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High Risk Pregnancy
PHCC Test 3 2008
| Question | Answer |
|---|---|
| Personal Social Economic Risk Factors | age ,16.35, primigravida or null X3, nutrion ,20% IBW or > 20%, dug use including nicotene, alcohol, addictive drugs, otc on a regular basis, longterm rx, unusual stress or anxiety, enviroment or occupation anesthetic gases, radiation or pesticides |
| Medical Risk factors | low intake folic acid, prepregnacy, DM, HTN, cardiac disease, thyroid disorders, anemia, maternal infection, psychiatric disorders (depression) |
| Present Pregnancy | exposure to tetraogens, hyperemesis, vaginal bleeding, polyhydraminos, oligohydraminos, PROM, multiple gestation, abnormal presentation, preterm labor, fetal distress, inappropriate fetal growth, cord accident, placental abruption, prolonged labor an ddel |
| Genetic Risk Factors | Family hx of inheritable disorder, previous infant congenital anomalies, parents are known carriers of recessive disorder, maternal age over 40 |
| Stages of Grieving | Shock and disbelief (denial) can result in noncomliance, 2) anger and rage directed toward self or others, 3) Bargaining with God, Depression develops with awareness of loss can include a communication breakdown within family, 4) Acceptance |
| Developmental Tasks of Pregnancy | accepting the less than perfect pregnancy, assuring safe passage ( great effort and $$$ means high drive to assure safe passage) Acceptance of child by significant others, Attachment (mother may be afraid to attach prenatally) Giving of oneself no work et |
| Tetarogen | any enviromental factor chemical or physical that effects fetus adversely Timing critical. Most devastating effects 3rd to 8th wk |
| Fetal response to tetratogen | tissues may atrophy or hypertrophy, structures may fuse or split, genreal inhibition of normal growth or development |
| Caffeine | no more than 300 mg daily associated with low birth weight and PROM |
| Drug withdrawal | seen in neonate 6-12 hrs after delivery |
| Heroin | IUGR, preterm birth, SGA, hyperbilirubinemia, hypoxia, inrauterine death, breech presentation, PROM, abruptio placentai and pre term labor. HIGHER O2 needed during withdrawal can lead to fetal distress, hypoxia, meconium staining and intrauterine death |
| Marijuana | shortened gestation, higher incidenceof precipitate delivery, higher incidence of meconium staining. 'When used with alcohol 5X risk FAS. Infants have fine motor tremors, prolonged startle reflexes, irritablilty, disappears by age 2 |
| Cocaine | effects are immediate, vasoconstriction tachycardia, acute HTN, uterine cx. Placental vasoconstriction causes reduced blood flow to fetus IUGR. Spontaneous abortion, congenital anomolies, abruptio placenta within one hr of use in 3rd trimester Fetal tachy |
| barbituates | RDS, withdrawal |
| smoking | IUGR, LBW, preterm birth, incidences increase with maternal age, higher incidence spontaneous abortion, placenta previa, abruptio placenta and PROM direct correlation to # smoked, dec placnetal blood flow |
| smoking also | shows changes in placenta that may indicate toxicity, Also seems to affect absorption of calcium, vit C B12 B6 B1 and A |
| Radiation | causes a number of congenital malformations specific organs affected depend on stage of fetal development at time of exposure |
| Lead | small weak amd neurologically damaged infants Sources: unglazed pottery, jewelery making, stained glass hobbies, acidic food left in open cans, old painted surfaces (1978) old pipes. Also associated with congenital anomalies, prematurity and fetal death |
| Drug Book Categories | Category A no risk to fetus or remote risk, B no risk to fetus of an animal possible in human C No study available D positive evidence of fetal risk, benefit may outweigh risk, X contraindicated risk outweighs benefit |
| TORCH | Toxoplasmosis, Oher (usually Hep A or B) Rubella, Cytomegalovirus and Herpes |
| Toxoplasmosis | protozoan cat feces and raw or undercooked meat |
| Risks of Toxoplasmosis | abortion, prematurity, stillbirths, severe CNS congenital anomolies. Microcephaly, coma, hydrocephaly Will recommend abortion if before 21 weeks |
| DX Tosoplasmosis | serological blood tests for antibodies |
| S/S Tosoplasmosis | unfortuantely non specific flu like |
| TX Tosoplasmosis | sulfa drugs or clindamycin if allergic to sulfa |
| Education is most important intervention | avoid poorly cooked or raw beef pork lamb, wash fruits and vegts thoroughly, wash all cooking utensils carefully, avoid contact with litter box, wear gloves when gardening |
| Hepatitis | pregnancy affected by both A&B sontaneous abortion, fetal anomalies, PTL, Neonatal hepatitis, intrauterine fetal demise, Infant often becomes affected during birth |
| DX Hep | Hep B surface antigen test |
| Prevention Hep | vaccination during pregnancy OK |
| Rubella | Viral infection with major effects on fetus. Transmission often occurs before development of rash. 50% infected pregnancies result in transmission to fetus |
| Rubella Fetal Risks | spontaneous abortion, congenital infection- cardiac disease (patent ductues areriolitis) IUGR, cataracts, petichial rash, hepatosplenomegaly, hyperbilirubinemia, mental retardation , cerebral palsy |
| If infant is born with congenital rubella syndrome | they are infectious |
| Management Prenatal Rubella | prevention is most important. assess rubella titer, avoid infected individuals, vaccination given postpartum do not become pregnant 3 mos |
| Cytomegalovirus | chronic persistant infection with virus that the individual may shed (saliva, blood) continually over many years. Becomes reactivated during pregnancy. Cam cross the placenta or baby can contract it as it passes through cervix. Results in severe effects |
| Effects Cytomegalovirus | fetal death, hemolytic anemia, jaundice, hydrocephaley, micrcephaly, SGA or Cytolmegalic Inclusion Disease |
| CID | Cytomegalic Inclusion Disease infants shed large amounts of the virus in saliva, urine, and respiratoru secrettions. Similar to cerebral palsy. Profuse secretions and very contagious Short lifespan |
| DX Cytomegalovirus | presence of CMV in urine or serum antibodies |
| TX Cytomegalovirus | none, avoid exposure |
| Herpes | HSV 1 oral HSV 2 genital often have both. Transmission occurs with close contact with a person shedding the virus. First infection smptoms are more pronounced and risk of transmission higher. Stressors can trigger a reoccurence often milder and shorter |
| S/S Herpes | painful blisters, fever, anorexia, painful inguinal nodes, dysuria, and painful intercourse |
| Herpes Transmission to Fetus | spontaneous abortion, PTL, IUGR. After rupture of membranes as virus ascends from active leisons can cross placenta or if baby comes into contact with leisions |
| C Section r/t Herpes | must be done within 6 hr window to prevent ascension of virus to fetus. Cultures may be done to r/o presenceof active leisons for vaginal delivery |
| Neonatal Infection of Herpes | 82% mortality lethargy, poor feeding, jaundice, bleeding, pneumonia, convulsions, bulging fontanels, skin and mouth leisions |
| Tx Herpes | Aclovvir not a cure decreases healing time, shortens time of live virus in the leisions, but not recommended during pregnancy. Balyclovar used during pregnancy. |
| Nx care Herpes | educate r/t infection control measures |
| gonorrhea | gram negative dipplococci. Women often asymptomatic ntil complications occur (PID). Screened during initial prenatal exam. May be r/t preterm birth, PROM, chorioamnionitis |
| Effects Gonorrhea Fetus/Neonate | opthalmia nenatorum (blindness), pneumonia, risk for infection at other sites |
| Mgt Gonorrhea | Rocephin or Spectinomycin |
| Neonatal prevention gonorrhea | erythromycin opthalmic ointememt |
| syphilis | caused by a spirochete Pregnancy does not alter progression of diseaseIf left untreated can lead to abortion or congenital syphylisNo residual effects if treated before 5 mos of pregnancy. |
| congential syphilis | occurs when spirochetes cross the placenta after 16th or 18th week of gestation |
| Neonatal manifestations of syphilis | rhinitis, rhagades (cracks & fissures around mouth) hydrocephaly, opaque corneas, . Later saddle nose, saber chin, hutchinson's teeth ( notched, tapered canines) and DM |
| Jarisch Herxheimer reaction | a transient, short-term, immunological reaction commonly seen following antibiotic treatment of early and later stage [infectious] diseases manifested by fever,chills,headache,tachycardia and exacerbations of cutaneous lesions. Preterm labor |
| VDRL | testing of infant for syphilis that detemines management and follow up |
| TX neonates syphylis | active infection PCN |
| PROM | sponataneous rupture of membranes before 38 wks Unknown cause |
| Contributing factors PROM | incompetent cervix, infection (UTI) hydraminios, trauma, multiple pregnancies and maternal genital tract abnormalities |
| Maternal Risks r/t PROM | chorioamnionitis, endometriosis |
| Fetal/Neonatal Risks PROM | RDS, sepsis, malpresentations, prolonged L&D |
| Mgt PROM | Dx confirmed nitrazine test, caculate gestational age. Of signs of infection antibiotic therapy IV and fetus will be born regardless of gestational age. If no signs infection and , 37 wks, conservative tx and bedrest betamethosone |
| Testing gestational age | Nagele's rule (EDD)fundal height, ultrasound (fetal biparietal diameter), and amniocentesis to assess lung maturity |
| Best time for surgery | early 2nd trimester; post op promote oxygenation TCDP and IS, positioning to provide optimal uteroplacental perfusion. Can place wedge under tips to tip uterus |
| Mothers over 35 | internal enviroment less than optimal, eggs may be defective with chromosomal abnormalities, increased incidence of multiple gestation, Inc incidence of HTN and DM Higher rate of C section r/t better insurance |
| Teen pregnancy | physical development still incomplete needs inc calories for own development as well as that of fetus, structural aspects may include cephalopelvic disproportion. |
| Tx teen pregnancy | non judgemental and accepting, need concrete examples when teaching, show not tell, emphasize nutrition and increased caloric demands, |
| Teens and L&D | you may need to play role of support, coach, and comforter |
| Teens Postpartum | assess support system, bonding, knowledge and attitude, contraception education, financial assistance, educational aspriations, who is going to care for baby |
| THE END | (blank) |
Created by:
margaretptz
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