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EXAM #3 - FAMILY
Pregnancy Complications
| Question | Answer |
|---|---|
| Causes of early bleeding | Spontaneous abortion, uterine fibroids, ectopic pregnancy, gestational trophoblastic disease, cerv ical insufficiency |
| Causes of late bleeding | Placenta previa, and placenta abruption |
| Spontaneous Abortion | Is the most common complication of early pregnancy. Refers to a loss of a fetus resulting from natural causes before 20 weeks gestation, also referred to as a miscarriage |
| Threatened Abortion | Vaginal bleeding (slight), early in pregnancy. No cervical dilation, or cervical consistency. Mild abdominal cramping, closed cervix, no passage of fetal tissue. |
| Inevitable Abortion | Vaginal bleeding, rupture of membranes, cervical dilation, strong abdominal cramping, possible passage of products. |
| Incomplete Abortion | Passage of some products of conception. History of vaginal bleeding and abdominal pain. Passage of tissue with subsequent decrease in pain and significant decrease in vaginal bleeding. |
| Missed Abortion | Nonviable embryo retained in utero for at least 6 weeks. Absent uterine contractions, irregular spotting, possible progression to inevitable abortion. |
| Recurrent Abortion | History of 3 or more consecutive spontaneous abortions. Not carrying the pregnancy to viability or term |
| Still Born | Loss of a fetus after the 20th week of development |
| Hyperemesis Gravidarum | A severe form of nausea and vomiting during pregnancy. Characterized as persistent, uncontrollable nausea and vomiting. Oral food and fluids may be withheld to allow the stomach to rest. Antiemetics will be ordered to control nausea. They are most likely dehydrated, so nurses shouold obtain baseline electrolyte levels and administer fluids. Total parenteral nutrition or feeding tubes are used to prevent malnutrition and are only used when the client does not improve with IV fluids |
| Disseminated Intravascular Coagulation | A bleeding disorder characterized by an abnormal reduction in the elements involved in blood clotting, resulting in widespead intravascular clotting. Often occurs secondary to placental abruption, amniotic fluid emobolism, endotoxin sepsis after an abortion and retained dead fetus. Posthemorrhagic shock, hydatiform mole, HELLP syndrome, and gynecologic malignancies. |
| Disseminated Intravascular Coagulation Symptoms | Can cause potentially severe bleeding. Petechiae, hematuria, prolonged clotting times, oozing from injection sites. Decreased fibrinogen and platelets, prolonged PT, and aPTT, and a positive D-Dimer test and fibrin split degradation products. Complications can include acute kidney failure, hepatic dysfunction, cardiac tamponade, gangrene, and loss of digits, shock, and death |
| Ectopic Pregnancy | Occurs when a fertilized ovum implants outside of the uterine cavity. Most commonly occurs secondary to tubal scarring from PID, but can be caused by any condition that obstructs the passage of the fertilized ovum through the fallopian tubes. Can result in a massive hemorrhaging, infertility, and even death. METHOTREXATE is a folic acid antagonist that inhibits cell division in the developing embryo and is the most commonly used to treat. |
| Ruptured Ectopic Pregnancy Symptoms | Phrenic nerve irritation, referred pain to the shoulder areas, which indicates bleeding into the abdomen |
| Gestational Trophoblastic Disease | Compromises a spectrum of neoplastic disorders that originate in the placenta. Two most common types are hydatidiform mole (partial or complete), and choriocarcinoma. It is a disorder of the placental development, and neoplasms of the trophoblast, with an abnormal hyerproliferation of trophoblastic cells that would normally develop into the placenta during pregnancy |
| Hydatidiform Mole | Benign neoplasm of the chorion in which the chorionic villi degenerate and become transparent vesicles containing clear, viscid fluid. |
| Complete Mole | Contains no fetal tissue, it is an empty egg. No circulation is established. Associated with development of choriocarcinoma Classic symptoms include vaginal bleeding, anemia, excessively enlarged uterus, preeclampsia, and hyperemesis |
| Partial Mole | Triploid karyotype (69 chromosomes) because two sperm cells provided double contribution by fertilizing the ovum. Usually presents with a missed or incomplete abortion with vaginal bleeding and a small or normal sized for date uterus |
| Gestational Trophoblastic Disease Treatment | Aimed to assess, control, and restore the amount of blood lost. Evacuation removes most of it. However some require long-term follow-ups to detect any remaining tissue. Serial HCG levels are monitored |
| Plcenta Previa | The placenta is inserted completely or partly into the lower uterine segment of the uterus. Clients have bright red bleeding, soft uterus, NO PAIN, and fetal heart tones are usually present |
| Placenta Previa Risk Factors | Older than 35, previous C section, multiple pregnancies, uterine injury, drug use, infertility treatment, asian background, previous surgical induced abortion, smoking, previous myomectomy to remove fibroids, hypertension or diabetes, and short interval between pregnancies. Typically appears between weeks 27-32 weeks. NO VAGINAL EXAMS |
| Placenta Abruption | Early separation of a normally implanted placenta. Bleeding may be dark red, which is often concealed. The uterus is rigid, firm, and the patient is in pain. Absent fetal heart tones. |
| Placenta Abruption Complications | Maternal risks include hemorrhage, need for blood transfusion, emergency hysterectomy, DIC, sheehan syndrome, or postpartum gland necrosis, or renal failure. Fetal risks include low birth weight, preterm birth, asphyxia, still birth, and pernatal death. |
| Placenta Abruption Grade one | No sign of vaginal bleed OR less than 500 mL of blood. Marginal Separation (10-20%). Tender uterus, no coagulopathy, no signs of shock, no fetal distress |
| Placenta Abruption Grade two | No signs of bleeding or moderate blood between 1,000 – 1,500 mL. Moderate Separate (20-50%). Continuous abdominal pain, milk shock, normal maternal BP, maternal Tachycardia, and fetal distress noted |
| Placenta Abruption Grade zero | Clinically unrecognized before birth. Diagnosis is made after birth |
| Placenta Abruption Grade three | Absent to moderate bleeding, more than 1,500 mL. Severe Separation (more than 50%). Profound shock, dark vaginal bleeding, agonizing abdominal pain, decreased maternal BP, significant maternal tachycardia, and development of DIC |
| Chronic Hypertension | BP elevated prior to 20 weeks gestation (or present before pregnancy). Above 140/90, on two readings taken at least 4 hours apart |
| Gestational Hypertension | New onset of BP elevated (140/90) identified after 20 weeks gestation. NO PROTEINURIA. BP returns to normal by 12 weeks postpartum |
| Preeclampsia | New onset hypertension WITH PROTEINURIA and/or MATERNAL ORGAN DYSFUNCTION that targets the cardiovascular, hepatic, renal, and CNS |
| Severe Preeclampsia | BP of 160/110 mm Hg. Cerebral and visual symptoms are present. Pulmonary edema, epigastric pain, impaired liver function thrombocytopenia, and progressive renal insufficiency |
| Eclampsia | Severe preeclampsia with the onset of seizures or coma. If a patient is experiencing a seizure, remain with the client, ensure the airway is open, turn client to their side, provide oxygen 8-10 L/min. Monitor FHR, administer meds to control seizure, insert oral airway after seizure and suction if needed. Document occurence, client's response, and the outcome. |
| HELLP Syndrome | A life threatening complications considered to be a severe form of preeclampsia involving hemolysis, elevated liver enzymes, and low platelet counts. Low Hematocrit that is not explained by any blood loss. ELEVATED LDH, AST, ALT & BILIRUBIN that indicates liver impairment. ELEVATED BUN, URIC ACID, AND CREATININE LEVELS that indicates renal impairment. LOW PLATELET COUNT of less than 100,000 cells/mm3 |
| Placenta Abruption treatment | Emergency measures include starting 2 large bore IV lines, obtaining blood specimens, and frequent FHR monitoring. Immedate C section at the earliest sign of fetal distress |
| HELLP Syndrome Nursing Considerations | BE ALERT FOR NAUSEA (WITH OR WITHOUT VOMITING), MALAISE, EPIGASTRIC OR RIGHT UPPER QUADRANT PAIN, HEADACHE, AND CHANGES IN VISION |
| Polyhydramnios | Too much amniotic fluid, more than 2,000 mL, surrounding the fetus between 32-36 weeks. Associated with maternal diabetes mellitus, fetal anomalies such as upper GI obstruction, Neural tube defects, Anterior abdominal wall defects, Trisomy’s 13 & 18, Anencephaly . In mild cases monitoring and frequent follow-up visits are needed. In moderate/severe where the mother is experiencing pain or SOB, an amniocentesis or artificial rupture of membranes is done. |
| Oligohydramnios | Decreased amount of amniotic fluid, less than 500 mL, between 32-36 weeks gestation. Associated with poor pregnancy outcomes. Puts the fetus at an increased risk of perinatal morbidity and mortality. |
| Amniocentesis | The insertion of a needle to remove fluid from the amniotic sac in woman who are suffering from polyhydramnios |
| Amniotransfusion | Transvaginal infusion of crystalloid fluid to compensate for the lost amniotic fluid. The fluid is introduced into the uterus through an intrauterine pressure catheter |
| Polyhydramnios Treatment | In mild cases monitoring and frequent follow-up visits are needed. In moderate/severe where the mother is experiencing pain or SOB, an amniocentesis or artificial rupture of membranes is done. |
| Oligohydramnios Treatment | Often managed on an outpatient basis. Frequent nonstress testing, and biophysical profiles. If the fetus is doing well, nothing needs to be done. If fetal-well being is compromised, birth may be planned along with amnioinfusion. After birth evaluate the newborn for signs of post maturity, congenital anomalies, and respiratory difficulty. |
| Multiple Gestation Risks (MATERNAL) | Women who are expecting more than one infant are at high risk for preterm labor, polyhydramnios, hyperemesis gravidarum, anemia, preeclampsia, and hemorrhage. |
| Multiple Gestation Interventions | Provide education on nutrition, increased rest periods, and monitor for complications such as anemia, excessive weight gain, proteinuria, edema, vaginal bleeding, and hypertension. PREVENTING PRETERM LABOR IS THE MAJOR PRIORITY. The patient should be advised to report any signs of preterm labor (contractions, uterine cramping, low backache, increased discharge, loss of mucus plug, pelvic pain, and pressure. |
| Monozygotic Twins | Identical Twins. Develop when a single, fertilized ovum splits during the first 2 weeks after conception. They share one placenta, two amnions, and one chorion |
| Dizygotic Twins | Fraternal Twins. Two sperm fertilizing two ova. Separate amnions, chorions, and placentas |
| Multiple Gestations Risks (Fetal/Newborn) | Prematurity, respiratory distress syndrome, birth asphyxia/perinatal depression, congenital anomalies (CNS, cardiovascular, and GI defects), intrauterine growth restriction, becoming conjoined twins, and TWIN-TO-TWIN TRANSFUSION SYNDROME (transfusion of blood from one twin, to the other twin) |
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