Exam 9: Common Complications of Pregnancy
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| Pregnancy Complications | Unique to pregnancy.
Can occur at any time, but are complications when in conjunction with pregnancy.
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| Danger Signals in Pregnancy | Vaginal Bleeding.
Fluid from vagina.
Swelling of fingers or puffiness of face & eyes.
Persistent headache.
Visual disturbances.
Severe ABD or epigastric pain.
Chills or fever.
Pain or burning with urination.
Persistent vomiting.
Change in fetal
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| S/S of Preterm Labor | Uterine contractions or Cramps.
Constant or irregular low backaches.
Pelvic Pressure.
Watery Vaginal Discharge.
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| What are the two categories of pregnancy complications? | Those unique to the pregnancy and those that could occur at any time, but when they occur concurrently with pregnancy complicate its course.
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| Assessment of Fetal Health: Purpose of Dx testing | To detect congenital anomalies.
To evaluate the condition of the fetus.
NO Dx test can guarantee the birth of a healthy baby.
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| Assessment of Fetal Health: Dx Testing | Ultrasound examination
Doppler ultrasound blood flow
Alpha-fetoprotein
Chorionic villus sampling
Amniocentesis
Non-stress test
Vibroacoustic stimulation test
Contractions stress test
Biophysical profile
Percutaneous umbilical blood
(kicks count)
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| Ultrasound Examination | Use of high frequency sound waves to visualize structures within the body
Transvaginal or Transabdominal
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| Ultrasound Examination: Uses | Confirm pregnancy.
Verify (Uterine/Ectopic).
Verify Fetal Viability.
Growth in multi-fetal gestations.
Fetal abnormalities.
Needle placement.
Gestational age.
Determine location of uterus, cervix and placenta.
Determine amount of amniotic fluid.
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| Transvaginal ultrasound: | used in 1st trimester.
Full bladder not required.
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| Transabdominal ultrasound: | used in 2nd and 3rd trimesters
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| Doppler Ultrasound Blood Flow Assessment | Determines adequacy of blood flow through the placenta and umbilical cord
Used for complications of:
Hypertension
Fetal growth restriction
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| Alpha-Fetoprotein Screening | Predominate protein in fetal plasma
AFP screening determines protein level in pregnant woman's serum or sample of amniotic fluid
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| Alpha-Fetoprotein Screening Use | Elevated levels:
spina bifida (open spine)
anencephaly (incomplete development of the skull and brain)
gastroschisis (open abdominal cavity)
Low Levels:
Down Syndrome or trisomy 21
Gestational trophoblastic disease (hydatidiform mole)
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| Alpha-Fetoprotein Patient Teaching | Many factors may influence the level of AFP
This is a screening test and further tests may be offered to explain abnormal levels.
Normal levels of AFP do not guarantee a perfect baby.
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| Chorionic Villus Sampling | Fetal tissue is analyzed to diagnose chromosomal, metabolic, or DNA abnormalities
Performed 10-12 weeks gestation
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| Types of Choronic Villus Sampling Techniques | Transabdominal
Transcervical
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| Amniocentesis: Procedure | A hollow needle is inserted through the mother's ABD into the uterus, and amniotic fluid is drawn for analysis.
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| Amniocentesis | Amniotic fluid contains cast-off fetal cells and various other fetal products
Best performed between 15 and 20 weeks’ gestation.
Ultrasonography used to guide procedure
Rh immune globulin given to Rh-neg women
Patient teaching
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| Amniocentesis: Midtrimester Uses | Identify chromosomal abnormalities
Fetal condition in women sensitized to Rh +
Diagnose intrauterine infections
Investigate AFP
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| Amniocentesis: Third Trimester Uses | Assess fetal lung maturity
Test for fetal hemolytic diseases when Rh incompatibility is suspected
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| Non-Stress Test | Noninvasive, 40 min test
Identifies how fetal heart rate responds to fetal movement
Identifies fetal compromise
Adequate accelerations are reassuring
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| Vibroacoustic Stimulation Test | Noninvasive, similar to NST
Fetus stimulated with sound; expected response is acceleration of fetal heart rate, as in NST
Used to confirm a nonreactive NST and shorten time required to obtain high-quality NST data
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| Contraction Stress Test | Evaluation of the fetal heart rate response to mild uterine contractions
Use:
Purposes are the same as the NST
May be done if the NST results are abnormal or questionable.
Done after 32 weeks gestation.
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| Biophysical Profile | A group of five fetal assessments:
Fetal heart rate and reactivity (interpreted from the NST)
Fetal breathing movements.
Gross fetal body movements
Fetal muscle tone (closure of the hand)
Volume of amniotic fluid
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| Biophysical Profile: Use | Used to determine how the fetal central nervous system reacts to hypoxemia and fetal acidosis.
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| Percutaneous Umbilical Blood Sampling | Aspiration of fetal blood from the umbilical cord for prenatal diagnosis or therapy
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| Percutaneous Umbilical Blood Sampling: Use | Management of Rh disease
Diagnosis of abnormal blood clotting factors
Acid-base status of the fetus
Clarify questionable results of genetic testing
Treat blood diseases and deliver therapeutic drugs that cannot be delivered to the fetus in another way
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| Maternal Assessment of Fetal Movement (Kick Counts) | Mother counts fetal movements in a prescribed period of time
Daily evaluation of movement provides way of evaluating fetus
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| Why is an ultrasound useful in pregnancy? | It has many uses. It can visualize structures in the body, and confirm pregnancy and most fetal anomalies.
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| What is it called when the mother counts the number of fetal movements in a prescribed period of time? | Maternal Assessment of Fetal Movement (Kick Counts)
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| What is the most common indication for an amniocentesis during the third trimester? | Assess if fetal lungs are mature enough to adapt to extrauterine life.
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| Psychosocial Nursing Interventions: Woman/Family | Provide information about the test and clear instructions for the procedure
Encourage the woman and her family to express their concerns
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| How can a nurse facilitate communication with a client undergoing fetal diagnostic procedures? | By providing clear, simple explanations of what the test measures and its purposes.
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| How can we help families cope? | By helping them set realistic goals and encouraging them to express their concerns.
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| Hyperemesis Gravidarum | Persistent, uncontrollable vomiting
Begins in first weeks of pregnancy
HEG can have serious consequences
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| Hyperemesis Gravidarum Manifestations | Loss of 5% or more of prepregnancy weight
Dehydration
Metabolic imbalances
Elevated ketones
Vitamin K &Thiamine deficiency
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| Hyperemesis Gravidarum Therapeutic Management | Exclude other causes
Lab studies
Home therapy (first)
Drug therapy
Correct dehydration and imbalances
IV fluids
TPN if severe
Enteral nutrition
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| Hyperemesis Gravidarum Nursing Considerations | I&O
Lab data.
Daily weights.
Urine for ketones.
Frequent small amounts of food & fluids:
-Q2-3 hrs
-Salting
-K & Mg rich foods
Bland low fat diet/easily digested carbs.
Sitting upright after meals.
emotional Support
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| What is it called when a female is pregnant has excessive nausea and vomiting, which significantly hinders nutritional status and causes electrolyte and metabolic imbalances? | Hyperemesis gravidarum
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| Name a nursing intervention that can be provided to a person with hyperemesis gravidarum? | Encourage bland, low fat diet; intake & output; daily weights; Monitor urine for ketones; meals every 2-3 hours
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| Abortion: | Loss of pregnancy before the fetus is viable, or capable of living outside the uterus. Fetus less than 20 weeks gestation or one weighing less than 500 g is not viable
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| Spontaneous abortion | termination of pregnancy without action by the woman or another person
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| Spontaneous Abortion Causes | Most common cause is severe congenital abnormalities incompatible with life
Maternal infections
Maternal endocrine disorders
Abnormalities of the reproductive organs.
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| Spontaneous Abortions Six Subgroups | Threatened
Inevitable
Incomplete
Complete
Missed
Recurrent
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| Types of Spontaneous Abortion | Threatened
Inevitable
Incomplete
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| Threatened Abortion | Vaginal bleeding occurs
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| Inevitable Abortion | Membrane rupture and cervix dilates.
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| Incomplete Abortion | Some products of conception have been expelled but some remain.
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| Spontaneous Abortion Therapeutic Management | Varies depending on type of abortion
D&C may be indicated to remove retained placental tissue
Iron supplementation if significant blood loss
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| Ectopic Pregnancy: definition | Implantation of a fertilized ovum outside the uterus.
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| Ectopic Pregnancy | More than 98% occur in fallopian tube
“Disaster of reproduction”
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| Ectopic Pregnancy: Causes | Scarring/abnormality in tube
Additional causes
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| Ectopic Pregnancy Manifestations | Abdominal pain
Vaginal spotting
Missed period
Ruptured tube symptoms
Sudden, severe pain in one of the lower quadrants
Profuse bleeding (hypovolemic shock)
Radiating scapula pain
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| Ectopic Pregnancy Diagnosis | Transvaginal Ultrasound
Beta HCG : lower than normal
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| Ectopic Pregnancy Therapeutic Management: Unruptured tube | Methotrexate
Surgery
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| Ectopic Pregnancy Therapeutic Management: Ruptured tube | Goal:
control bleeding
prevent hypovolemic shock
Salpingectomy
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| Ectopic Pregnancy Nursing Considerations | Prevention or early detection
Monitor for signs of rupture or bleeding
Pain management
Patient teaching
Rhogam given to Rh-negative mothers
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| Disseminated Intravascular Coagulation (DIC): definition | A life-threatening defect in coagulation that may occur with several complications of pregnancy
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| DIC Clinical Manifestations | Sudden onset
Patient may complain of chest pain or dyspnea and become extremely restless and cyanotic, occasionally expectorating frothy, blood-tinged mucus
Profound circulatory shock from hemorrhage may occur rapidly
Fetal and maternal death may occu
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| DIC Clinical Diagnosis | Lab studies show :
Decreased fibrinogen and platelets
Prolonged prothrombin (PT) and activated partial thromboplastin time (aPTT)
Increased fibrin degradation products
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| DIC Treatment | Priority is to correct the cause
Administer blood products
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| List appropriate nursing care for a patient experiencing a bleeding disorder of early pregnancy. | Assess for shock, pain control, and provide emotional support.
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| List signs and symptoms of hypovolemic shock. | Fetal heart changes, rising weak pulse, rising respiratory rate, shallow irregular respirations, falling blood pressure, decreased urine output, pale skin, cold clammy skin, faintness and thirst
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| What is it called when all products of conception are expelled from the uterus? | Complete abortion
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| What is it called when the fertilized ovum is implanted outside the uterus? | Ectopic pregnancy
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| Hemorrhagic Conditions of Late Pregnancy | Bleeding Disorders of Late Pregnancy:
Placenta Previa
Abruptio Placenta
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| Placenta Previa: Definition | Implantation of the placenta in the lower uterus; as a result the placenta is closer to the internal cervical os than the presenting part of the fetus
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| Placenta Previa: Three types | Marginal/low lying
Partial
Total
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| Placenta Previa: Manifestations | Painless vaginal bleeding
Bleeding results from tearing of the placental villi
Bleeding may not occur until labor starts
NO vaginal exam
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| Placenta Previa: Therapeutic Managment | Determine the amount of hemorrhage
Electronic monitoring
Conservative if pt is stable and fetus is immature
Home care may include
Delivery may be scheduled
Immediate delivery via stat C/section if hypovolemia or fetal compromise
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| Abruptio Placentae: Definition | premature separation of a normally implanted placenta from the uterine wall
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| Abruptio Placentae: Predisposing factors/etiology | Chronic HTN or PIH
Cocain use (#1)
Premature rupture of membranes.
Blunt external ABD trauma.
Short umbilical cord.
Smoking.
Prior Hx of abrupto placentae.
Maternal age
3X greater risk of multigravida greater than 5.
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| Abruptio Placentae Manifestations | Bleeding evident vs. concealed
Uterine tenderness (board-like)
Uterine irritability
Abdominal or low back pain
High uterine resting tone
Additional signs
hypovolemic shock
fetal distress
fetal death
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| Abruptio Placentae: Divided into two main types | Concealed hemorrhage
Apparent hemorrhage
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| Abruptio Placenta Therapeutic Management | Immediate hospitalization and evaluation
Conservative management may be initiated. Must evaluate CV status of mother and status of fetus
Immediate delivery may be done
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| Abruptio Placenta Nursing Management | Side lying position with wedge under right hip for uterine placental perfusion
Preparation for immediate cesarean delivery
Blood/fluid replacement: two large-bore IV lines should be placed
Foley catheter
Continuous external FHM
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| Abruptio Placenta Nursing Management Cont. | Frequent monitoring of vital signs, hemodynamic status
Oxygen via mask
Emotional support for pt and family
Patient/family teaching about medical treatment
Provide support for grieving family if fetus dies
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| What is the premature separation of a placenta that is normally implanted? | Abruptio placenta
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| What occurs when the placenta develops in the lower part of the uterus? | Placenta previa
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| Name two nursing interventions used in both placenta previa and placenta abruptio? | Standard vital signs and fetal monitoring
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| Which disorder of pregnancy has painless, profuse, bright red bleeding? | Placenta previa
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| Hypertensive Disorders of Pregnancy: Four Categories | Gestational Hypertension
Preeclampsia
Eclampsia
Chronic Hypertension
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| Gestational Hypertension | BP elevation after 20 weeks that is NOT accompanied by proteinuria
May progress to preeclampsia
*HTN with NO protein in urine*
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| Preeclampsia | SBP > or = 140
DBP > or = 90
Significant proteinuria
*Occurring after 20 weeks of pregnancy
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| Eclampsia | Progression of preeclampsia to generalized seizures
Seizures CAN occur postpartum
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| Chronic hypertension | High BP known to exist before pregnancy
If gestational HTN persists after birth, then chronic HTN is diagnosed
Relatively common
Major cause of perinatal death
Associated with IUGR
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| Hypertensive Disorders of Pregnancy: Risk Factors | First pregnancy
Age > 35
African American
Anemia
Family history of PIH
Inadequate prenatal care
Chronic HTN
Chronic renal disease
Obesity
Diabetes mellitus
Antiphospholipid Syndrome
Multifetal pregnancy
Mother or sister had preeclampsia
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| Hypertensive Disorders of Pregnancy: Classic signs | Hypertension
Proteinuria
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| Hypertensive Disorders of Pregnancy: Additional S/S | Retinal changes
Hyperreflexia
Lab studies showing liver, renal, & hepatic dysfunction
Symptoms of arterial vasospasm
Continuous headache, drowsiness or mental confusion
Epigastric pain or upset stomach
Decreased urinary output
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| Therapeutic Management Mild Preeclampsia | Only cure is delivery of the baby
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| Therapeutic Management Mild Preeclampsia: Home Care | : Systolic BP > 140 but < 160; Diastolic BP > 90 but < 110; proteinuria 1+
Activity restrictions
BP checked in same arm 2-4 times/day
Daily weight: use same scale
Urinalysis
Fetal assessment
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| Therapeutic Management Severe Preeclampsia: Inpatient Management | Systolic BP > 160 x two readings, 6 hours apart, while on bedrest; Diastolic BP > 110; Proteinuria 3+ or higher; elevated renal labs and liver enzymes, low platelets, headache, RUQ pain and visual disturbances may or may not be present.
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| Therapeutic Management Severe Preeclampsia: Antepartum goals | Improve fetal blood flow &fetal oxygenation
Prevent seizures
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| Therapeutic Management Severe Preeclampsia | Bedrest
Antihypertensive drugs
Other medications
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| Antihypertensives | given to decrease risk for stroke or CHF
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| Antihypertensives | Hydralazine (Apresoline)
Nifedipine (calcium channel blocker)
Labetolol (beta-adrenergic blocker)
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| Hydralazine (Apresoline): | major advantage over other antihypertensives is that it is a vasodilator that increases cardiac output and blood flow to the placenta
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| Therapeutic Management Severe Preeclampsia: Caution | When antihypertensive meds are given to a woman receiving magnesium sulfate, HYPOTENSION may result, reducing placental perfusion
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| Therapeutic Management Anticonvulsants | Magnesium sulfate: most common
-CNS depressant
-Not an antihypertensive, but relaxes smooth muscle
-Administer IVPB
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| Therapeutic Management Severe Preeclampsia: Intrapartum Management | Most seizures occur during labor or the first 24 hrs after birth
Monitor mother & fetus continuously
Medical management
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| Therapeutic Management Severe Preeclampsia: Postpartum management | watch for signs of shock
-Aggravated blood loss during delivery
-Assessment of preeclampsia must be continued for at least 48 hours
-Magnesium sulfate is continued for at least 24 hours
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| Therapeutic Management Eclampsia | Facial twitching, followed by rigidity of the body.
Tonic-clonic movements.
Breathing stops.
Unlikely to recall event.
FHR pattern.
Magnesium sulfate is drug of choice.
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| HEELP Syndrome: Definition | acronym that refers to a life-threatening occurrence that complicates about 10% of pregnancies.
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| HEELP Syndrome: HE | Hemolysis
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| HEELP Syndrome: EL | Elevated liver Enzyme
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| HEELP Syndrome: LP | Low Platelet Count
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| Why is the patient placed on her left side while on bed rest? | It helps improve the blood flow to the placenta and more effectively providing oxygen and nutrients to the fetus
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| What compound is present in urine with a person who has preeclampsia? | Protein
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| Rh Incompatibility (Example/explanation) | Rh-negative woman with Rh-Positive fetus.
Cells from Rh-positive fetus enter mother's bloodstream.
Woman becomes sensitized- antibodies form to fight Rh-positive blood cells.
In the next Rh-positive pregnancy, antibodies attack fetal blood cells.
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| Rh Incompatibility: Manifestations | Mother
Fetus
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| ABO Incompatibility | A common and generally mild type of haemolytic disease in babies.
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| What drug is administered to mom's who are RH negative? | RhoGAM
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| What is the disease that occurs when anti-Rh antibodies cross the placenta and destroy fetal erythrocytes? | Erythroblastosis fetalis
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