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OB Exam 6 Ch. 12 High Risk Prenatal Care

Terms in this set (47)

High risk prenatal history?
Slide 3
Pregnancy induced HTN risk factors?
-primagravida 8x higher risk
-obesity
-smoking
-age extremities (<20, >40)
-DM
-preexisting HTN
-multiple gestation
Gestational HTN?
-onset of HTN without proteinuria after the 20th week of pregnancy
Preeclampsia?
-HTN develops with proteinuria after 20 weeks in previously non HTN woman
-vasospastic systemic disorder categorized as mild/severe
Eclampsia?
-seizure activity/coma
-can occur before/during/after birth
Chronic HTN?
-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?
Severe?
-140/90 or 15 above normal

->160/110
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?
-methyldopa
-hydralazine
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
-monitor LOC
-keep crash cart/suction nearby
What should the UO be when monitoring severe preeclampsia?
->30 ml/hr
Therapeutic levels for mag sulfate?
5-7 mg/ml
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
-resp <12/min
-UO <25 ml/hr
-CNS depression
-chest pain
What will labs look like with mag sulfate toxicity?
-mag >8
-elevated liver enzymes
-elevated renal function tests (BUN, creatine, albumin)

-prepare to give calcium gluconate 1G IV
What to teach about mag sulfate?
-initial flushing
-will feel hot
-some sedation
-nausea
Antidote for mag sulfate toxicity?
-calcium gluconate
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
DTR grade
What is HELLP? How prevalent?
-H = hemolysis
-EL = elevated liver enzymes
-LP = low platelets

-occurs 15% with severe preeclampsia
S/S of hyperemesis gravidarum?
-prolonged vomiting
-weight loss
-dehydration
-electrolyte imbalances
-ketosis
-malaise
-low BP
Maternal risks for hemorrhagic disorder?
-hypovolemia
-anemia
-infection
-preterm labor/birth
Fetal risks for hemorrhagic disorders?
-blood loss/anemia
-hypoxemia/hypoxia/anoxia
-preterm birth
-death
Threatened abortion?
-vaginal bleeding occurs
-cramping
-no cervical dilation
Inevitable abortion?
-membranes rupture and cervix dilates
Incomplete abortion?
-heavy bleeding
-some products have been expelled but some remain in uterus
Missed abortion?
-fetus has died but not expelled
Recurrent abortions?
-3 consecutive
Induced therapeutic abortion? Elective?
-medically necessary to save mom

-moms choice
Possible treatments?
slide 19
Medical tx
slide 20
RF for ectopic pregnancy?
-PID, endometriosis, tied tubes
CM of ectopic pregnancy?
-abdominal pain
-Cullen's sign (blueness around belly button)
-missed misses
-abnormal vaginal bleeding
Tx of ectopic pregnancy?
-Medical = methotrexate
-Surgical = salpingectomy
Types of gestational trophoblastic disease (MOLE)? How is it diagnosed?
-complete (classic)
-partial

-ultrasound
CM of MOLE?
-vaginal bleeding
-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?
-invasive mole
-cancer

-pregnancy after must be postponed 1 year
-consistent/reliable BC for 1 year
CM of placental previa?
-abnormal placental attachment
-excessive bleeding
-uterine rupture
Fetal risks of placenta previa?
-malpresentation
-vasa previa
-preterm birth
-fetal anemia
-death
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
-painful bleeding
Complications from placental abruption?
-bleeding in abdominal cavity
-growth restriction/prematurity
-fetal anoxia
-maternal shock
What can trigger DIC?
diffused clotting

-severe preeclmapsia
-HELLP
-gram negative sepsis
Diagnostic labs for DIC?
-fibrinogen
-PT
-PTT
-platelets
-D-Dimer
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