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M6 13-005
Exam 9: Common Complications of Pregnancy
| Term | Definition |
|---|---|
| Pregnancy Complications | Unique to pregnancy. Can occur at any time, but are complications when in conjunction with pregnancy. |
| 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 |
| S/S of Preterm Labor | Uterine contractions or Cramps. Constant or irregular low backaches. Pelvic Pressure. Watery Vaginal Discharge. |
| 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. |
| 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. |
| 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) |
| Ultrasound Examination | Use of high frequency sound waves to visualize structures within the body Transvaginal or Transabdominal |
| 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. |
| Transvaginal ultrasound: | used in 1st trimester. Full bladder not required. |
| Transabdominal ultrasound: | used in 2nd and 3rd trimesters |
| Doppler Ultrasound Blood Flow Assessment | Determines adequacy of blood flow through the placenta and umbilical cord Used for complications of: Hypertension Fetal growth restriction |
| Alpha-Fetoprotein Screening | Predominate protein in fetal plasma AFP screening determines protein level in pregnant woman's serum or sample of amniotic fluid |
| 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) |
| 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. |
| Chorionic Villus Sampling | Fetal tissue is analyzed to diagnose chromosomal, metabolic, or DNA abnormalities Performed 10-12 weeks gestation |
| Types of Choronic Villus Sampling Techniques | Transabdominal Transcervical |
| Amniocentesis: Procedure | A hollow needle is inserted through the mother's ABD into the uterus, and amniotic fluid is drawn for analysis. |
| 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 |
| Amniocentesis: Midtrimester Uses | Identify chromosomal abnormalities Fetal condition in women sensitized to Rh + Diagnose intrauterine infections Investigate AFP |
| Amniocentesis: Third Trimester Uses | Assess fetal lung maturity Test for fetal hemolytic diseases when Rh incompatibility is suspected |
| Non-Stress Test | Noninvasive, 40 min test Identifies how fetal heart rate responds to fetal movement Identifies fetal compromise Adequate accelerations are reassuring |
| 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 |
| 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. |
| 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 |
| Biophysical Profile: Use | Used to determine how the fetal central nervous system reacts to hypoxemia and fetal acidosis. |
| Percutaneous Umbilical Blood Sampling | Aspiration of fetal blood from the umbilical cord for prenatal diagnosis or therapy |
| 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 |
| 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 |
| 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. |
| 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) |
| 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. |
| 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 |
| 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. |
| How can we help families cope? | By helping them set realistic goals and encouraging them to express their concerns. |
| Hyperemesis Gravidarum | Persistent, uncontrollable vomiting Begins in first weeks of pregnancy HEG can have serious consequences |
| Hyperemesis Gravidarum Manifestations | Loss of 5% or more of prepregnancy weight Dehydration Metabolic imbalances Elevated ketones Vitamin K &Thiamine deficiency |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| Spontaneous abortion | termination of pregnancy without action by the woman or another person |
| Spontaneous Abortion Causes | Most common cause is severe congenital abnormalities incompatible with life Maternal infections Maternal endocrine disorders Abnormalities of the reproductive organs. |
| Spontaneous Abortions Six Subgroups | Threatened Inevitable Incomplete Complete Missed Recurrent |
| Types of Spontaneous Abortion | Threatened Inevitable Incomplete |
| Threatened Abortion | Vaginal bleeding occurs |
| Inevitable Abortion | Membrane rupture and cervix dilates. |
| Incomplete Abortion | Some products of conception have been expelled but some remain. |
| 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 |
| Ectopic Pregnancy: definition | Implantation of a fertilized ovum outside the uterus. |
| Ectopic Pregnancy | More than 98% occur in fallopian tube “Disaster of reproduction” |
| Ectopic Pregnancy: Causes | Scarring/abnormality in tube Additional causes |
| 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 |
| Ectopic Pregnancy Diagnosis | Transvaginal Ultrasound Beta HCG : lower than normal |
| Ectopic Pregnancy Therapeutic Management: Unruptured tube | Methotrexate Surgery |
| Ectopic Pregnancy Therapeutic Management: Ruptured tube | Goal: control bleeding prevent hypovolemic shock Salpingectomy |
| 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 |
| Disseminated Intravascular Coagulation (DIC): definition | A life-threatening defect in coagulation that may occur with several complications of pregnancy |
| 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 |
| DIC Clinical Diagnosis | Lab studies show : Decreased fibrinogen and platelets Prolonged prothrombin (PT) and activated partial thromboplastin time (aPTT) Increased fibrin degradation products |
| DIC Treatment | Priority is to correct the cause Administer blood products |
| List appropriate nursing care for a patient experiencing a bleeding disorder of early pregnancy. | Assess for shock, pain control, and provide emotional support. |
| 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 |
| What is it called when all products of conception are expelled from the uterus? | Complete abortion |
| What is it called when the fertilized ovum is implanted outside the uterus? | Ectopic pregnancy |
| Hemorrhagic Conditions of Late Pregnancy | Bleeding Disorders of Late Pregnancy: Placenta Previa Abruptio Placenta |
| 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 |
| Placenta Previa: Three types | Marginal/low lying Partial Total |
| Placenta Previa: Manifestations | Painless vaginal bleeding Bleeding results from tearing of the placental villi Bleeding may not occur until labor starts NO vaginal exam |
| 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 |
| Abruptio Placentae: Definition | premature separation of a normally implanted placenta from the uterine wall |
| 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. |
| 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 |
| Abruptio Placentae: Divided into two main types | Concealed hemorrhage Apparent hemorrhage |
| 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 |
| 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 |
| 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 |
| What is the premature separation of a placenta that is normally implanted? | Abruptio placenta |
| What occurs when the placenta develops in the lower part of the uterus? | Placenta previa |
| Name two nursing interventions used in both placenta previa and placenta abruptio? | Standard vital signs and fetal monitoring |
| Which disorder of pregnancy has painless, profuse, bright red bleeding? | Placenta previa |
| Hypertensive Disorders of Pregnancy: Four Categories | Gestational Hypertension Preeclampsia Eclampsia Chronic Hypertension |
| Gestational Hypertension | BP elevation after 20 weeks that is NOT accompanied by proteinuria May progress to preeclampsia *HTN with NO protein in urine* |
| Preeclampsia | SBP > or = 140 DBP > or = 90 Significant proteinuria *Occurring after 20 weeks of pregnancy |
| Eclampsia | Progression of preeclampsia to generalized seizures Seizures CAN occur postpartum |
| 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 |
| 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 |
| Hypertensive Disorders of Pregnancy: Classic signs | Hypertension Proteinuria |
| 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 |
| Therapeutic Management Mild Preeclampsia | Only cure is delivery of the baby |
| 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 |
| 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. |
| Therapeutic Management Severe Preeclampsia: Antepartum goals | Improve fetal blood flow &fetal oxygenation Prevent seizures |
| Therapeutic Management Severe Preeclampsia | Bedrest Antihypertensive drugs Other medications |
| Antihypertensives | given to decrease risk for stroke or CHF |
| Antihypertensives | Hydralazine (Apresoline) Nifedipine (calcium channel blocker) Labetolol (beta-adrenergic blocker) |
| Hydralazine (Apresoline): | major advantage over other antihypertensives is that it is a vasodilator that increases cardiac output and blood flow to the placenta |
| Therapeutic Management Severe Preeclampsia: Caution | When antihypertensive meds are given to a woman receiving magnesium sulfate, HYPOTENSION may result, reducing placental perfusion |
| Therapeutic Management Anticonvulsants | Magnesium sulfate: most common -CNS depressant -Not an antihypertensive, but relaxes smooth muscle -Administer IVPB |
| Therapeutic Management Severe Preeclampsia: Intrapartum Management | Most seizures occur during labor or the first 24 hrs after birth Monitor mother & fetus continuously Medical management |
| 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 |
| 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. |
| HEELP Syndrome: Definition | acronym that refers to a life-threatening occurrence that complicates about 10% of pregnancies. |
| HEELP Syndrome: HE | Hemolysis |
| HEELP Syndrome: EL | Elevated liver Enzyme |
| HEELP Syndrome: LP | Low Platelet Count |
| 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 |
| What compound is present in urine with a person who has preeclampsia? | Protein |
| 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. |
| Rh Incompatibility: Manifestations | Mother Fetus |
| ABO Incompatibility | A common and generally mild type of haemolytic disease in babies. |
| What drug is administered to mom's who are RH negative? | RhoGAM |
| What is the disease that occurs when anti-Rh antibodies cross the placenta and destroy fetal erythrocytes? | Erythroblastosis fetalis |
Created by:
jtzuetrong
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