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OB Exam 6 Ch. 12 High Risk Prenatal Care
Terms in this set (47)
High risk prenatal history?
Pregnancy induced HTN risk factors?
8x higher risk
-age extremities (<20, >40)
-onset of HTN
after the 20th week
after 20 weeks
in previously non HTN woman
-vasospastic systemic disorder categorized as mild/severe
-can occur before/during/after birth
-present before pregnancy or diagnosed
before 20 weeks
Chronic HTN with superimposed preeclampsia?
-chronic HTN that may acquire preeclampsia or eclampsia
-may lead to placental abruptions, preterm birth, and IUGR
Mild HTN r/t preeclampsia?
-140/90 or 15 above normal
Management for mild preeclampsia?
-limit salt to 1.5g NA/day
-take daily weights
-bedrest (activity restriction)
check urine for protein
-fetal kick counts
Possible oral antihypertensives for mild HTN?
What to do in the last trimester for mild HTN?
-NSTs, BPPs, US one or twice weekly
Management of severe preeclampsia?
-needs to be hospitalized
-administer mag sulfate (anticonvulsant and antihypertensive)
-check vitals and UO q15min
-keep crash cart/suction nearby
What should the UO be when monitoring severe preeclampsia?
Therapeutic levels for mag sulfate?
see critical box pg. 292
What labs to monitor with mag sulfate?
-urine protein levels
-renal/liver function (RFT/LFT)
-coagulation (platelets, fibrinogen)
S/S of mag sulfate toxicity?
-absent DTRs and flaccid
-UO <25 ml/hr
What will labs look like with mag sulfate toxicity?
-elevated liver enzymes
-elevated renal function tests (BUN, creatine, albumin)
prepare to give calcium gluconate 1G IV
What to teach about mag sulfate?
-will feel hot
Antidote for mag sulfate toxicity?
Environment precautions for preeclampsia?
-quiet, low-lit room
-seizure precautions ready (suction, O2, crash cart)
-emergency meds (labetalol, nifedipine, hydralazine, calcium gluconate)
-emergency birth pack
What is HELLP? How prevalent?
-H = hemolysis
-EL = elevated liver enzymes
-LP = low platelets
-occurs 15% with severe preeclampsia
S/S of hyperemesis gravidarum?
Maternal risks for hemorrhagic disorder?
Fetal risks for hemorrhagic disorders?
-vaginal bleeding occurs
no cervical dilation
-membranes rupture and cervix dilates
-some products have been expelled but some remain in uterus
-fetus has died but not expelled
Induced therapeutic abortion? Elective?
-medically necessary to save mom
RF for ectopic pregnancy?
-PID, endometriosis, tied tubes
CM of ectopic pregnancy?
-Cullen's sign (blueness around belly button)
-abnormal vaginal bleeding
Tx of ectopic pregnancy?
-Medical = methotrexate
-Surgical = salpingectomy
Types of gestational trophoblastic disease (MOLE)? How is it diagnosed?
CM of MOLE?
-significantly larger uterus
Management of MOLE?
-most pass spontaneously
-might require suction curettage
induction with oxytocin or prostaglandins NOT recommended
Complications of MOLE? Pregnancy after MOLE?
-pregnancy after must be postponed 1 year
-consistent/reliable BC for 1 year
CM of placental previa?
-abnormal placental attachment
Fetal risks of placenta previa?
What not to do if placenta previa?
NO VAGINAL EXAMS
-if bleeding continues, prepare for c section
CM of placental abruption?
-painful, board like abdomen
Complications from placental abruption?
-bleeding in abdominal cavity
What can trigger DIC?
-gram negative sepsis
Diagnostic labs for DIC?
THIS SET IS OFTEN IN FOLDERS WITH...
OB Exam 6 Ch. 10 High Risk Assessment
OB Exam 6 Ch. 11 Pre-Gestational Diseases
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