & 3rd
  • Significant contributor to maternal & perinatal morbidity & mortality
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2
Q

Gestational Hypertension

A
  • Develops after 20th wk of preg w/out proteinuria
  • Need more than 1 HTN reading
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3
Q

Chronic Hypertension

& risk for, & fetal effects

A
  • HTN before pregnancy or diagnosed before 20 wks
  • Risk for
    > placental abruption
    > superimposed preeclampsia: development of preeclamp from HTN
    > incrd perinatal mortality
  • Fetal Effects
    > growth restriction
    > preterm birth
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4
Q

Preeclampsia

A
  • HTN & proteinuria develops after 20wks
    or
  • HTN w/ end organ damage
    > renal/liver
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5
Q

Eclampsia

A
  • Seizure activity or coma in women diagnosed w/ preeclampsia
  • No previous hx
    > or pre-existing patho of seizure disorder
  • Eclamptic seizures can occur before, during, or after birth
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6
Q

Chronic HTN w/ Superimposed Preeclampsia

A
  • A sudden incr in blood pressure tht was previously well-controlled
  • New-onset proteinuria or a sudden & sustained incr in proteinuria in a women known to have proteinuria before conception or early in pregnancy
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7
Q

Preeclampsia - Pathophysiology

A
  • Disruptions in placental perfusion & endothelial cell dysfunctions
  • Placental itching (spasm)
    > = small baby
  • Generalized vasospasm
    > incrd risk of clots
  • Spiral arteries don’t remodel to allow for incrd blood flow
  • Reduced kidney perfusion
    > protein in urine
    > generalized edema
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8
Q

Preeclampsia - Etiology

A

S/S only develop during pregnancy and disappear after birth

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9
Q

Preeclampsia - Risk Factors

A
  • Fam hx
  • Multifetal pregnancy
  • African-American race
  • Obesity
  • 19-40yrs
  • Any pre-existing medical or genetic conditions
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10
Q

Preeclampsia: HELLP Syndrome

A
  • Lab diagnostic variant of severe preeclamp involves hepatic dysfunction, characterized by:
    > Hemolysis (H)
    > Elevated liver enzymes (EL)
    > Low platelets (LP)
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11
Q

Preeclampsia: HELLP Syndrome - Associated w/ Incrd Risk For

A
  • Pulm edema
  • Renal failure
  • Liver hemorrhage or failure
  • Disseminated intravascular coagulation (DIC)
    > use up all clotting factors; bleed out of all holes
  • Placental abruption
  • Acute resp distress syndrome
  • Sepsis
  • Stroke
  • Fetal & maternal death
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12
Q

Identifying & Preventing Preeclampsia

LILI LUK

A
  • Physical Examination
    > dependent, pitting edema
    > DTR (clonus): suppose to be negative
    > blurred/double vision
    > RUQ pain: liver ischemia
    > listen to lungs/HR: pulm edema
    > SOB
  • Lab Tests
    > urine output (oliguria)
    > kidney labs (Cr/proteinuria)
    > low platelets
    > incrs factor 8
    > liver func tests
    > lipids incrd
    > incrd Hct
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13
Q

Mild Gestational HTN & Mild Preeclampsia

treatment
diet

A
  • Treatment:
    > BP control
    > May have some restriction
    > Maternal/fetal assessment
  • Diet
    > don’t reduce salt
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14
Q

Severe Gestational HTN & Severe Preeclampsia

cure
med

A
  • Cure
    > delivery
  • Drug used during delivery to prevent eclampsia
    > magnesium sulfate: prevent & treat a seizure
  • severe GHTN & preeclamp put pregnancy at greater risk for complications
    > control BP
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15
Q

Magnesium Sulfate

how to admin
therapeutic lvls
excretion

A
  • Drug of choice for prevention & treatment of eclampsia
  • Administered almost excusively IV
    > 4-6gram loading dose over 15-20mins
    > followed by maintenance dose of 2gram/hr after delivery
    > big bore IV
  • Therapeutic lvls
    > 4-7mEq/L
  • Excreted by kidneys
    > if compromised, lvls will rise
    > watch I&Os for toxicity
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16
Q

Magnesium Sulfate - Adverse Effects

A
  • Warming
  • Flushing
  • Diaphoresis
  • IV site irritation
  • may need Pitocin to help contract since mag causes relaxation
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17
Q

Magnesium Sulfate - Mild Toxicity

A
  • Appears drunk:
  • Lethargy
  • Muscle weakness
  • Dcrd DTRs
  • Double vision
  • Slurred speech
  • draw labs, watch I&Os
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18
Q

Magensium Toxicity - Severe Toxicity

A
  • Maternal hypotension
  • Bradycardia
    > dcrd HR
  • Bradypnea
    > dcrd RR
  • Cardiac arrest
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19
Q

Magnesium Toxicity - Managing Toxicity

A
  • Discontinue infusion
    > priority
  • Notify HCP
  • Administer Calcium Gluconate
    > antidote
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20
Q

Hyperemesis Gravidarum - Define

Study These Flashcards
A
  • Excessive vomiting accompanied by dehydration, electrolyte imbalance, ketosis, & acetonuria
  • last entire pregnancy
21
Q

Hyperemesis Gravidarum - Etiology

Study These Flashcards
A
  • Relaxation of the smooth muscle of the stomach
  • Incrd hCG lvls
22
Q

Hyperemesis Gravidarum - CMs

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A
  • Weight loss <5%
  • Dehydration
  • Electrolyte imbalance
23
Q

Hyperemesis Gravidarum - Care Management

Study These Flashcards
A
  • IV fluids
  • Pyridoxine (vit B6)
24
Q

Hemorrhagic Disorders - Maternal Risks

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A
  • Hemorrhagic disorders in pregnancy are medical emergencies
  • Maternal blood loss dcrs oxygen-carrying capacity
    > incrd risk for: hypovolemia, anemia, infection, preterm labor & birth
    > adversely affects oxygen delivery to fetus
25
Hemorrhagic Disorders - Fetal Risks
**Fetal risks includes blood loss or anemia, hypoxemia, hypoxia, anoxia, & preterm birth**
26
Spontaneous Abortion
**Spontaneous abortions often lead to a D&C**
27
Reduced Cervical Competence (Cerclage)
- **A procedure in which the cervical opening is stitched closed to prevent or delay preterm birth due to premature dilation** - **Prophylactic Cerclage** > placed at 11-15wks of gestation
28
Ectopic Pregnancy
- **Fertilized ovum implanted outside the uterine cavity** - **Most occur in fallopian tube**(Ampulla)
29
Ectopic Pregnancy - CMs
- **Abdominal pain** - **Delayed menses** - **Abnormal vaginal bleeding** - **Unilateral pelvic pain**
30
Ectopic Pregnancy - Management
- **Medical** > Methotrexate: stops growth and prevents rupture - **Surgical** > Salpingectomy: removal of one or both fallopian tube, cannot come to term
31
Gestational Trophoblastic Disease - Define ## Footnote & education
- **Define**: abnormal fertilization w/out viable fetus > tumor, mass of cells - **Education**: > risk for developing a type of cancer > measure hCG for a year > don't get pregnant for next year: monitoring hCG
32
Gestational Trophoblastic Disease - CMs
- **Vaginal bleeding** - **Significantly larger uterus**
33
Gestational Trophoblastic Disease - Management
- **Most end up passing spontaneously** - **Suction curettage (D&C) is safe, rapid, and effective if necessary** - **Do NOT recommend induction of labor w/ oxytocin or prostaglandins**
34
Late Pregnancy Bleeding: Placenta Previa - Define ## Footnote & fetal risks
- **Placenta implanted in LOWER uterine segment near or over interal cervical** - **Excessive bleeding** - **Fetal risks include malpresentation, preterm birth, fetal anemia, & congenital anomalies**
35
Late Pregnancy Bleeding: Placenta Previa - Classification & CMs
- **Classified based on** > complete; more painless bleeding > marginal - **CMs** > abnormal placental attachment > excessive bleeding: ask if painful
36
Late Pregnancy Bleeding: Placenta Previa - Diagnosis
**Transabdominal ultrasound examination**
37
Late Pregnancy Bleeding: Placenta Previa - Management
- **Expectant management: observation & bed rest** > no treatment unless symps appear - **Alternative birth**: > cesarean birth > home care - **Active Management**: > birth regardless of gestational age if excessive bleeds or complications arise
38
Late Pregnancy Bleeding: Abruptio Placentae - Define
- **Premature separation of placenta** - **Biggest concern w/ pre-existing conditions & trauma**
39
Late Pregnancy Bleeding: Abruptio Placentae - Classifications
- **Grade 1** (mild) - **Grade 2** (moderate) - **Grade 3** (severe)
40
Late Pregnancy Bleeding: Abruptio Placentae - CMs
- **Vaginal bleeding** > very painful - **Abdominal pain** - **Uterine tenderness** - **Contractions**
41
Late Pregnancy Bleeding: Abruptio Placentae - Maternal Outcomes
- **Blood loss** - **Coagulopathy** - **Need for transfusion** - **End-organ damage**
42
Late Pregnancy Bleeding: Abruption - Etiology
- **Maternal HTN, chronic or pregnancy related, is the most common risk factor** - Drugs/trauma
42
Late Pregnancy Bleeding: Abruptio Placentae - Fetal Outcomes
- **Fetal growth restriction** > low birth weight, organ dysfuntion - **Oligohydramnios** > low amniotic fluid - **Preterm birth** - **Hypoxemia** > low oxygen in blood - **Stillbirth**
43
Late Pregnancy Bleeding: Abruption - Management
- **Depends on severity, if stable they will just watch** - **Unstable then active management & delivery required**
44
Disseminated Intravascular Coagulation (DIC) - Pathophysiology
- **Diffuse clotting causing widespread external & internal bleeding** - **Triggered by large amounts of tissue thromboplastin** > placental abruption or dead fetus - **Triggered by widespread damage to vascular integrity** > severe preeclampsia, HELLP, gram neg sepsis
45
Disseminated Intravascular Coagulation (DIC) - Management
- **Correction of underlying cause** - Volume expansion - Rapid replacement of blood products and clotting factors - Optimization of oxygenation - Continued reassessment of lab parameters
46
Trauma During Pregnancy - Maternal Physiologic Characteristics
- **Requires strategies adapted for appropriate resuscitation, fluid therapy, positioning, assessments**: - **Cardiac Output** > could have no signs of shock until more than 30% of blood lost - **Circulating Blood Volume** > can lose 1000mL of blood - **Decreased Intolerance for Hypoxia Apnea** > risk for acidosis - **Uterus & Bladder Positioning** > risk for vena caval compression in supine - **Elevated Lvls of Progesterone** > relaxes LES and an incr in hydrochloric acid, can result in aspiration, protect airway
47
Trauma During Pregnancy - Fetal Physiologic Characteristics
- **Careful monitoring of fetal status assists greatly in maternal assessment** - **Fetal monitor tracing works as "oximeter" of internal maternal well-being**
48
Trauma During Pregnancy - Nursing Care Management
- **Immediate stabilization** - **Primary Survey** > cardiopulm resuscitation - **Seconday survey** - **Electronic fetal monitoring** - **Fetal-maternal hemorrhage** > ultrasound > radiation exposure - **Perimortem cesarean delivery**
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