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OB....CH #5 Complications During Pregnancy
Terms in this set (94)
the end of a pregnancy before the fetus is viable, whether spontaneous or elective
age of viability
20 weeks of gestation; the fetus can potentially survive outside the uterus, after birth
closing of the cervix with a suture to prevent early dilation and spontaneous abortion
disseminated intravascular coagulation...DIC
a condition affecting the blood's ability to clot and stop bleeding
pregnancy-induced hypertension complicated by one or more seizures
hemolytic anemia in the fetus caused by transplacental transmission of maternal antibodies to fetal RBC's. This disorder usuall results from incompatibility between maternal and fetal blood groups, often Rh antigens
-intrauterine transfusion may be done for the severly anemic fetus
-fetal assessment tests done throughout pregnancy
gestational diabetes mellitus ...GDM
an endocrine disorder that manifests during pregnancy
polyhydramnios; an excess of amniotic fluid, leading to overdistention of the uterus.....often seen in diabetic pregnant women even if there is no coexisting fetal anomaly
a mechanical defect in the cervix, making it unable to remain closed throughout pregnancy and resulting in spontaneous abortion
-the leaking of fetal Rh+ blood into the Rh- mother's circulation, causing her body to respond by making antibodies to destroy the Rh+ erythrocytes
an abnormally large infant, or neonatal birth weight above the 90th percentile
a potentially dangerous pregnancy complication characterized by high blood pressure
termination of a pregnancy fter 20 weeks gestation
products of conception....POC
the tissue derived from the union of an egg and a sperm; fetal, placental,or membrane tissue that remains inutero following delivery or abortion
a nongenetic factor that can produce malformations of the fetus
like grand-mal; facial muscle twitch, followed by generalized contraction of ALL muscles, then alternate contraction & relaxation of the muscles
-uses high frequency sound waves to visualize structures within the body
AFV...amniotic fluid volume
-an ultrasound scan that measures the amniotic fluid pockets in all 4 quadrants
MRI...magnetic resonance imaging
-noninvasive radiological view of feal structures, including the placenta
-maternal assessment of fetal movement; fewer than 3 in 1 hr, or 10 in 12 hours
doppler ultrasound blood flow assessment
-high-frequency sound waves to study the flow of blood through the vessels
-test determines the level of this fetal protein in serum or amniotic fluid sample; correct interpretation requires an accurate gestational age; defects like sins bifida, anencephaly
CVS.....chorionic villus sampling
-sampling consists of obtaining a small part of the developing placenta to analyze fetal cells at 10-12 weeks gestation
-insertion of a thin needle through abdominal & uterine walls to obtaina sample of amniotic fluid; usually done at 15-17 weeks.
****sampling BEFORE 15 weeks NOT RECOMMENDED due to risk of Club Foot
-uses an electric fetal monitor to evaluate fetal heart rate for accelerations of at least 15 BPM lasting 15 seconds in a 20 minute period. Fetal movements do not have to accompany accelerations: identifies fetal compromise in conditions related to poor placental function
-profile consists of a group of 5 fetal assessments.....fetal heart rate and reactivity (NST), fetal breathing movements, fetal body movements, fetal tone/closure of the hand, and volume of amniotic fluid
CST....contraction stress test
-evaluates the feteal heart rate in response to mild uterine contractions by using an electronic fetal monitor
percutaneous umbilical cord sampling
-obtains a fetal blood sample from a placental vessel of from the umbilical cord; may be used to give blood transfusion to anemic fetus
hypertensive disorders of pregnancy
-Preecalmpsia with superimposed chronic hypertension
risk factors for GH
-family history of GH....mother, sister
-age more than 35 or less than 19
-chronic renal disease
'NORMAL' MORNING SICKNESS
-PERSISTENT nausea & vomiting, often with COMPLETE inability to retain food & fluids
-SIGNIFICANT weight loss...more than 5% or pre-pregnant weight
-DEHYDRATION as evidenced by a dry tongue and mucous membranes, decreased turgor of the skin, scant & concentrated urine, and high serum Hct level
-electrolyte & acid-base IMBALANCES
-psychological factors such as unusual stress, emotional immaturity, passivity, or ambivalence about the pregnancy
Danger Signs of Pregnancy
-a sudden gush of fluid from the vagina
-edema of face & hands
-severe, persistent headache
-blurred vision or dizziness
-chills with fever greater than 100.4 F/38.0 C
-painful urination or reduced urine output
the most common fetal diagnostic tests given for complication during pregnancy....
types of abortions with S/S.....
-THREATENED...cramping, backache with light spotting; cervix is closed, no tissue is passed
-INEVITABLE...increased bleeding, cramping; cervix dilates
-INCOMPLETE...bleeding, cramping, dilation of cerevix, passage of tissue
-COMPLETE...passage of all POC; cervix closes; bleeding stops
-MISSED...fetus dies in utero but is not expelled; uterine growth stops; sepsis can occur
-RECURRENT...2 or more consecutive spontaneous abortions; habitual abortion
-THERAPEUTIC...intentional termination of pregnancy to preserve the health of the mother
-ELECTIVE...intentional termination of the pregnancy for reasons other than health of the mother
ectopic pregnancy S/S.....
-lower abdominal pain
-sometimes light vaginal bleeding
-sudden severe lower abdominal pain, if tube ruptures
-shoulder pain accompanies bleeding into the abdomen
-signs of hypovolemic shock
bleeding disorders in early pregnancy....
-hydatidiform mole pregnancy
S/S of hypovolemic shock
-fetal heart rate changes...increased, decreased, less fluctuation
-shallow, irregular respirations; air hunger
-decreased or absent urine output; less than 30 mL/hr
-pale skin or mucous membranes
-cold, clammy skin
nursing care of early pregnancy bleeding disorders
-document amount & character of bleeding
-save anything that looks like clots or tissue for evaluation by a pathologist
-perineal pad count with estimated amount of blood per pad...ex: 50%
-monitor vital signs
-if actively bleeding, woman should be kept NPO in case surgical intervention is needed
post abortion teaching....
-report increased bleeding
-take temp q8 for 3 days
-take an oral iron supplement if prescribed
-resume sexual activity as recommended by the health care provider
-return to health care provier at the recommended time for a checkup and contraception info
-pregnancy can occur before the first menstrual period returns after the abortion procedure
ectopic pregnancy facts....
-95% occur in the fallopian tubes
-scarring or tubal deformities may result form....hormonal abnormalities, inflammation, infection, adhesions, congenital defects, endometriosis
treatment for an ectopic pregnancy
-priority it to control bleeding
-3 actions that can be taken
1. no action taken
2. treatment with methotrexate to inhibit cell division
3. surgery to remove pregnancy from the tube
S/S of hydatidiform mole pregnancy
-rapid uterine growth
-failure to detect fetal heart activity
-signs of hyperemesis gravidarum
-unusually early development of GH
-higher than expected levels of hCG
-a distinct 'snowstorm' pattern on US with no evidence of a developing fetus
treatment for a hydatidiform mole pregnancy
-dilation & evacuation
follow-up care for a hydatidiform mole pregnancy
-hCG levels are checked/tested until it is undetectable....levels are followed for 1 year
-delay conceiving until follw-up care is complete
-Rhogam prescribed for Rh- woman
bleeding disorders of late pregnancy
-premature separation of a placenta that is normally implanted
-predisposing factors....hypertension, cocaine, smoking, poor nutrition, blows to the abdomen, previous history of abruptio placentae, folate deficiency
-DARK RED bleeding
-enlarging uterus suggests accumulating blood within the cavity
-uterus is tender & unusually firm...boardlike
-frequent uterine contractions
-occurs when the placenta develops in the lower part of the uterus rather than the upper
-3 degrees, depending on where the placenta is located in relation to the cervix
****marginal...within 2-3 cm of the cervical opening
****partial.....placenta partially covers the cervial opening
****total....placenta completely covers the cervical opening
-bright red vaginal bleeding
-fetus in abnormal presentation
complications of placenta previa...
-fetus.neonate may have anemia or hypovolemic shock
-fetal hypoxia may occur
-woman is more likely to experience infection or postpartum hemorrhage
complications of abruptio placentae
-fetus may or may not have problems; fetal anemia or hypovolemic shock
-disseminated intravascular coagulation/DIC...clotting factors consumed, rest of body compromised
biggest distinguishing factor between abruptio placentae & placenta previa is????
care of the pregnant woman with excessive bleeding....
-document blood loss
-closely monitor vital signs, including I & O
-observe for pain, uterine rigidity or tenderness
-verify that orders for blood typing & corss match have been carried out
-monitor IV infusion
-prepare for surgery, if indicated
-monitor fetal heart rate & contractions
-monito lab results, including coagulation studies
-administer O2 by mask
-prepare for newborn resuscitation
S/S of gestational hypertension: GH, preeclampsia, eclampsia
-an increase over baseline BP of 30 mmHg or more systolic
-15 mmHg diastolic increase
-occurs after 20 weeks of gestation
-edema; sudden excessive weight gain
-PREECLAMPSIA....also renal involvement/proteinuria, CNS involvement severe headache, blurry vision, decreased urine production, pulmonary edema, epigastric pain, blood clotting HELLP syndrome
treatment for GH/preeclampsia/eclampsia
-maintaining blood flow to woman's vital organs & placenta; prevent convulsions
-Mg sulfate administered to reduce seizure activity
-close fetal monitoring/kick counts
-check urine for protein
-monitor uterine contractions
-PREVENTION & EARLY DETECTION of GH....improve diet, early & regular prenatal care!!!
BIRTH is the cure for GH
HELLP syndrome is
Mg Sulfate administration with GH
-a therapeutic level of 4-8 mg/dL
-hourly monitoring of.....urine I & O qh, respirations qh, level of consciousness, O2 saturation qh, deep tendon reflexes qh-q4, BP qh, temp q4, urine protein checked every void, lab levels of Mg q4
given to prevent/stop seizures
what do you give for Mg toxicity????
10% Calcium GLucomate....keep at bedside
each prenatal visit includes screening for....
nursing care focuses on....
1. promoting prenatal care
2. helping pt to cope with therapy
3. caring for the acutely ill woman...
4. administering medications
S/S of deterioration....
-increased hypertension; BP of 160/100 or higher
-signs of CNS irritability; facial twitching or hyperactive deep tendon reflexes
-decreased urine output; less than 25 mL/hr
-abnormal fetal heart rates
-severe headache, visual disturbances, epigastric pain....oftene immediately precedes convulsion
S/S of possible Mg toxicity/factors that may cause Mg toxicity....
-absent deep tendon reflexes
-respiration rate under 12 breaths/min
-urine output less than 30 mL/hr...allows accumulation of excess Mg in the blood
-serum Mg levels above 8 mg/dL
RhoGAM info.....who gets it and why
-if woman is Rh- and baby/fetus is Rh+, woman receives injection at 28 weeks gestation and within 72 hours after birth/abortion/miscarriage/hydatidiform mole pregnancy/turning of the baby
-if the maternal and fetal blood factors differ, the mother's body will produce antibodies to destroy the foreign fetal RBC. These antibodies will pass thru the placenta to the fetus and destroy the Rh+ blood cells of the fetus
-also given after amnio, woman experiences bleeding during pregnancy,
Rh- blood type is an.....
autosomal recessive trait
Rh+ blood type is a...
Rh incompatibility can ONLY occur if....
the woman is Rh- and the fetus is Rh+
-type 1 or type 2 diabetes mellitus that existed before pregnancy occurred
-glucose intolerance with onset during pregnancy
-true GDM usually returns to normal by 6 weeks postpartum
risks associated with diabetes and pregnancy....
-preterm labor & premature rupture of the membranes
-hydramnios...excessive amniotic fluid
-infections: vaginitis, UTI's
-complications of large fetal size: birth canal injuries, forceps assisted birth or C-section
FETAL & NEONATAL EFFECTS
-intrauterine growth restriction
-delayed lung maturation; respiratory distress syndrome
-neonatal hyperbilirubinemia & jaundice
-neonatal polycythemia, excess RBC, caused by hypoxia
how does pregnancy effect glucose metabolism?
-hormones estrogen & progesterone, enzyme insulinase produced by the placenta and increased prolactin levels have two effects....
1. increased resistance of cells to insulin
2. increased speed of insulin breakdown
- woman will have periods of hyperglycemia because the fetus continually draws glucose from her
-the fetus is at risk for organ damage resulting from the hyperglycemia
-yearly bloodwork done postpartum
major risk for congenital abnormalities to occur from maternal hyperglycemia......
during the embryonic period of development; weeks 1-8
factors linked to GDM...
-maternal obesity....over 198 lbs
-large infant....about 9 lbs
-maternal age over 25
-previous unexplained stillbirth or infant having congenital abnormalities
-history or GDM in a previous pregnancy
-family history of DM
-fasting glucose over 126 mg/dL or postmeal glucose over 200 mg/dL
treatment for GDM....
-diet modification....3 meals, 2 snacks to maintain stable levels
-monitor blood glucose levels...several times a day
-fetal assessments done more frequently
-insulin administration.....orally....Glyburide not teratogenic and injecting insulin, insulin pump
care of a woman with GDM, during labor...
-IV infusion of dextrose may be needed
-assess blood glucose levels hourly and adjust accordingly
what is the SAFEST medication to give a pregnant woman with GD?
INSULIN....it does not cross the placenta
treatment for iron-deficiency anemia....
-woman needs extra iron, oral doses of elemental iron
-continnue therapy for about 3 months after anemia has been corrected
the reduced ability of the blood to carry oxygen to the cells
4 types of anemia
2 nutritional types: iron deficiency, folic acid deficiency
2 genetic disorders: sickle cell disease, thalassemia
sickle cell disease...
-autosomal recessive disorder
-causes distorted RBC during hypoxic or acidotic episodes
-painful during crisis
-can cause preterm birth, growth restriction, fetal dermise
-genetic trait causes abnormality in one of two chains of hemoglobin
-major, from both parents
-minor, from one parent
-woman has few problems other than anemia
-fetus does not appear affected
-body absorbs and stores iron in higher than normal amounts
nursing care/teaching for anemic pt
-take supplements with OJ
-do NOT take with milk or coffee
-stools will be dark green to black
-do not take antacids
-avoid infectious people
-prevent dehydration and activities that cause hypoxia
TORCH...infections that can be devastating to fetus or newborn
when is rubella vaccine administered?
-if pregnant woman is NOT immune, it is offered postpartum
-woman is advised to NOT get pregnant for at least 1 month after the immunization
2 ways that infant can be infected with herpes.....
1. thru contact with active lesions
2. if the virus ascends into the uterus after the mebranes rupture
-infected infant may have: intellectual disability, seizures, blindness, deafness, dental abnormalities
-treatment....no effective treatment is known; therapeutic abortion may be offered if CMV is discovered in ealry pregnancy
-destructive effects on fetus: microcephaly, intellectual disability, congenital cataracts, deafness, cardiac effects, intrauterine growth restriction
-transmitted by blood, saliva, vaginal secretions, semen, breast milk, can also cross the placenta
-upon delivery, infant receives single dose hepatitis B immune globulin, followed by vacccine
-parasite acquired by contact with cat feces or raw meat
-causes low birth weight, enlarged liver & spleen, jaundice, anemia, inflammation of eye structures, neurologic damage
group B strep infection.....
-leading cause of perinatal infection with high mortality rate
-organism found in woman;s rectum, vagina, cervix, throat or skin
-risk to infnat is greater if labor is long or premature rupture of membranes
-can be deadly to infant
-treated with penicillin
-if mother has active TB, infant must be kept away until she has been cleared by health dept
S/S of UTI's in pregnancy....
-cystitis: burning with urination, increased frequency & urgency of urination, normal to slightly elevated temp
-pyelonephritis: high fever, chills, flank pain/tenderness, N & V, GH, chronic renal disease, preterm birth. High fever can cause fetal metabolic rate to increase, increased fetal oxygen needs
-antibiotics, often ampicillin
-asymptomatic bacteruria...oral antibiotcs for 10 days
-cystitis....full 7 days of antibiotic therapy
-pyelonephritis....multiple antibiotics, IV
environmental hazards during pregnancy
-bioterrorism and the pregnant woman:
3 categories: Category A....easily transmitted person to person
Category B...spread via food or water
Category C...spread via manufactured weapons designed to spread disease
***educating women on the effect of drugs on a developing fetus is best done before pregnancy
trauma during pregnancy
3 leading causes of traumatic death...
1. automobile accidetns
if a woman confides that she is being abused during pregnancy....
this information must be kept absolutely confidential; she may be in danger is the abuser finds out that she told anyone
nurses can refer women to shelters and other services if they wish to leave the abuser.....
but the decision o leave her abuser is hers alone.
psychosocial nursing interventions for women with high-risk pregnancies and their families
-disruption of usual roles...identifying sources of support ot help maintain reasonabl normal household functtion
-financial difficulties....referring them to social services for help
-delayed attachment to the infant...high-risk may halt planning for birth
-loss of expeced birh experience....a loss is a loss.....allow them to feel and grieve
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