Term
| What are Common factors that might place a pregnancy at high risk ? |
|
Definition
Existing health conditions
Age
Lifestyle Factors
Conditions of pregnancy |
|
|
Term
| What are Existing health conditions that cause hi-risk preg? |
|
Definition
High blood pressure
PCOS
Diabetes
Kidney disease
Autoimmune disease
Thyroid disease
Infertility
Obesity
HIV/AIDS |
|
|
Term
| What is high BP effect on fetus? |
|
Definition
| increased risk of damage to mother’s kidneys, increase risk for low birth weight and preeclamsia |
|
|
Term
| What is the PCOS effect on fetus? |
|
Definition
| inhibits pregnancy, incr risk SAB, GDM, preeclampsia, premature delivery |
|
|
Term
| What is kidney disease's effect on fetus? |
|
Definition
|
|
Term
| What is autoimmune diseases' effect on fetus? |
|
Definition
| lupus or MS, inc risk of preterm birth and still birth |
|
|
Term
| What is thyroid diseases's effect on fetus? |
|
Definition
| can cause probs for fetus like heart failure, poor weight gain, birth |
|
|
Term
| What is obesity's effect on fetus? |
|
Definition
| incr risk of Diabetes and difficult birth |
|
|
Term
| What is HIV/AIDS effect on fetus? |
|
Definition
| damage to immune system cells, difficult to fight infection and some CA, can pass virus to fetus during pregnancy, labor, and breastfeeding. Women with very low viral loadlow risk of transmissionvg del; high viral loadC/S, decreased risk of transmission. Meds are effective |
|
|
Term
| What do teen pregnancies increase risk for? |
|
Definition
| inc risk of HTN and anemia, labor earlier than older women, inc exposure to STDs, less likely to get prenatal care, less understanding of meds they can use |
|
|
Term
| What do after age 35 pregnancies increase risk for? |
|
Definition
| typically normal pregnancy, incr risk of c/s; del complications including excessive bleeding during labor, prolonged labor, labor that does not advance, infants with genetic disorders, (Downs) |
|
|
Term
| How does alcohol effect pregnancy? |
|
Definition
| passes directly to fetus, inc risk of SAB and still birth, icr risk of birth defects and fetal alcohol syndrome ( facial features, short stature, low body weight, hyperactivity disorder, intellectual disabilities, vision or hearing problems) |
|
|
Term
| How does smoking effect pregnancy? |
|
Definition
| risk for preterm birth, birth defects, SIDS, second hand smoke also increases risk |
|
|
Term
| How does multiple gestation effect pregnancy? |
|
Definition
| 2,3,4, ect; prematurity; age 30 + fertility drugs=inc multiples; inc risk of C/S, smaller babies, difficulty |
|
|
Term
| How does gestational diabetes effect pregnancy? |
|
Definition
| uncontrolled—incr risk of preterm labor and del, preeclampsia, HTN, difficult delivery |
|
|
Term
| How does pre/eclampsia effect pregnancy? |
|
Definition
| sudden increase in blood pressure after 20th wk ; can affect maternal kidneys, liver, brain; if untreated, can be fatal, can result in long term probs;;seizure, coma |
|
|
Term
| What are the maternal risks that are increased with multiple gestations? |
|
Definition
Preterm labor
Hydramnios
Hyperemesis
Anemia
Preeclampsia
Antepartum hemorrhage |
|
|
Term
| What are the infant risks that are increased with multiple gestations? |
|
Definition
Prematurity
Respiratory distress syndrome
Birth asphyxia/perinatal depression
Congenital anomalies (CNS, GI, Cardiovascular)
Twin-to-twin transfusion
IUGR
Conjoined twins |
|
|
Term
| What is a monozygotic twin? |
|
Definition
| one egg splits during first two weeks after conception; identical, share placenta, two anmions, one chorion |
|
|
Term
| What is a dizogotic twin? |
|
Definition
| two sperm fertilize two ova; fraternal, each has own placenta, amnion, and chorion |
|
|
Term
| How are pregnancies managed? |
|
Definition
Serial US, BPP, NST
Prevent preterm labor—hospitalized, often fetal malpresentation
Nursing assessment
Health hx ond physical exam
Complications—fatigue, severe nausea/vomiting,
Continuous monitoring
US for presentation
Extra staff for delivery
PP hemorrhage/uterine involution/fundal massage/lochia
Be support for patient and family |
|
|
Term
|
Definition
Lack of insulin or absence of hormone necessary for glucose metabolism
Long term damage and dysfunction |
|
|
Term
|
Definition
| autoimmune process, before age 30 |
|
|
Term
| What is type 2 insulin resistance? |
|
Definition
| , r/t obesity, sedentary lifestyle, usually older than 30, but also seen in children, 90% of all diagnoses |
|
|
Term
| What is impaired fasting glucose? |
|
Definition
| hyperglycsemia, but lower than qualified Diabetes (100-125mg/dL fasting and 140-199mg/dL 2 hr PP); risk of LGA |
|
|
Term
| What is gestational diabetes? |
|
Definition
| glucose intolerance with onset during pregnancy |
|
|
Term
| What are the neonatal complications of g. diabetes? |
|
Definition
| macrosomia, hypoglycemia, birth trauma, preeclmapsia, C/S. |
|
|
Term
| What is the pathophys of gestational diabetes? |
|
Definition
| Placental hormones cause insulin resistance (as placenta grows, more hormones are secreted |
|
|
Term
| What is the pathophys of non diabetic women who become diabetic once pregnant? |
|
Definition
| pancreas responds to demands for inc. insulin production to maintain normal glucose levels thoughout preg |
|
|
Term
| What is the pathophys of diabetic women who become pregnant? |
|
Definition
women with resistance or diabetes can not cope with changes in metabolism resulting from insufficient insulin to meet the needs during gestation
Increased demand on pancreas for insulin=can not accomadate-=hyperglycemia |
|
|
Term
| When does insulin resistance peak? |
|
Definition
|
|
Term
| When do you NOT screen for diabetes? |
|
Definition
IF:
No hx of glucose intolerance
Less than 25 yrs old
Normal body weight
No fam hx
No hx of poor obstetric outcome
Not from ethnic group with high prevalence |
|
|
Term
| When do you normally test for diabetes? |
|
Definition
|
|
Term
| What test is done at 24-28 wks? |
|
Definition
75 g challenge test, glucose measured 1 hour later
If abnormal, followed by a 3 hour tolerance test
Fasting, less than 95
1 hour, less than 180
2 hour, less than 153
3 hour, less than 140 |
|
|
Term
| What are the most common malformations from g.dm? |
|
Definition
Renal, cardiac, skeletal, central nervous system
Defects occur by 8th week of preg |
|
|
Term
| What is tight glucose control? |
|
Definition
frequent glucose measurements
Fasting 60-90mg/dL
1 hour PP 100-120mg/dL
Reduction of MACROSOMIA
Maintain normal weight gain in preg |
|
|
Term
| What is nutritional therapy? |
|
Definition
nutritional management, exercise, pharmacologic therapy—regimens vary
Insulin—historically med of choice
Glyburide
Metformin
Do not cross placenta, do not cause fetal hypoglycemia
HYPOGLYCEMIC BABY |
|
|
Term
| During labor, what do you do for GDM? |
|
Definition
Ns or LR as IVF, glucose check Q1-2 hrs, glucose maintained below 110 mg/dL
Conitnued monitoring, VS, urine output
After del, monitor glucose q2-4 hrs for 48 hrs; insulin needs decrease by 50% |
|
|
Term
| Can you use insulin in labor? |
|
Definition
|
|
Term
| What happens after delivery? |
|
Definition
usually return to pre-pregnant state
Esp if diet controlled
If on meds, should retest 2 months PP
If at risk, screen at first visit |
|
|
Term
| What is screened at 1st visit? |
|
Definition
Prev infant with congenital anomaly, hx of GDM, fam hx of diab, AMA, prev infant weighing 9#, prev unexplained fetal demise/neonatal death, maternal obesity (BMI>30), HTN before preg, Hispanic, Native Amer, Pacific Islander, African American, recurrent monolia inf, presence of glycosuria or protenuria
Urine each visit, Hem A1C q 4-6 wks |
|
|
Term
| What are the symptoms of cardiovascular disease in pregnant women? |
|
Definition
| Palpitations, SOB with exertion, occasional chest pain |
|
|
Term
| What are the complications of CVD in pregnant women? |
|
Definition
Heart failure, arythmia, stroke
Premature birth, low birth weight, respiratory distress syndrome, death |
|
|
Term
|
Definition
| structural defects are present at birth, may not be discovered at that time |
|
|
Term
| How is congenital CVD fixed? |
|
Definition
Surgical techniques can correct defect, women can become pregnant
Some should avoid pregnancy |
|
|
Term
|
Definition
| conditions affecting heart and its associated blood vessels that develop during a person’s lifetime |
|
|
Term
| What are ex. of acquired CVD? |
|
Definition
| Coronary artery disease, rheumatic disease, pulmonary vessel and disease of aorta, diseased hear t tissues, and diseased heart valves, mitral valve prolapse, aortic stenosis |
|
|
Term
| What is the goal of patients with CVD? |
|
Definition
| healthy mother and baby at end of pregnancy |
|
|
Term
| What are pregnant women w/ CVD most vulnerable for? |
|
Definition
| decompensation (impaired tissue perfusion of mother and fetus) @ 28-32 wks, and first 48 hrs PP |
|
|
Term
| What are the s/s of decompensation? |
|
Definition
SOB on exertion, dyspnea
Swelling of hands, face, feet
Jugular vein engorgement
Rapid respirations
Abnormal heartbeat/palpitations
Chest pain
Syncope
Fatigue
Moist, frequent cough |
|
|
Term
| What does a drop a maternal bp or volume cause? |
|
Definition
| decrease in maternal blood pressure or volume will cause blood to be shunted away from the uterus—reducing placental perfusion |
|
|
Term
| What drug therapy is used for CVD in pregnancy? |
|
Definition
Diuretics—Lasix
Digitalis
Beta blockers
Calcium Channel blockers
Anticoagulants |
|
|
Term
| Can you take coumadin during pregnancy? |
|
Definition
|
|
Term
| What should you monitor DURING labor of CVD woman? |
|
Definition
Hemodynamic monitoring, during and after delivery
Fluid shift from periphery to central circulation taxes the heart
Monitor IFV, avoid overload
Anticipate use of epidural |
|
|
Term
| What does asthma cause in the fetus? |
|
Definition
| IUGR, preeclamsia, preterm birth, LBW—linked to severity of asthma |
|
|
Term
|
Definition
Aggressively!
Close monitoring, education of clients, avoid triggers, medications (inhaled corticosteroids—ex. Albuterol)
Avoid Hemabate and Cytotec—both cause bronchospasms and bronchoconstriction |
|
|
Term
| What is the most common condition in pregnancy that causes complications? |
|
Definition
|
|
Term
| What is the nursing assessment/management of asthma? |
|
Definition
Obtain thorough hx
Auscultate lungs
Labs—CBC and pulmonary function tests
Patient education—asthma control, adhere to med regimen
S/S
Labor—monitor O2, pain management (epidural) to reduce stress; assess newborn for s/s of hypoxia |
|
|
Term
| How is TB treated in pregnant women? |
|
Definition
| WHO recommends that the treatment of TB in pregnant women should be the same as that in non-pregnant women, except avoidance of Streptomycin (ototoxic to fetus) |
|
|
Term
| What are the symptoms of tuberculosis? |
|
Definition
| Fatigue, fever/night sweats, nonproductive cough, weakness, slow weight loss, anemia, hemoptysis, anorexia |
|
|
Term
| What is the standard treatment of TB? |
|
Definition
| Ethambutol, isoniazid, rifampicin, pirazinamide x 2 months (intensive phase), then x 4 months of isoniazid and rifampin (continuation phase) |
|
|
Term
|
Definition
Reduction of red blood cell volume or decrease in concentration of Hemoglobin in the peripheral blood.
Decrease capacity of blood to carry O2 to vital organs of mother and fetus |
|
|
Term
| What is iron deficiency anemia? |
|
Definition
Usually r/t inadequate dietary intake of iron
75-95% of all anemias |
|
|
Term
| What are the maternal consequences of iron deficiency anemia? |
|
Definition
Fatigue, headache, restless leg syndrome, PICA.
Preterm delivery, perinatal mortality, postpartum depression
Risk of hemorrhage (impaired platelet function), infection |
|
|
Term
| What are the fetal/neonatal consequences of iron deficiency anemia? |
|
Definition
| Low birth weight, poor mental psychomotor performance |
|
|
Term
| How do you correct anemia? |
|
Definition
| replenish iron stores (30mg/day) (Hct <11g/dL; Hct <35% |
|
|
Term
|
Definition
Group of hereditary anemias, synthesis of one or both chains of the hemoglobin molecule (alpha and beta)
Autosomal recessive inheritance |
|
|
Term
| What are the lab results of Thalassemia? |
|
Definition
| Low Hgb and microcytic, hypochromic anemia results |
|
|
Term
| What is Alpha Thalassemia? |
|
Definition
MINOR!
Heterozygous, inherit one abnormal gene from parentoffspring is a carrier
most prevalent in Mediterranean, Asian, Italian, Greek, African American
Clinically asymtomatic
Does not respond to iron supplements
Decreased rate of pregnancy-ilfelong anemia, severe hemolysis, premature death |
|
|
Term
| What is Beta Thalassemia? |
|
Definition
MAJOR!
Inherit both genes from parents, child has disease
May be severe
most common in USA
If mother is carrier, screen father, child may have disease
Genetic counseling |
|
|
Term
| What is sickle cell anemia? |
|
Definition
Autosomal recessive, defective hemoglobin molecule (S hemoglobin)
Mostly African American, Southeast Asian pop. |
|
|
Term
| What does sickle cell anemia cause? |
|
Definition
| Protects agians malaria, but chronic pain and early death |
|
|
Term
| What are the s/s of s.c. anemia? |
|
Definition
| Infection, fever, acidosis, dehydration, physical exertion, excessive cold exposure, hypoxia |
|
|
Term
| What complications can arise from sickle cell anemia and pregnancy? |
|
Definition
| Microvascular sickling associated with miscarrige, placental abruption, preeclampsia, pretem labor , IUGR, fetal distress, LBW. |
|
|
Term
| How is s.c. anemia managed? |
|
Definition
| prevent pain crises, chronic organ damage, education |
|
|
Term
| What kind of therapy is given during pregnancy> |
|
Definition
ONLY SUPPORTIVE
blood transfusion, analgesics for pain, antibiotics for infection |
|
|
Term
| What do you do for s.c. anemia mom's in labor? |
|
Definition
| rest, pain management, O2, IV hydration, continuous monitoring, TED hose PP |
|
|
Term
| What are possible causes of dysfxn labor patterns? |
|
Definition
Catecholamines (response to anxiety/fear), increase physical/psychological stress, leads to myometrial dysfunction; painful & ineffective labor.
Premature or excessive analgesia, particularly during latent phase.
Maternal factors.
Fetal factors.
Placental factors.
Physical restrictions (position in bed). |
|
|
Term
| What maternal factors cause dysfnx labor patterns? |
|
Definition
Pelvic ctx
Uterine tumors (myomas, carcinoma)
Congenital uterine anomalies (bicornnate uterus)
Pathological contraction ring (Bandl’s ring)
Rigid cervix, cervical stenosis/stricture.
Hypertonic/hypotonic ctx.
Prolonged ROM (intrauterine infection may have caused ROM or may follow rupture).
Prolonged 1st or 2nd stage.
Medical conditions: diabetes, hypertension. |
|
|
Term
| What fetal factors cause dysfxn labor patterns? |
|
Definition
Macrosomia
Malposition/malpresentation
Congenital anomaly (hydrocephalus, anencephaly)
Multifetal gestation (ex-interlocking twins)
Prolapsed cord
Posterm |
|
|
Term
| What placental factors cause dysfxn labor patterns? |
|
Definition
| Placenta previa; inadequate placental function with ctx.;abruptio placentae; placenta accreta. |
|
|
Term
| What assessments are needed for hi-risk preggers? |
|
Definition
Antepartal history.
Emotional status.
Vital signs, FHR.
Contraction pattern (frequency, duration, intensity).
Vaginal discharge. |
|
|
Term
| What is the goal of hi-risk preg. deliveries? |
|
Definition
to minimize physical
/ psychological stress during labor/birth. Emotional support. |
|
|
Term
How can we to minimize physical
/ psychological stress during labor/birth. Emotional support? |
|
Definition
Reinforce relaxation techniques.
Support couple’s effective coping techniques / mechanisms.
Encourage verbalization of anxiety / fear / concerns.
Explain all procedures – to minimize anxiety / fear, encourage cooperation / participation in care.
Provide quiet environment conducive to rest.
CONTINUOUS MONITORING OF MATERNAL / FETAL STATUS & PROGRESS THROUGH LABOR:
To identify early signs of dysfunctional labor, fetal distress.
To facilitate prompt, effective treatment of emerging complications.
MINIMIZE EFFECTS OF COMPLICATED LABOR ON MOTHER, FETUS:
Position change: lateral Sims’ to reduce compression of inferior vena cava.
Oxygen per mask, as indicated.
Institute interventions appropriate to emerging problems. |
|
|
Term
|
Definition
| Occurs after 20 weeks gestation and before 38 weeks |
|
|
Term
| What is the primary prevention of preterm labor? |
|
Definition
| : close observation and education in S&S of labor. |
|
|
Term
| What is the secondary prevention of preterm labor? |
|
Definition
| prompt, effective Rx of associated disorders. |
|
|
Term
| What is the tertiary prevention of preterm labor? |
|
Definition
| suppression of preterm labor |
|
|
Term
| What interventions can be done to stop preterm labor? |
|
Definition
Bedrest.
Position: side-lying – to promote placental perfusion.
Hydration.
Pharmacological: beta-adrenergic agents to reduce sensitivity of uterine myometrium to oxytocic & prostaglandin stimulation; increase bld flow to uterus.
Pt may be maintained at home with adequate follow-up & health teaching. |
|
|
Term
| What are coexisting disorders that may cause preterm labor? |
|
Definition
Infections that may cause PROM.
Hypertension (preeclampsia, eclampsia)
Uterine overdistention (hydramnios, multifetal gestation)
Maternal diabetes, renal or cardiovascular disorder, UTI.
Severe maternal illness (ex-pneumonia, acute pylenephritis)
Placental abnormalities (previa, abruption)
Iatrogenic: miscalculated EDC for repeat C/S.
Fetal death.
Incompetent cervical os (small percentage).
Uterine anomalies (rare): intrauterine septum, bicornate uterus.
Positive fetal fibronectin assay (protein found in fetal tissue, membranes, amniotic fluid & decidua) found in cervical / vaginal fluid 1st half of pregnancy & normally absent through mid to late pregnancy). |
|
|
Term
| Who is the suppression of preterm labor contraindicated in? |
|
Definition
Placenta previa or abruptio placenta.
Chorioamnionitis.
Erythroblastosis fetalis.
Severe preeclampsia.
Severe diabetes (brittle).
Increasing placental insufficiency.
Cervical dilation of 4 cm or more.
ROM (depends on cause & if sepsis exists). |
|
|
Term
| What responses to medication for stopping labor are to be expected? |
|
Definition
Hypotension
Tachycardia, arrhythmia
Dyspnea, chest pain
Nausea & vomiting |
|
|
Term
| What are s/s of infection that can cause preterm labor? |
|
Definition
Increased temperature
Tachycardia
Diaphoresis
Malaise |
|
|
Term
| What emotional statuses are expected w/ preterm labor? |
|
Definition
| denial, guilt, anxiety, exhaustion. |
|
|
Term
| What are the signs of continual/progressive labor? |
|
Definition
Effacement
Dilation
Station |
|
|
Term
| What else should be assessed with preterm labor? |
|
Definition
Status of membranes.
FHR, activity (continuous monitoring).
Ctx: frequency, duration, strength. |
|
|
Term
| When should you call the doctor in a pre-term labor situation? |
|
Definition
Maternal pulse of 110 or more.
Diastolic pressure of 60 mmHg or less.
Increase in maternal temperature.
Respirations of 24 or more; crackles (rales).
Complaint of dyspnea.
Contractions: increasing frequency, strength, duration, or cessation of ctx
Intermittent back and thigh pain.
Rupture of membranes.
Vaginal bleeding.
Fetal distress. |
|
|
Term
| If you cannot stop preterm labor, what is the goal? |
|
Definition
| goal is to facilitate infant survival, emotional support, comfort measures, health teaching. |
|
|
Term
| Why are analgesics contraindicated in preterm labor? |
|
Definition
| to prevent depression of fetus / neonate. |
|
|
Term
| What health teaching is important with preterm labor? |
|
Definition
Discuss the need for an episiotomy, possibility of outlet forceps-assisted birth (to reduce stress on fetal head).
Prepare for c/s: to reduce possibility of fetal intraventricular hemorrhage (usually under 34 weeks).
Rationale for avoiding use of medications to reduce contraction pain |
|
|
Term
| What is post term pregnancy? |
|
Definition
| Continues past 42nd week (42 0/7 and beyond) |
|
|
Term
| What are maternal risk factors of post term? |
|
Definition
| Large size of fetus at birth, inc. risk C/S, dystocia, birth trauma, postpartum hemorrhage, infection, foceps/vacuum, induction, maternal exhaustion |
|
|
Term
| What are fetal risk factors for post term? |
|
Definition
| Macrosomia, dystocia, brachial plexus injury, low Apgars, postmaturity syndrome (loss of subcutaneous fat and muscle, mec staining) |
|
|
Term
| What are the antepartum assessments made for a post term labor patient? |
|
Definition
Daily fkcs
NSTs 2x/week
AFI/BPP
Cervical exams |
|
|
Term
| What is important to note about labor in post partum patents? |
|
Definition
Dysfunctional patterns are common
Asses amniotic fluid
Continuous monitoring
May need anmioinfusion (decrease meconium aspiration) |
|
|
Term
| What is hypertonic dysfxn? |
|
Definition
| Increased resting tone of uterine myometrium; diminished refractory period; prolonged latent phase. |
|
|
Term
| What is nullipara hypertonic dysfnx? |
|
Definition
|
|
Term
| What is multipara hypertonic dysfxn? |
|
Definition
|
|
Term
| What are contractions like in hypertonic dys,? |
|
Definition
Continuous fundal tension, incomplete relaxation.
Painful.
Ineffectual – no effacement or dilation. |
|
|
Term
| What are the signs of fetal distress? |
|
Definition
Meconium-stained fluid.
FHR irregularities. |
|
|
Term
| What is used to rule out CPD (big head) in hypertonic dysfxn? |
|
Definition
| Vaginal examination, x-ray pelvimetry, ultrasonography |
|
|
Term
| What can you do for hypertonic dysfxn? |
|
Definition
Short-acting barbiturates (to encourage rest, relaxation).
IV fluids (to restore / maintain hydration & fluid-electrolyte balance).
If CPD – c/s.
Provide emotional support.
Provide comfort measures.
Prevent infection (strict aseptic technique).
Prepare patient for c/s if needed. |
|
|
Term
| What is hypotonic dysfxn? |
|
Definition
| After normal labor at onset, ctx diminish in frequency, duration, & strength |
|
|
Term
| How does labor progress in hypotonic dysfxn? |
|
Definition
| Lowered uterine resting tone; cervical effacement & dilation slow / cease. |
|
|
Term
| What is the etiology of hypotonic dys.? |
|
Definition
Premature or excessive analgesia / anesthesia (epidural, spinal block).
CPD.
Overdistention (hydramnios, fetal macrosomia, multifetal pregnancy).
Fetal malposition / malpresentation.
Maternal fear / anxiety. |
|
|
Term
| What are contractions like w/ hypotonic? |
|
Definition
Decreased frequency.
Shorter duration.
Diminished intensity (mild to moderate).
Less uncomfortable. |
|
|
Term
| What are cervical changes like w/ hypotonic? |
|
Definition
|
|
Term
| Is fetal distress common with hypotonic? |
|
Definition
|
|
Term
| When does fetal distress occur with hypotonic? |
|
Definition
Usually late in labor d/t infection secondary to prolonged ROM.
Tachycardia. |
|
|
Term
| How is hypotonic managed? |
|
Definition
Amniotomy (artificial ROM).
Oxytocin augmentation of labor.
If CPD, prepare for c/s.
Emotional support, comfort measures, prevent infection |
|
|
Term
| What is precipitous labor? |
|
Definition
| Labor that progresses rapidly and ends with the delivery occurring less than 3 hours after the onset of uterine activity. |
|
|
Term
| What causes precipitous labor? |
|
Definition
Soft perineal tissue that stretches easily
Or abnormally strong uterine contractions |
|
|
Term
| What can precipitous labor lead to? |
|
Definition
Could lead to cervical tear or uterine rupture
Head trauma (intracranial hemorrhage or nerve damage) or hypoxia |
|
|
Term
| What needs to be done with precipitous labor? |
|
Definition
Could lead to cervical tear or uterine rupture
Head trauma (intracranial hemorrhage or nerve damage) or hypoxia
Continuous monitoring, updates on progress, pain management, reassurance |
|
|
Term
| What is a breech presentation? |
|
Definition
Fetal descent in which the fetal buttocks, legs, feet, or combination of these parts is found first in the maternal pelvis.
Labor tends to be longer and more difficult due to a softer presenting part, that does not fill the birth canal completely.
Increase risks for fetal outcome. |
|
|
Term
| What is a shoulder presentation? |
|
Definition
Fetal descent in which the shoulder precedes the fetal head in the maternal pelvis alone or along with the arm and hand.
Vaginally undeliverable |
|
|
Term
| What is a face presentation? |
|
Definition
Fetal descent in which hyperextension of the fetal head and neck allows the fetal face to descend into the maternal pelvis
Brow presentation = occurs when the area between the anterior fontanelle and the fetal eyes descends first |
|
|
Term
|
Definition
Persistent occipitoposterior position, OP.
Persistent occipitotransverse position, OT. |
|
|
Term
| What do malpositions result from? |
|
Definition
| fetal rotation as the fetus descends through the pelvis. |
|
|
Term
| What are possible precipitating factors of malpositioning? |
|
Definition
| macrosomia and pelvic abnormalities. |
|
|
Term
| What does malpositioning result in? |
|
Definition
| increased discomfort (particularly back labor), prolonged, abnormal labor, soft tissue injury, lacerations, or an extensive episiotomy incision. |
|
|
Term
|
Definition
| Obstruction of fetal descent and birth by the axis of the fetal shoulders after the fetal head has been delivered OR failure of the shoulders to spontaneously traverse the pelvis after delivery of the fetal head. |
|
|
Term
| What is the goal of managing dystocia? |
|
Definition
| to prevent fetal asphyxia, while avoiding physical injury (eg, Erb's palsy, bone fractures). |
|
|
Term
| What causes shoulder dystoica? |
|
Definition
| If the fetal shoulders remain in an anterior-posterior position during descent or descend simultaneously rather than sequentially into the pelvic inlet, then the anterior shoulder can become impacted behind the symphysis pubis and/or the posterior shoulder may be obstructed by the sacral promontory. |
|
|
Term
|
Definition
|
|
Term
| What injuries can dystocia cause? |
|
Definition
Maternal—Postpartum hemorrhage (uterine atony or vag lac)
Fetal-Erb’s or Brachial Plexus palsy, clavicular or humeral fracture |
|
|
Term
|
Definition
“3 Ps” for mother: Psych, Placenta, Position.
3Ps” for fetus: Power, Passageway, Passenger. |
|
|
Term
| How does POWER cause dystocia? |
|
Definition
: forces of labor (uterine contractions, use of abdominal muscles).
Premature analgesia / anesthesia.
Uterine overdistension (multifetal pregnancy, fetal macrosomia)
Uterine myomas. |
|
|
Term
| How does PASSAGEWAY cause dystocia? |
|
Definition
Rigid cervix.
Distended bladder.
Distended rectum.
Dimensions of the bony pelvis: pelvic contractures. |
|
|
Term
| How does PASSENGER cause dystocia? |
|
Definition
Fetal malposition / malpresentation.
Fetal anomalies.
Fetal size. |
|
|
Term
| What are the malpositions and presentations that can cause dystocia? |
|
Definition
MALPOSITION / MALPRESENTATION:
Transverse lie.
Face,brow presentation.
Breech presentation.
CPD. |
|
|
Term
| What are the fetal anomalies that can cause dystocia? |
|
Definition
Hydrocephalus.
Conjoined (Siamese) twins.
Meningomyelocele. |
|
|
Term
| What are maternal hazards w/ dystocia? |
|
Definition
Fatigue, exhaustion, dehydration.
Lowered pain threshold, loss of control.
Intrauterine infection.
Uterine rupture.
Cervical, vaginal, perineal lacerations.
Postpartum hemorrhage. |
|
|
Term
| What are fetal hazards w/ dystocia? |
|
Definition
Hypoxia, anoxia, demise.
Intracranial hemorrhage.
Palsy
Fractures |
|
|
Term
| What is McRobert's Manuver? |
|
Definition
Mother’s thighs are flexed and abducted as much as possible to straighten pelvic curve
Suprapubic Presure
Light pressure applied judt above pubic bone
Push the fetal anterior shoulder down to displace it from above the mother’s symphysis pubis |
|
|
Term
| What is Velamentous insertion of the cord? |
|
Definition
Condition where the umbilical cord joins the placenta at the edge, rather than the typical insertion in the center.
Can result in chronic altered fetal perfusion. Can lead to trauma and compression during L&D, resulting in rupture and hemorrhage |
|
|
Term
| What is umbilical cord prolapse? |
|
Definition
| Cord descent in advance of presenting part; compression interrupts blood flow, exchange of fetal / maternal gases. Leads to fetal hypoxia, anoxia, death (if unrelieved). |
|
|
Term
| What causes umbilical cord prolapse? |
|
Definition
SROM or AROM.
Excessive force of escaping fluid (hydramnios).
Malposition (breech, compound presentation, transverse lie).
Preterm or SGA fetus – allows space for cord descent. |
|
|
Term
| What assessment is done for cord prolapse? |
|
Definition
Visualization of cord outside (or inside) vagina.
Palpation of pulsating mass on vaginal exam.
Fetal distress – variable deceleration and persistent bradycardia. |
|
|
Term
| What nursing interventions are done for cord prolapse? |
|
Definition
Reduce pressure on cord.
Increase maternal / fetal oxygenation (O2 per mask @ 8-10 liters).
Protect exposed cord (continuous pressure on presenting part to keep pressure off cord).
Identify fetal response to these measures, reduce threat to fetal survival: monitor FHR continuously.
Expedite termination of threat to fetus (prepare for immediate vaginal or c/s).
Support mother and significant other (try to explain things while mobilizing delivery team). |
|
|
Term
| How do you reduce pressure on a umbilical cord? |
|
Definition
Position = knee to chest; lateral modified Sims’ with hips elevated; modified Trendelenburg.
With gloved hand, support fetal presenting part. |
|
|
Term
|
Definition
| amniotic fluid volume of less than 500cc |
|
|
Term
| When are peak amniotic fluid amounts? |
|
Definition
|
|
Term
| What are the risk factors for oligohyrdaminos? |
|
Definition
| uteroplacental insufficiency, renal abnormalities, vairable decesl, intolerance to labor |
|
|
Term
| What is oligohyrdaminos an indicator of? |
|
Definition
Predictor of IUGR, morbidity/mortality, and tolerance to labor
Diagnosed by ultrasound |
|
|
Term
| How do you manage oligohyrdaminos? |
|
Definition
serial US, NST, BPP, planned delivery with amnioinfusion (variable decels are common with cord compression
After delivery, evaluate newborn for sign of post maturity, congenital anomalies, respiratory difficulty |
|
|
Term
|
Definition
| too much amniotic fluid surrounding fetus 32-36 weeks; >2000cc |
|
|
Term
| What is polyhydraminos associated with? |
|
Definition
| maternal disease such as Diabetes (18%), fetal congenital anomalies, increased incidence of preterm births, fetal malpresentations, and cord prolapse. |
|
|
Term
| What is the cause of polyhydraminos? |
|
Definition
| fluid not being taken up or too much produced, or both |
|
|
Term
| How is polyhydraminos managed? |
|
Definition
frequent visits when mild to moderate
Severe cases-invasive—amniocentesis (temporary); AROM
Non-invasive-Indomethacin (prostaglandin synthesis inhibitor)—decrease AFI by decreasing fetal urinary output; may cause premature closure of fetal ductus arteriosus. |
|
|
Term
| What is an amniotic fluid embolus? |
|
Definition
| Amniotic fluid or fetal material (ex. Hair) enters maternal bloodstream. |
|
|
Term
| When does amniotic fluid embolus occur? |
|
Definition
| Most likely to occur during childbirth or immediately afterward. |
|
|
Term
| What are the s/s of amniotic fluid embolus? |
|
Definition
Sudden shortness of breath
Excess fluid in the lungs (pulmonary edema)
Sudden low blood pressure
Sudden circulatory failure (cardiovascular collapse)
Life-threatening problems with blood clotting (disseminated intravascular coagulopathy)
Altered mental status, such as anxiety
Nausea or vomiting
Chills
Rapid heart rate or disturbances in the rhythm of the heart rate
Fetal distress, such as a slow heart rate
Seizures
Coma |
|
|
Term
| What causes amniotic fluid embolus? |
|
Definition
when amniotic fluid or fetal material enters the maternal bloodstream
Possibly by passing through tears in the fetal membranes |
|
|
Term
| Why is AFE sometimes a problem? |
|
Definition
| contains components that cause an inflammatory reaction and activate clotting in the mother's lungs and blood vessels |
|
|
Term
| What are the risk factors of AFE? |
|
Definition
Advanced maternal age
Placenta problems
Preeclampsia
Medically induced labor
Operative delivery
Genetics |
|
|
Term
| What are the maternal complications of AFE? |
|
Definition
-Brain injury
-Lengthy hospital stay
-Maternal deaths in foreign countries |
|
|
Term
| What are the fetal complications of AFE? |
|
Definition
| brain injury due tolack of O2; can be fatal to babies. |
|
|
Term
|
Definition
| no lab test to diagnose; often made after r/o other complications; made after maternal death. |
|
|
Term
| What is premature rupture of membranes? |
|
Definition
| Rupture of the bag of water before the onset of true labor |
|
|
Term
| What happens if PROM is prolonged/ |
|
Definition
| increased risk of infection, continues to increase the longer BOW is ruptured |
|
|
Term
| What are perinatal risks to PROM? |
|
Definition
| Immaturity, RDS, intraventricular hemorrhage, patent ductus arteriosus, necrotizing enterocolitis |
|
|
Term
| What is PROM associated w? |
|
Definition
| Associated with vag bleeding, placental abruption, microbial invasion of amniotic cavity, defective placenta |
|
|
Term
|
Definition
Close monitoring, hydration, reduction in activity, labs (infection), corticosteriods, antibiotics
Obtain health hx, assess VS, amniotic fluid
Goal—prevent infection and identify contractions, identify fetal tracing changes (decels, tachycardia)
May be discharge home in 48 hours if stable with close home/office monitoring |
|
|
Term
|
Definition
Hemolysis, elevated liver enzymes, low platelet count
Is a variant of preeclampsia/eclampsia syndrome |
|
|
Term
| What is the pathophys of HELLP? |
|
Definition
| RBS fragment when passing through damaged blood vessels; liver blood flow decreased as fibrin deposits obstruct the liver; low plateles result from platelet aggregation at vascular sites that are damaged from vasospasms |
|
|
Term
|
Definition
Occur usually in late pregnancy, life-threatening
Most time diagnosed 22-36 wks gest |
|
|
Term
| What does early diagnosis do? |
|
Definition
| Prevent liver distension and rupture, hemorrhage, onset of DIC, stroke, cardiac arrest, seizure, renal damage, ext |
|
|
Term
| How is HELLP syndrome managed? |
|
Definition
antihypertensive medications
prevention of seizures with Mag Sulfate
steroids for fetal lung maturity
When stable, plan delivery
May need blood transfusion |
|
|
Term
| What are the s/s of HELLP? |
|
Definition
| Nausea, malaise, epigastric or RUQ pain, edema, visual disturbances |
|
|
Term
| What lab results are associated w/ HELLP? |
|
Definition
Low Hgb and Hct unexplained by any blood loss
Elevated LDH, AST, ALT (liver impairment)
Elevated BUN, bilirubin level, elevated uric acid and creatinine level (renal involvement)
Low platelets (less than 100,000 cells/mm3) |
|
|
Term
| What is placental abruption? |
|
Definition
Placenta peels away from the inner wall of the uterus before delivery (completely or partially)
Deprives the baby of oxygen and nutrients and cause heavy bleeding in the mother
Happens suddenly |
|
|
Term
| What are the s/s of placental abruption? |
|
Definition
Vaginal bleeding—amount varies, may be none
Abdominal pain-sudden onset
Back pain—sudden onset
Uterine tenderness
Rapid uterine contractions, often coming one right after another |
|
|
Term
| What causes placental abruption? |
|
Definition
| unknown, trauma, injury to abdomen, MVA or fall, rapid loss of amniotic fluid |
|
|
Term
| What are the risk factors for placental abruption? |
|
Definition
Previous placental abruption
High blood pressure
Abdominal trauma
Substance abuse
Premature rupture of membranes
Blood clotting disorders
Multiple pregnancy
Maternal age (esp after age 40) |
|
|
Term
| What are the maternal complications of placental abruption? |
|
Definition
Shock due to blood loss
Blood clotting problems (disseminated intravascular coagulation)
The need for a blood transfusion
Failure of the kidneys or other organs
Hysterectomy |
|
|
Term
| What are the fetal complications of placental abruption? |
|
Definition
Deprivation of oxygen and nutrients
Premature birth
Stillbirth |
|
|
Term
| How is placental diagnosed? |
|
Definition
Physical exam—uterine tenderness/rigidity
Blood test
Ultrasound
Hospitalization (prior to 34 weeks if mild, bleeding stops, and fetus stable)
Bed rest, steroids??
After 34 weeks—delivery by c/s, ??blood transfusion |
|
|
Term
| What is umbilical cord prolapse? |
|
Definition
complication that occurs prior to or during delivery of the baby
the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby
cord can then become trapped against the baby’s body during delivery |
|
|
Term
| What are the nurses action during umbilical cord prolapse? |
|
Definition
Elevate the hips, administer oxygen, and keep warm.
If the umbilical cord is seen in the vagina, insert two gloved fingers to raise the fetus off the cord. Do not push cord back. Place woman in a Sims position.
Wrap cord in sterile moist towel.
Transport immediately; do not attempt delivery. |
|
|
Term
| What are the causes of umbilical cord prolapse? |
|
Definition
Premature delivery of the baby
Delivering more than one baby per pregnancy (twins, triplets, etc.)
Excessive amniotic fluid
Breech delivery (the baby comes through the birth canal feet first)
An umbilical cord that is longer than usual
Rupture of membranes |
|
|
Term
| What are the consequences of u.c. prolapse? |
|
Definition
Pressure on cord cuts of O2 supply to babyFetal bradycardia
Emergent Cesarean Section
May have no permanent injury
May result in stillbirth |
|
|
Term
|
Definition
Must be dealt with immediatelly
Pelvic exam
Try “reducing” the cord, moving it away from baby’s head |
|
|
Term
|
Definition
Tearing, or rupture, of the uterus.
Along scar of prior Cesarean |
|
|
Term
| What are the s/s of uterine rupture? |
|
Definition
Patient complains of severe abdominal pain and will often be in shock. Abdomen is often tender and rigid.
Fetal heart tones are decreased or absent. |
|
|
Term
| How is uterine rupture managed? |
|
Definition
Treat for shock.
Give high-flow, high-concentration oxygen and start two large-bore IVs of normal saline.
Transport patient rapidly, proceed with emergent Cesarean. |
|
|
Term
| What are the life threatening risks of uterine rupture? |
|
Definition
Blood loss
Infection
Brain damage for baby
Often--hysterectomy |
|
|
Term
| What is intrauterine growth restriction? |
|
Definition
SGA—small for gestational age
LGA—large for gestations age
SGA + rate of growth does not meet expected growth patterns= IUGR |
|
|
Term
| What are common problems associated w/ SGA/IGUR? |
|
Definition
Asphyxia—poor tolerance stress of labor, no oxygen reserves, decreased placental insuffiency,
Less muscle mass
Increased risk for acidosis and hypoglycemia, loss of subcutaneous fat
--asociated with diabetic mothers, lack of glyccogen stores
--inability to break down RBCs and immature liver function to handle load |
|
|
Term
| What are smoking's effect on pregnancy? |
|
Definition
Vasoconstriction, reduced uteroplacental blood flow (decreased blood flow to fetus contributing to fetal hypoxia, decreased birth weight, abortion, prematurity, abruptio placentae, fetal demise.
Perinatal deaths are 20-35% higher to smoking mothers
Increased risk for low birth weight, SIDS, cognitive deficits |
|
|
Term
| What is group beta strep colonization? |
|
Definition
Naturally occurring bacteria
Found in 50% of healthy adults, if found in pregnant womencarriers (transient, doen not indicate illness)
At 36 wks gestation—vaginal/rectal swab |
|
|
Term
| What is the treatment of Group B strep colonization |
|
Definition
If positive
If unknown and temp>100.4, ROM>18 hrs, PTL, or fam hx of infected infant
Penicillin 5 mill units, then 2.5 mill units q 4 hrs; or Ampicillin 2gm, then 1 gm q 4 hrs.
If severe allergy, treat with clindamycin or erythromycin
If not high risk for allergy, treat with Ancef |
|
|
Term
| What does maternal disease lead to? |
|
Definition
| Maternal diseasechorioamnionitis, endometritis, and postpartum wound infection. |
|
|
Term
| What newborn diseases are associated w/ strep b? |
|
Definition
| Sepsis, meningitis, pneumonia |
|
|
Term
| What are the s/s of chorioamnionitis? |
|
Definition
Fever (intrapartum temp .100.4’F or 37.8’C)
Significant maternal tachycardia (>120 beats per minute)
Fetal tachycardia (>160 bpm)
Purulent r foul-smelling amniotic fluid or vaginal discharge
Uterine tenderness
Maternal leukocytosis (15,000-18,000 cells/mm3) |
|
|
Term
| What are the bleeding disorders of early pregnancy? |
|
Definition
Abortion
Ectopic Pregnancy |
|
|
Term
| What are the bleeding disorders of late pregnancy? |
|
Definition
Placenta previa
Abruptio placentae |
|
|
Term
| What is placental abruption? |
|
Definition
| separation of a normally located placenta after the 20th week of gestation and prior to birth that leads to hemorrhage. |
|
|
Term
| What are the s/s of placental abruption? |
|
Definition
| knife-like abdominal pain, bleeding?, change in FHTs, uterine hyperstimulation |
|
|
Term
| What are the risk factors of placental abruption? |
|
Definition
| multiparity, hx of abruption, smoking, sickle cell anemia, high blood pressure (pre-existing or PIH), trauma or injuries to abdomen, cocaine use, intrauterine infection, overdistended uterus (polyhydramnios, twins)---MAY FORCE BLOOD INTO THE UNDERLAYER OF THE PLACENTA AND CAUSE IT TO DETACH |
|
|
Term
| How is placental abruption babies delivered? |
|
Definition
Maintain cardiovascular status of mother, plan fast delivery
Cesarean if fetus is alive
SVD if fetal demise |
|
|
Term
| What is placental previa? |
|
Definition
“afterbirth first”
Bleeding condition, 2nd and 3rd trimester, painless
When implantation at lower uterine segment, uterus can not contract adequetly to stop flow of blood from open vessels
Placenta implants over cervical os |
|
|
Term
| Who has an increased risk of Placental previa? |
|
Definition
| Increased incidence with repeat Cesarean Sections, prev. uterine surgery, multiparity, prior previa, infertility, ect. |
|
|
Term
| How is placenta pre via managed? |
|
Definition
| monitoring fetal-maternal status, vag bleeding, fetal distress, plan del by C/S |
|
|
Term
| What is a spontaneous abortion? |
|
Definition
| The involuntary loss of the products of conception prior to 24 weeks’ gestation |
|
|
Term
| What is a threatened abortion? |
|
Definition
| Cervix is closed & no tissue is passed |
|
|
Term
| What is an inevitable abortion? |
|
Definition
| Increased bleeding & cervix dilates |
|
|
Term
| What is an incomplete abortion? |
|
Definition
| Bleeding dilation of cervix & passage of tissue |
|
|
Term
| What causes spontaneous abortions? |
|
Definition
Chormosomal abnormalities (1st trimester)
Maternal disease (2nd trimester) |
|
|
Term
| What happens w/ spontaneous abortions in the 1st trimester? |
|
Definition
| may del without intervention, will del at home, will follow HCG levels |
|
|
Term
| What happens w/ spontaneous abortions in the 2nd trimester? |
|
Definition
| admited, augmented labor and delivery—focus on emotional support |
|
|
Term
| What is a complete abortion? |
|
Definition
| Passage of all products of conception, cervix closes and bleeding stops |
|
|
Term
| What is a missed abortion? |
|
Definition
| Fetus dies in uterus but is not expelled, uterine growth stops and sepsis is possible |
|
|
Term
| What is a recurrent abortion? |
|
Definition
| 2 or more consecutive spontaneous abortions |
|
|
Term
| What is a therapeutic abortion? |
|
Definition
| Intentional termination of pregnancy before age of viability to preserve the health of the mother |
|
|
Term
| What is an elective abortion? |
|
Definition
| Intentional termination of pregnancy for reasons unrelated to mothers health |
|
|
Term
| What do you do for abortions? |
|
Definition
Document amount and character of bleeding
Save anything that looks like clots or tissue for evaluation by a pathologist
Monitor vital signs
If actively bleeding, woman should be kept NPO in case surgical intervention is needed |
|
|
Term
| What is post abortion teaching? |
|
Definition
Report increased bleeding
Take temperature every 8 hours for 3 days
Take an oral iron supplement if prescribed
Resume sexual activity as recommended by the health care provider
Return to health care provider at the recommended time for a checkup and contraception information
Pregnancy can occur before the first menstrual period returns after the abortion procedure |
|
|
Term
| What is an ectopic pregnancy? |
|
Definition
Implantation outside uterine cavity
Most common site is within fallopian tube 95%
SURGICAL EMERGENCY |
|
|
Term
| What does Scarring or tubal deformity may result from? |
|
Definition
Hormonal abnormalities
Inflammation
Infection
Congenital defects |
|
|
Term
| What are risk factors for ectopic pregnancy? |
|
Definition
Previous PID – chlamydia infection
Previous ectopic pregnancy
Tubal ligation
Previous tubal surgery
Intrauterine device
Prolonged infertility
Diethylstilbestrol (DES) exposure in-utero
Multiple sexual partners |
|
|
Term
| What are the s/s of ectopic pregnancy? |
|
Definition
Lower abdominal pain, may have light vaginal bleeding
If tube ruptures:
May have sudden severe lower abdominal pain
Vaginal bleeding
Signs of hypovolemic shock |
|
|
Term
| HOw is ectopic pregnancy treated? |
|
Definition
Pregnancy test
Transvaginal ultrasound
Laparoscopic examination
Priority is to control bleeding
Actions can be taken:
Using medications
Or by surgery to remove pregnancy from the tube |
|
|
Term
| Should you use methotrexate in pregnancy? |
|
Definition
NO
Methotrexate should never be used during an active pregnancy. Prior to use there should be an ultra sound determining implantation site and fetal death . A consent must be signed for the administration of this medication. |
|
|
Term
| What is a puerperal infection? |
|
Definition
It is an infection developing in the birth structures after delivery.
It is a major cause of maternal morbidity and mortality. |
|
|
Term
| Where do most puerperal infections occur? |
|
Definition
|
|
Term
| What causes puerperal infections? |
|
Definition
| poor sterile technique, cesarean birth. |
|
|
Term
| What are the clinical manifestations of puerperal infections? |
|
Definition
Fever.
pain, redness, tenderness and firmness. |
|
|
Term
| What is thrombophlebitis? |
|
Definition
is an inflammation of the vascular endothelium with clot formation on the vessels wall.
A thrombus forms when blood components (platelets and fibrin) combine to form an aggregate body (clot). |
|
|
Term
|
Definition
| occurs when a clot traveling through the venous system lodges within the pulmonary circulation system, causing occlusion or infarction. |
|
|
Term
| What are the predisposing factors for thrombophlebitis? |
|
Definition
Hx of thrombophlebitis.
obesity.
Hx of cesarean delivery.
Maternal age older than 35 years.
Varicosities.
Anemia |
|
|
Term
| What are the 3 major causes of thrombus formation? |
|
Definition
| venous stasis, hypercoagulable blood, and injury to innermost layer of blood vessel. |
|
|
Term
| What are the s/s of femoral thrombophlebitis? |
|
Definition
| generally occurring 10-14 days after delivery, produces chills, fever, stiffness, and pain. |
|
|
Term
|
Definition
| sudden intense chest pain with severe dyspnea followed by tachypnea, pleuratic pain cough, tachycardia, hemoptysis, and temperature above 38 C. |
|
|
Term
| What are the lab findings of thrombophlebitis? |
|
Definition
Venography.
Doppler ultrasound. |
|
|
Term
| How are thrombus managed? |
|
Definition
Promote resolution of symptoms and prevent the development of embolus.
Anticoagulant therapy. (Heparin, Lovenox, Aspirin, Coumadin)
It is important not to administer estrogen for lactation suppression, because it may encourage clot formation.
Coumadin is teratogenic during pregnancy
Provide client and family teaching.
Assist the client and family to deal with physical and emotional stresses of postpartum complications. |
|
|
Term
| What are the s/s of hypovolemic shock? |
|
Definition
Changes in fetal heart rate
Rising pulse (tachycardia)
Rising respiratory rate (tachypnea)
Shallow, irregular respirations; air hunger
Falling blood pressure (hypotension)
Decreased or absent urinary output (usually less than 30 ml/hr)
Pale skin or pale mucous membranes
Cold, clammy skin
Faintness
Thirst |
|
|
Term
| What is normal vaginal bleeding near the end of pregnancy? |
|
Definition
| Light bleeding, often mixed with mucous, near the end of pregnancy could be a sign that labor is starting. Vaginal discharge that is pink or bloody is known as the bloody show. |
|
|
Term
| What is cervical insufficiency? |
|
Definition
| Weak cervical tissue causes or contributes to premature birth or loss of otherwise healthy pregnancy |
|
|
Term
| WHat happens w/ cervical insufficiency/ |
|
Definition
Spontaneously dilates in the absence of cxs
2nd and 3rd trimester
Incidence less than 1%, 1 in 500 to 1 in 2000 (20-25% of all 2 & 3 trim losses) |
|
|
Term
| What are the s/s of cervical insufficiency? |
|
Definition
Painless cervical dilatation and bulging fetal membranes upon presentation in the second trimester of pregnancy
Preterm premature rupture of membranes (PPROM)
Rapid delivery of a previable infant
Rare or absent uterine contractions |
|
|
Term
| How is cervical insufficiency diagnosed? |
|
Definition
History of midtrimester pregnancy loss
Ultrasound measurement of cervical length
Fetal fibronectin (fFN) testing |
|
|
Term
| What are the symptoms of cervical insufficiency/ |
|
Definition
Pelvic pressure
Cramping
Back pain
Increased vaginal discharge |
|
|
Term
|
Definition
| Studies have demonstrated the utility of fFN testing in addition to cervical length assessment, with a significant improvement in the prediction of preterm delivery in women with a positive fFN and a cervical length of less than 30 mm |
|
|
Term
| What is hyperemesis gravidum? |
|
Definition
| Excessive nausea and vomitting |
|
|
Term
| What are the side effects of hyperemesis gravidum? |
|
Definition
Electrolyte/acid base imbalance
Significant weight loss
Decreased urine output
High hematocrit |
|
|
Term
| How is hyperemesis gravidum treated? |
|
Definition
| Correct dehydration and inadequate nutrition |
|
|
Term
| What patient educated is included w/ hyperemesis gravidum? |
|
Definition
Reduce factors that trigger nausea and vomiting
Keep accurate I&O
Frequent, small meals
Easley digested carbohydrates
Drinking liquids between meals
Reduce stress |
|
|
