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prego complications
gravidarum, earlyprego, previa/abruptio, PIH, RH- mom,
| Question | Answer |
|---|---|
| what are two broad categories of complications of prego? | 1. complications only with pregnancy, 2. complications that occur at anytime yet are concurrent with prego |
| what are danger signals during pregnancy? | vaginal drainage more than normal mucous, vaginal bleeding, severe abd or epigastric pain, persistent vomiting, edema of face and hands, severe, sudden persistent h/a, visual disturbances,s/s infection, dysuria, excessive weight gain, less fetal movement |
| why are antepartal fetal assessments tested? | detect congenital anomalies, eval the conditio of fetus |
| use of high frequency sound waves to visualize structures within the body; the examination may use a transvaginal probe or an abdominal transducer. | ultrasound examination, |
| why is ultrasound used? | confirmation of pregnancy, verification of the location of the pregnancy, verify viability, id multifetal gestations, dx fetal structural abnormalities, with amniocentesis, locations of uterus, cervix, placenta, determine amount of amniotic fluid |
| what position is the pt in for transabdominal ultrasound? | supine with head/knees supported, head elevated, turned slightly to one side |
| abdominal ultrasound during pregnancy requires: | full bladder (drink 1-2 qts of water before the exam. ultrasound may take 10-30 min |
| high frequency sound waves to study the flow of lbood through the unbilical artery and vesels | Doppler ultrasound blood flow assessment |
| purpose of doppler is: | to determine adequacy of blood flow through the plaacenta and umbilical cord artery in women in whom it is likely to be impaired. |
| predominate protein in the fetal plasma that is synthesized by the developing fetal liver and gastrointestinal tract. | Alpha fetprotein (AFP) |
| Elevated AFP levels are associated with : | open neural tube defedts, such as spina bifida, anencephaly, gastroschisis, |
| low levels of AFP are associated with: | chromosome abnormalities such as down syndrom or trisomy 21 or gestational trophoblastic disease |
| when is the AFP screening peformed? | b/w 16 and 18 weeks gestation |
| what procedure analyzes fetal tissues to reflect the chormosomal and genetic makeup of the fetus? | chorionic villi sampling |
| How is the procedure performed? | transcervical or transabdominal |
| when performing this procedure what precaution is taken? | a needle is inserted via the abdominal wall and myometrium and the tip is advanced to the placenta, a smple of the chorionic villi is withdrawn,FHR is documented, mother's VS, if mother is RH- RhoGAM is given because this increases risk-Rh sensitization |
| when is amniocentesis usually performed? | 11-14weeksgestation, most b/w 15-20 weeks gestation |
| what is used to identify fetal compromise in conditions associated with poor placenta function, such as htn, diabetes mellitus, post term gestation, adequate accerleations of the fetal heart rate with movement are reassuring thatthe placenta is working? | Non stress test |
| what noninvasive procedure is used to confirm a nonreactive NST finding and shorten the time required to obtain high-quality NST data druing the last third of pregnancy? the stimulator is applied to the maternal abd over the area of fetal head. | vibroacoustic stimulation test, it is given with artificial larynx device stimulation for up to 3 seconds repeated for 1 minute intervals up to three times, expecting an acceleration of the FHR |
| eval of FHR response to mild uterine contractions by using an external fetal monitor. desired response is no change in fetal hear rate resulting in a negative test. | contraction stress test, testing is done after 32 weeks of gestation, head elevated, fetal monitors, baseline activity is recorded, uterine contractions are spontaneous, self stimulated, or by oxytocin |
| what assesses FHR/and reactivity from NST, getal breathing movments, gross feta body movements, feta muscle tone? | biophysical profile |
| aspiration of fetal blood fro umbilical cord for prenatal dx/therapy:Rh disease, dx abnormal blood clotting factors, acid base status, genetic testing, blood diseases, deliver therapeutic drugs, | Percutaneous Umbilical Blood Sampling, PUBS |
| provide info on testing procedure, clear simple instructions, encourage expression of concern about condition of fetus, help family set realistic goals | nursing interventions for fetal dx procedures |
| persisten uncontrollable vomiting that gegins before the 20th week of pregnancy, may continue throughout pregnancy, unlike morning sickness, which is self limited and causes no serious complications, this may have serious consequences? | HEG Hyperemesis Gravidarum |
| what are s/s of HEG | 5% or more of pre pregnancy weight, dehydration, ketosis, electrolyte imbalance, metabolic alkalosis may develop because large amounts of HCL acid are lost in the vomitus deficiency of vitamin K-coagulation disorders, thyamine deficiency-encphalopathy |
| most common in what pts? | unmarried, white, 1st pregnancy and in multifetal pregnancies |
| tx | r/o cholecystitis, PUD; get HCT/HGB, electrolytes, vitamins B6, phenergan, Benadryl, zantac, prilosec, reglan, zofran, methylprednisone, |
| nursing condierations | I/O, freq, character of emesis, labs for fluid / metabolic status, daily weights, for keytones in urine, 2-3hr meal intervals, liquids b/w meals, sit upright, emo support, monitor skin turgor |
| termination of pregnancy without action by the woman or another person. Miscarriage is the lay term. | spontaneous abortion loss of prengancy before the fetus is viable, or capable ofliving outside the uterus. fetus less than 20 weeks gestation or one weighin less than 500g is not viable. |
| most commonly caused by | severe congenital abnormalities incompatibile with life, Chromosomal abnormalities (50-60%) |
| others result from | maternal causes; syphilis, toxoplasmosis, rubella, CMV, hypothyroidism, (endocrine disorders), abnormal reproductive organs, immunologic factors. |
| what subgroups make up spontaneous abortion | threatened-bleed/rhythmic uterine cramps; inevitable-membranes rupture/cervix dilates; incomplete-some products of conception expelled/bleed/cramp; complete-all products of conception expelled, missed-fetus dies in first half, but remains in utero |
| Recurrent abortion | defined as threee or more spontaneous abortins, although some now use two or more pregnancy losses as the definition. |
| ectopic pregnancy | implantation of a fertilized ovum outside the uterus, may occur in the abdomen or cervix, more thatn 98% occure in the fallopian tube, caused by scarring abnormality in tube due to pelvic inflammation or surger. |
| manifestations? | abd pain, vaginal spotting, missed menstrual period, ruptured tube symptoms include sudden, severe pain, in one of the lower quad, prfuse bleed, radiating scapula pain, |
| treatment | unruptured tube: methotrexate is used to inhibit cell division in the embryo. ruptured tube control bleed/prevent shock, Salpingectomy and ligatio of bleeding vessels |
| DIC | defect in coagulation with several complications of surgery, abruptio placentae, incomplete abortion, hypertensive disease or infedftius process, may occur if fetus is retained for a prolonged period. |
| manifestations | sudden chest pain or dyspnea, restlessness, cyanotic, frothy blood tinged mucus, circulatory shock, fetal / maternal death |
| treatment | the priority is correction, blood products for volume/O2, may include heparin, O2 at 10-12 LPM, monitor I/O's, deliver ASAP |
| Nursing considerations | early ID of shock, pain control-eval effectiveness of analgesia, psychological support, pt education for methotrexate usage s/e, vacuum suctio or dilation and curettage montior for vaginal bleeding, VS, RH immune globulin for Rh - Mother. |
| placenta previa | implantation of the placenta in the lower uterus, placenta closer to cervix of os than presenting part of fetus, 1 in 200 births, common in multiparas ethnic, previous placenta previa, previous abortion, or older women |
| three classifications of placenta are dependent on what? | how much the cervical os is covered: marginal;placenta's lower border is more than 3 cm from the internal cervical os, partial: lower border is within 3 cm of internal cervical os, total: placenta completely covers internal os |
| manifestations | sudden onset of painless vaginal bleeding in the last half of pregnancy, bleeding results from tearing of the placental villi from uterine wall, resulting in exposure of uterine vessels, bleedin with labor, cervical changes disrupt placental attachmnt, |
| treatment | eval for hemorrhage, conservative treatment if stable and fetus is immature, delivery if fetus is older than 36 weeks, delivery is mandatory if hypovolemia or fetal compromise, C section likely performed depending on location of previa |
| abruptio placentae | separation of normally implanted placenta from uterine wall, 0.5% to 1% incidence |
| chronic htn, PIH, cocaine use, premature rupture of membranes, blunt external abd trauma, short umbilical cord, Cigarette smoking, |
Created by:
redhawk101
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