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N113 Risky Pregnancy
N113 - High Risk Pregnancy
| Question | Answer |
|---|---|
| Heart disease - prenatal | Assess functional capacity-ADL's, factors that increase strain on heart-wt gain, infection, anxiety, Assess for CHF. |
| Heart disease - diet | Increased need for iron & protein, decrease sodium |
| Heart disease - rest | Very important - 8-10 hrs of sleep needed to preserve cardiac reserve - frequent rest periods are necessary |
| Heart disease - infection | Upper respiratory infection can tax the heart and increase risk for endocarditis |
| Heart disease - blood volume | Week 28-30 is when maximum blood volume is reached |
| Heart disease - during labor | Decrease physical exertion & fatigue, frequent vitals. Pulse >100 or respirations >25 may indicate decompensation. Side lying & semi-fowlers ensure cardiac emptying & adequate O2. Prevent valsalva maneuver |
| Heart disease - postpartum | Increased blood flow w/decreased intra-abdominal pressure can lead to CHF. Monitor carefully. |
| Diabetes - 1st 1/2 of pregnancy | Increased estrogen & progesterone stimulate increased insulin production & increase response to insulin - can cause decrease in blood sugar levels. By 8th week fetus secretes insulin. |
| Diabetes - 2nd 1/2 of pregnancy | Hormones (HPL & others) increase insulin resistance. Assures an abundant supply of glucose to the fetus. Fat is metabolized and can cause ketones in urine - normal. Too resistant = gestational diabetes |
| Detection & diagnosis of gestational diabetes | Urine test on every visit for ketones & glucose. |
| 1 hour glucose tolerance test | Done at 24-28 weeks, results over 140 requires 3 hour GTT |
| Glycosylated Hgb (Hgb A1C) | Reflects glucose control over 4-12 weeks. |
| Management of diabetes in pregnancy | Must have excellent blood sugar control. Insulin administration only oral=glyburide, usually injectable insulin. |
| Diabetes & fetal status | Placental concerns due to vascular changes. Serum AFP 16-18 wks due to risk of neural tube defects. Repeat non-stress tests. Daily evaluation of fetal activity beginning at 28 wks. |
| Diabetes & labor management | Frequent glucose levels, difficult labor w/fetal macrosomia, increased risk for infection, |
| Diabetes & fetal/neonatal risks | Macrosomia in neonate, hypoglycemia, IUGR, respiratory distress syndrome, polycythemia, hyperbilirubinemia, |
| Macrosomia | High levels of fetal insulin stimulated by high glucose from mother leads to excessive growth. Can be decreased with tight glucose control. Infants over 10 lbs - suspect maternal diabetes |
| IUGR w/diabetes | With advanced DM in mother, vascular changes decrease the efficiency of the placenta |
| Respiratory distress syndrome w/diabetes | High levels of insulin inhibit fetal production of sufactant |
| Diabetes & postpartal period | Maternal insulin needs decrease significantly w/regular & gestational diabetes. Breast feeding decreases insulin needs. |
| Pregnancy & diabetes | Pregnancy will cause problems associated with diabetes to accelerate, such as vascular disease - renal & peripheral |
| Influence of DM on pregnancy | Higher risk of complications, increased amniotic fluid, may lead to PROM & premature labor, fetal malformation & neural tube disorders, PIH |
| Pregnancy induced hypertension (PIH) | Progressive disorder - Pre-eclampsia, HELLP syndrome, eclampsia. Some women become more sensitive to angiotension II leading to vasoconstriction. |
| PIH complications | Decreased renal profusion leads to decreased urine output, increased serum creatinine, BUN & uric acid. NA retention increases extracellular volume & increases sensitivity to angiotension II. |
| PIH definition | BP of 140/90 during 2nd half of pregnancy in previously normotensive women. Noted on 2 occasions at least 6 hours apart. Close observation if systolic of 30mm or 15 mm diastolic over baseline. |
| Mild preeclampsia definition | All of the symptoms of PIH plus proteinuria & pathaologic edema. |
| Proteinuria | > or = to 30 mg/dl on a dipstick or > or = 0.3 in 24/hr |
| Preeclampsia | BP 160/110 or greater Proteinuria > or = to 5g/24 hrs or 2+ or 3+ Oliguria < or = to 400 ml/24hrs less than 20 ml/hr |
| HELLP syndrome | Hemolyhsis, Elevated Liver enzymes, Low Platelets |
| HELLP syndrome treatment | Only treatment is delivery of fetus. |
| HELLP Maternal risks | Retinal detachment, increased deep tendon reflexes, clonus, seizures |
| HELLP & seizures | If seizures occur = eclampsia. Baby must be delivered ASAP |
| HELLP Fetal risks | Decreased placental perfusion, small for gestational age, prematurity, fetal mortality |
| HELLP syndrome treatment | Bed rest-left lateral recumbent, moderate to high protein diet, restricted sodium, evaluation of fetal status |
| HELLP syndrome medications | Magnesium sulfate to prevent seizures |
Created by:
jrb265
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