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OB Tutoring
Conditions Existing Before Pregnancy
| Term | Definition |
|---|---|
| Asthma | Some women experience worsening of their symptoms during pregnancy, while others see improvement |
| Asthma Complications | - Antepartum & Postpartum Hemorrhage (due to coagulation changes with asthma) - Pulmonary Embolism (PE) - Preeclampsia (Low oxygen level - narrowed pulmonary arteries and increased blood pressure) |
| Asthma Complications | - Preterm Birth (Less oxygen is delivered to the fetus) - Low Birth Weight (Less oxygen is delivered to the fetus) - Miscarriage (Less oxygen is delivered to the fetus) - Cesarean Birth (to ensure safety; d/t less oxygenation) |
| Asthma Nursing Assessments | Should be done at each visit: - Lung Auscultation - Respiratory Rate - Include the rate, rhythm and depth of respirations - Skin Color, cyanotic? - Heart/Pulse Rate - Blood Pressure - Signs of fatigue - Weight - Fundal Height |
| Asthma Nursing Assessments | - Urine: - Protein? - Ketones? - Glucose? |
| Asthma Treatment Goals | To optimize control and limit exacerbations - Stop Smoking (if applicable) - Evaluate asthma exacerbations with continuous pulse oximetry - Education about triggers |
| Asthma Treatment Goals | - Encourage Adherence to Meds (Benefits of medications outweigh risks) - Uncontrolled asthma can negatively affect pregnancy outcomes |
| Asthma Treatment Goals | An asthma exacerbation may be recognized by dyspnea with wheezing or cough. Exacerbations that do not respond fully to rescue medications are medical emergencies!!! (STATUS ASTHMATICUS) |
| Treatment for Patient Admitted with Asthma Exacerbation | - Continuous Pulse Ox > 95% - Spirometry, O2 - Sitting Position - Fetal Heart Rate Assessment - Non-Stress Test after 24 Weeks - Want Accelerations (reassuring) |
| Asthma Medications | Rescue Agents (SABAs) - Albuterol (bronchodilator) & Ipratropium (anticholinergic) Maintenance Agents - Beclomethasone (corticosteroid) & Salmoteral (bronchodilator; LABA) |
| Asthma Medications | Medication Adherence Importance: Lack of placental perfusion due to asthma can cause complications; the severity of asthma symptoms typically peaks during 24-36 weeks |
| Epilepsy Complications | - Preeclampsia - Hemorrhage - Preterm Labor - Placental Abruption - Fetal Growth Restriction - Fetal Demise, Death |
| Epilepsy | Seizure Disorder Need to Take Anti-Seizure Medication Despite Risks to Fetus |
| Epilepsy | Increased Risk of Neural Tube Defects - Supplement with folic acid (4 mg/day) - Alpha-Fetoprotein Test to Check for Neural Tube Defects (15-20 Weeks Gestation) |
| Epilepsy | Increased Risk for SGA Increased risk of neonatal bleeding - Mother supplements with 10-20 mg of Vitamin K |
| Epilepsy | Teaching: - Do Not Walk Around with the Baby if Seizures are not Controlled - Increased Visits to OB During Pregnancy |
| Hypothyroidism Complications | - Infertility - Gestational Hypertension - Preeclampsia - Low birth weight (due to Insufficient Metabolism) - PPH - Preterm birth - Placental abruption - Early pregnancy loss |
| Hypothyroidism Complications | Neonatal Complications (d/t abnormal T4 levels) - Cognitive Impairment & Neuropsychological Damage |
| Hypothyroidism | Treat with Levothyroxine (a T4 replacement): May have Anxiety/Tachycardia if on a higher dose - Take in AM on empty stomach with no further oral intake for next hour |
| Hypothyroidism | Need thyroid studies in early pregnancy because symptoms are similar to normal discomforts of pregnancy (fatigue for example) |
| Hyperthyroidism Complications | - Spontaneous Abortion - Low Birth Weight - Preterm Labor - Preeclampsia - Maternal Heart Failure |
| Hyperthyroidism Treatment | - Thioamides - Cross Placenta - Need to Weigh Risks and Benefits |
| Hyperthyroidism Goal | Maintain Mild Hyperthyroidism; Avoid Hypothyroidism in the Fetus |
| Diabetes (Pregestational) | Main Goal - Achieve Glycemic Control Before Attempting Pregnancy T1 - Insulin T2 - Switch to Insulin During Pregnancy (if controlled with metformin & glyburide; continue diet and exercise) |
| Diabetes (Pregestational) | Poor Glycemic Control Causes Hyperglycemia - Decreased Perfusion to the Placenta from Diabetic Vasculopathy |
| Diabetes (Pregestational) Complications | - Preeclampsia - Perinatal Death - Macrosomia (LGA) - Risk for PPH due to Overdistended Uterus - Congenital Abnormalities |
| Diabetes (Pregestational) Complications | - Polyhydramnios - Fetal Diuresis Caused by Hyperglycemia - Fetal Loss - Preterm Birth - Neonatal Hypoglycemia due to Hyperinsulinemia |
| Diabetes (Pregestational) Assessments | - Rule Out Asymptomatic Bacteriuria (can cause secondary issues) - Check A1C - The goal is 6.5 - Kidney Function Tests - Thyroid, Heart, and Eye Screenings - Early Ultrasound for Accurate Dating |
| Diabetes (Pregestational) Assessments | Second Trimester - Visits Every 1 - 4 Weeks - Check for Fetal Growth Restriction (Vasculopathy) |
| Diabetes (Pregestational) Assessments | Fetal Movement Tests - Want 10 Movements in 2 Hours - Active Involvement of Mom |
| Diabetes (Pregestational) Assessments | Fetal Movement Tests - Non-Stress Tests (NST) (Reactive + or Nonreactive -) - Want a Reactive + NST - How Does the Fetus React to Activity - Should Go Up (HR) or Stay in Normal Range - If Not Properly Perfusing, Then the HR Will Drop |
| Diabetes (Pregestational) Assessments | Fetal Movement Tests - Contraction Stress Tests - Want a Negative Contraction Stress Test (-) It Means the Baby’s HR is Going Up with Contractions - Means the Baby is Tolerating Contractions Well |
| Diabetes (Pregestational) Assessments | Fetal Movement Tests - Biophysical Profiles - Usually performed in the third trimester of pregnancy to assess fetal well-being - Scored on fetal movement, muscle tone, fetal breathing, amniotic fluid, and FHR |
| Diabetes (Pregestational) Assessments | Fetal Movement Tests - Biophysical Profiles - Each parameter is scored from 0-2, with a total score of 8-10 being the highest, and a score of 6 indicating further monitoring or interventions |
| Diabetes (Pregestational) Birth Considerations | - Potential for C-Section if Baby is Macrosomic - However, Vaginal Birth is Not Contraindicated - Labor Induced Between 39 - 40 Weeks, so the baby is not too big |
| Diabetes (Pregestational) Care Considerations | - Diet, exercise, and medications are important care components that should be closely monitored - Be mindful of exercise tolerance when pregnant - DKA is not an indication for emergent delivery |
| Systemic Lupus Erythematosus (SLE) | - When SLE has been in remission for 6 months, that is when pregnancy is safest - SLE patients have 2- 7x the risk of pregnancy complications Complications - Preeclampsia - IUGR |
| Multiple Sclerosis (MS) | - Chronic demyelination of the CNS with relapses and remissions - Pregnancy is often a time of disease remission, while postpartum is a significant time for relapse. |
| Multiple Sclerosis (MS) Complications | - Preterm Labor - Infection - Cardiovascular Disease - Anemia - Neuro Effects |
| Multiple Sclerosis (MS) Medication Considerations | - Some teratogenic, contraindicated - Some may not be safe to breastfeed an infant on |
| CV Disease | - The inability of the heart to maintain adequate circulation - Decreased perfusion to the mother and fetus - Increased Cardiac Output Can Exacerbate Underlying Issues |
| CV Disease: Monitor for Cardiac Decompensation | - Generalized Edema - Frequent, Moist Cough - Cyanosis of Nails and Lips - Tachypnea (> 25 RR/min) - Crackles (that do not clear with coughing) - Rapid, Weak, Irregular Pulse (100 > bpm) |
| CV Disease: Monitor for Cardiac Decompensation | - Difficulty Catching Breath - Increased fatigue - Palpitations - Generalized Edema - Feeling of being smothered |
| Chronic HTN Complications | - Preterm Birth - IUGR - Still Birth - Preeclampsia - Stroke |
| Chronic HTN | - Makes it more difficult for the heart to pump blood to the placenta - Treatment - Only for severe (160/110 or higher) - Goal: Maintain (140-150)/(90-100) may be lower if patient has evidence of organ damage |
| Chronic HTN Medications | - Labetalol (Beta Blocker) - Methyldopa (Alpha-2 Adrenergic Agonist) - Nifedipine (Calcium Channel Blocker) - Try to avoid NSAIDs if possible as they can increase BP findings |
| Chronic HTN | Monitor Closely for Preeclampsia and HELLP |
| Obesity | Fat has Endocrine Features - Affects Inflammatory Pathways - Affects Vasculature - Affects Metabolism |
| Obesity | Prepregnancy weight loss can improve outcomes (RNs can encourage) HOWEVER, weight loss should not be encouraged during pregnancy |
| Obesity Complications | - Gestational DM Preeclampsia - Hypertension - Medically Induced Preterm Labor - Postdate pregnancies - Slower First Stage of Labor - Macrosomia - PP thromboembolism - PPH |
| Eating Disorders | - Normal pregnancy body changes may be challenging for a patient with an ED - These patients may not menstruate, but they should be informed that they can ovulate |
| Eating Disorders | Anorexia Nervosa - Disturbed Body Image - Amenorrhea - Electrolyte Imbalances Binge Eating Disorders - No Compensatory Actions |
| Eating Disorders | Bulimia Nervosa - Compensatory Actions - Tooth Erosion (d/t vomiting) - Hand Calluses - Electrolyte Imbalances |
| Iron Deficiency Anemia | - Normal Hemoglobin Levels in Pregnancy: 11-14 g/dL - Hemoglobin < 10.5 g/dL (concerning) |
| Iron Deficiency Anemia | Need Iron Supplementation (Ferrous Sulfate) - Absorption is best on an empty stomach or supplemented with vitamin C (enhances iron absorption) - Be mindful of dark green/black stools |
| Iron Deficiency Anemia Complications | - Hysterectomy - Blood Transfusion - Preeclampsia - Eclampsia - Death - Hemorrhage - Surgical Birth |
| IPV | - Often underreported - Should be screened at all visits when alone with patient - Often accelerates in pregnancy |
| Substance Abuse | - May not seek prenatal care because of shame or worry about social services - Complications vary based on the substance |
| Substance Abuse | Opioids - Infants at high risk of neonatal abstinence syndrome ETOH - Fetal Alcohol Spectrum Disorder - NO known safe amount of alcohol during pregnancy |
| Substance Abuse Complications | - Smoking - Preterm birth - IUGR - Miscarriage - Subfertility - Preeclampsia - Placental Abruption - Stillbirth - Sudden infant death syndrome (SIDS) |
| Substance Abuse Considerations | - May have several other comorbid conditions - Psychosocial challenges - Homelessness - Stopping at any point during pregnancy can improve outcomes |
| Depression | If left untreated can lead to: - Substance Abuse - Poor adherence to care - Less prenatal care - Poor nutrition - Suicide SSRIs have been associated with lower APGAR scores - Benefits outweigh risks |
| Anxiety | Assessed with the GAD-7 Scale Treatment: - SSRIs - Counseling - Benzos May cause withdrawal in neonates and a higher risk of fetal loss and preterm birth - Weigh risks vs. benefits Self-care measures: mindfulness, exercise, good nutrition |
| Sudden Infant Death Syndrome (SIDS) Risk Factors | - Maternal smoking - Maternal age under 20 yo - Little or no prenatal care - Maternal substance abuse - Low birth weight/preterm - Twin |
| Sudden Infant Death Syndrome (SIDS) Risk Factors | Environmental factors - Sleeping on a soft surface - Sleeping with loose blankets, pillows, toys, or crib bumper pads - Sharing a bed - Overheating - Sleeping prone |
| Sudden Infant Death Syndrome (SIDS) Protective factors | - Room sharing - Pacifier use - Breastfeeding - Supine sleep position - Firm sleep surface |
| Sudden Infant Death Syndrome (SIDS) | - The unexplained death of an infant under 1 year old - Leading cause of infant death between 1 month and one year old |
| Rubin's Phases | - Taking In: The birthing parent exhibits dependent behavior, focusing on recovering from pregnancy and birth, taking a passive role in self and newborn care, and processing the birth experience by discussing it with others. |
| Rubin's Phases | - Taking Hold: Transition from dependent to independent behavior that may last several weeks. Growing used to the new reality. Taking charge of their care and care of the newborn. May require reassurance |
| Rubin's Phases | Letting Go: The patient acknowledges the new normal, accepts the baby as an individual, and embraces their altered role as a mother. |
Created by:
getit