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OB Tutoring
Conditions Occurring During Pregnancy
| Term | Definition |
|---|---|
| Hyperemesis Gravidarum | characterized by unusually acute nausea and vomiting during pregnancy. It is more severe than typical morning sickness. |
| Hyperemesis Gravidarum Symptoms | weight loss, malnutrition, dehydration, ketonuria, and electrolyte imbalances |
| Hyperemesis Gravidarum Risk Factors | - History of HG - Gestational Trophoblastic Disease - Multiple Pregnancy - Hyperthyroidism - GI disease prior - Depression - Anxiety - Female fetus |
| Hyperemesis Gravidarum Priority Interventions | - Stop all food and fluid intake until vomiting has stopped. (NPO) - Establishing IV access for rehydration. - Administering antiemetics, though some may have teratogenic effects. - Promoting comfort and nutrition. - Providing education and support. |
| Hyperemesis Gravidarum Priority Interventions | Monitoring for signs of dehydration and malnutrition. - Check for ketones in urine - Check weights - Monitor urine output (goal is 30ml/hr) |
| Bleeding in Pregnancy (Miscarriage) | - Miscarriage (Spontaneous Abortion): A spontaneous pregnancy loss that occurs before 20 weeks of gestation. - Causes: Approximately 70% of miscarriages are associated with chromosomal abnormalities. |
| Bleeding in Pregnancy (Miscarriage) Symptoms | Vaginal bleeding, cramping, and the passage of tissue. |
| Bleeding in Pregnancy (Miscarriage) Nursing Management | - Assess maternal bleeding, cramping, and vital signs. - Monitor the patient's state of mind. - Provide support and be aware of the grieving process. |
| Bleeding in Pregnancy (Miscarriage): Medications Related to Abortions | Misoprostol (Cytotec): Stimulates uterine contractions to terminate a pregnancy and evacuate the uterus. - Side Effects: Diarrhea, abdominal pain, nausea, vomiting, & dyspepsia |
| Bleeding in Pregnancy (Miscarriage): Medications Related to Abortions | Mifepristone (RU-486): Acts as a progesterone antagonist, causing the endometrium to slough. May be followed by misoprostol (within 48 hrs). Can also administer an antiemetic prior to reduce N/V. |
| Bleeding in Pregnancy (Miscarriage): Medications Related to Abortions | Mifepristone (RU-486) Side Effects: Headache, vomiting, diarrhea, and heavy bleeding. |
| Bleeding in Pregnancy (Miscarriage): Medications Related to Abortions | PGE2, dinoprostone (Cervidil, Prepidil Gel, Prostin E2): Stimulates uterine contractions, causing expulsion of uterine contents. Used for missed abortion in the second trimester and to efface and dilate the cervix at term |
| Bleeding in Pregnancy (Miscarriage): Medications Related to Abortions | Rh(D) immunoglobulin (RhoGAM): Suppresses the immune response of Rh-negative patients exposed to Rh-positive blood. Administer intramuscularly. Will be needed after subsequent deliveries if the fetus is Rh-positive |
| Bleeding in Pregnancy (Ectopic Pregnancy) | - Pregnancy that occurs outside the uterus, often in the fallopian tube. - LIFE-THREATENING |
| Bleeding in Pregnancy (Ectopic Pregnancy) Signs | - Severe Pelvic Pain - Referred pain to one shoulder - Bleeding |
| Bleeding in Pregnancy (Ectopic Pregnancy) Diagnostics | - Serial Beta hCG - determine if levels are increasing or decreasing - Transvaginal US - Get a better idea of where the pregnancy has implanted |
| Bleeding in Pregnancy (Ectopic Pregnancy) Risk Factors | History of pelvic infection, Slows down peristalsis of the tube, Previous ectopic pregnancy, History of infertility or fertility treatments, Smoking, Douching, Increased age |
| Bleeding in Pregnancy (Ectopic Pregnancy) Treatment | - Medical/Surgical Management - Depends on when this is discovered - how far along she is - Pregnancy cannot continue to term |
| Bleeding in Pregnancy (Ectopic Pregnancy) Nurses Role | Emotional & Physical Support |
| Bleeding in Pregnancy (Gestational Trophoblastic Disease) | - Molar Pregnancy - Nonviable mass of trophoblastic tissue - Produces high levels of beta hCG - Diagnosed on ultrasound |
| Bleeding in Pregnancy (Gestational Trophoblastic Disease) Treatment | - Hysterectomy - D&C - Serial hCG - Prophylactic Chemo Tx (Avoid pregnancy for at least 1 year due to recurrence) |
| Bleeding in Pregnancy (Placenta Previa & Placental Abruption) | Placenta Previa: Occurs when the placenta overlies the internal cervical opening of the cervix either partially or completely Placental Abruption: Premature detachment of placenta after 20 weeks |
| Rh Isoimmunization | RhoGAM is Rh(D) immunoglobulin, used to prevent Rh isoimmunization in Rh-negative people exposed to Rh-positive blood. - Rh- mother; Rh+ father; Rh + baby Diagnosis and Prevention are Key |
| Rh Isoimmunization | Mom's body is sensitized to Rh+ blood during birth Mom's body creates antibodies against the baby’s positive blood Subsequent pregnancies are affected - Antibodies attack fetal RBCs |
| Rh Isoimmunization Treatment | Rhogam at 28 weeks & within 72 hours after delivery If any bleeding occurs during pregnancy, patient needs to receive Rhogam - Threatened abortion - Amniocentesis (a prenatal test that takes amniotic fluid from around your baby in the uterus) |
| HTN in Pregnancy | - Preferred Antihypertensives include labetalol, methyldopa, and nifedipine. |
| HTN in Pregnancy | Chronic Hypertension: Exists prior to pregnancy or develops before 20 weeks' gestation. |
| HTN in Pregnancy | - Mild to Moderate Chronic Hypertension: systolic BP of 140-159 mmHg and/or a diastolic BP of 90-109 mmHg. |
| HTN in Pregnancy | - Severe Chronic Hypertension: systolic BP greater than 160 mmHg or diastolic BP greater than 110 mmHg. |
| Gestational Hypertension (Pregnancy Induced Hypertension [PIH]) | Elevated blood pressure (≥140/90 mmHg) identified after 20 weeks' gestation without proteinuria. |
| Gestational Hypertension (Pregnancy Induced Hypertension [PIH]) | - Blood pressure returns to normal by 6 weeks postpartum. - No signs of organ dysfunction - Complications: preterm birth, small for gestational age (SGA) infants, and placental abruption. |
| HTN in Pregnancy | Gestational → Preeclampsia → Eclampsia → HELLP Syndrome |
| Preeclampsia | Gestational hypertension with proteinuria (protein in urine) and/or signs of end-organ dysfunction. - It can be mild or severe. |
| Preeclampsia Symptoms | - Headache - Vision Changes - Mental Status Changes - Epigastric and RUQ Pain (Pain from the liver) |
| Preeclampsia Diagnostic Criteria | systolic BP of 140 mmHg or higher and/or diastolic BP of 90 mmHg or higher on two occasions at least 4 h apart at, or after, 20 weeks of gestation AND proteinuria or dipstick +1 > or creatinine ratio > 0.3. |
| Preeclampsia Complications | oligohydramnios, placental abruption, intrauterine growth restriction, renal damage, pulmonary edema, liver damage, cerebral edema, hemorrhage, and thrombocytopenia. |
| Preeclampsia Treatment | magnesium sulfate to prevent seizures and antihypertensive medications. |
| Preeclampsia Treatment | - Assess for signs and symptoms of magnesium toxicity, such as decreased level of consciousness, depressed respirations and DTRs, slurred speech, weakness, and respiratory and/or cardiac arrest. Have calcium gluconate on hand. |
| Eclampsia | Preeclampsia with tonic-clonic seizure activity |
| Eclampsia Symptoms | - Tonic-Clonic Seizure Activity - Headache - Vision Changes - Mental Status Changes - Epigastric and RUQ Pain (Pain from the liver) |
| Eclampsia Nursing Interventions | - Frequent VS DTR (may have brisk reflexes or clonus due to cerebral edema) - Monitoring Urine output and proteinuria - Severe Headache, Vision Changes & Mental Status Changes indicate worsening Preeclampsia/Eclampsia. NOTIFY HCP!! |
| Eclampsia Nursing Interventions | - Epigastric & RUQ Pain - Monitor fetal movement and fetal heart rate - Notice any vaginal bleeding or discharge - Fundal height measurements - 1 cm per week of gestation - NST - Assess for the presence of edema |
| HELLP Syndrome | A severe variant of preeclampsia, involving hemolysis, elevated liver enzymes, and low platelet count. |
| HELLP Syndrome | Hemolysis - Resulting in Anemia or Jaundice |
| HELLP Syndrome | Elevated Liver Enzymes - Resulting in elevated AST/ALT, epigastric pain, and N/V |
| HELLP Syndrome | Low Platelet Count - Resulting in thrombocytopenia, abnormal bleeding and clotting time, bleeding gums, petechiae, and potentially DIC and bleeding. |
| HELLP Syndrome Complications | - Increased risk for placental abruption - Acute renal failure - Hepatic hematoma or rupture - Preterm birth - Fetal/maternal death. |
| HELLP Syndrome Management | - Managed in the ICU - Treatment includes lowering blood pressure (hydralazine or labetalol) - Seizure prevention (magnesium sulfate) |
| HELLP Syndrome Management | - Blood component therapy (fresh-frozen plasma, packed RBCs, platelets) - Delivery of the fetus (steroids for fetal lung maturity) - Stabilize the patient & fetus |
| Gestational Diabetes | Diabetes that develops during pregnancy, associated with insulin resistance resulting in high blood glucose levels. |
| Gestational Diabetes Complications | - Preeclampsia - Fetal Macrosomia - High levels of circulating glucose cause fetuses to increase insulin production - The fetus grows, but most is adipose tissue - Risk for shoulder dystocia |
| Gestational Diabetes Complications | - C-section or surgical vaginal delivery - Birth trauma - Neonatal respiratory problems - Neonatal metabolic problems - Hypoglycemia - Hypocalcemia - Jaundice - Perinatal mortality |
| Gestational Diabetes Screening | High-risk individuals may be screened at the first prenatal visit. All individuals are screened between 24 and 28 weeks of gestation. |
| Gestational Diabetes MOMMA Risk Factors | - Maternal age greater than 40 - Obese or overweight - Macrosomia in prior birth - Multiple pregnancies - A history of GD, or familial diabetes |
| Gestational Diabetes Initial screening | Non-fasting 50g glucose tolerance test, and if blood glucose is > 130, diagnostic testing is indicated. |
| Gestational Diabetes Diagnostic test | Fasting 100g glucose tolerance test, with blood sugar evaluated at fasting, 1, 2, and 3 hours after ingestion. If two or more values are elevated, the patient has gestational diabetes. |
| Gestational Diabetes Diagnostic test | - Fasting ≥ 95 mg/dL - One hour ≥ 180 g/dL - Two hours ≥ 155 mg/dL - Three hours ≥ 140 mg/dL |
| Gestational Diabetes | - Risks: stillbirth, fetal macrosomia, and postpartum hemorrhage. - Treatment: diet, exercise, and sometimes medications (insulin) |
| Infections in Pregnancy: STIs | Gonorrhea - Treat with antibiotics then retest 3-4 months later Chlamydia - Treat with antibiotics then retest 3-4 months later Syphilis HCV Trich |
| Infections in Pregnancy: STIs | HSV - risk to neonate during active outbreak - Can cause encephalitis or death - Vaginal delivery contraindicated during active outbreak - Prophylactic acyclovir |
| Infections in Pregnancy: STIs | HIV - Pregnancy is not contraindicated for HIV+ patients - C-Section is recommended to reduce risk of transmission to fetus HBV - Hep B vaccine needs to be given to the neonate within 12 hours of birth |
| Infections in Pregnancy: UTIs | - May present abnormally/asymptomatic - Treated with antibiotics during pregnancy |
| Infections in Pregnancy: Vaginal Infections | BV - Benign & self-limiting - Poses a risk for preterm birth, postpartum pelvic infection, and late miscarriage in pregnant patients Yeast Infections |
| Infections in Pregnancy: TORCH | Toxoplasmosis Others: - Syphilis - Varicella - Parvovirus - Mumps - Enterovirus Rubella CMV HSV |
| Cervical Insufficiency | - Painless, premature dilation and effacement of the cervix during the second trimester - No contractions - High risk for miscarriage and premature birth |
| Cervical Insufficiency Treatment | - Progesterone supplementation - Cervical cerclage (stitching around the cervix to prevent preterm birth) |
| Trauma | - Assault/MVA/IPV/etc. - Wedge under the R hip to avoid supine hypotension - Chest compressions are more challenging and effective later in pregnancy - Oxygen consumption demand increases - should be monitored closely for hypoxia |
| Trauma | - Risk for placental abruption (when the placenta separates from the uterine wall prematurely) - Rhogam may be indicated - Assess the patient and fetus for complications |
| IUGR | A condition indicating a complication of pregnancy where a fetus does not meet its growth potential. May be maternal, placental, or fetal in origin. |
| IUGR | SGA (Small for Gestational Age) is a fetus measuring under the 10th percentile for weight. - SGA and IUGR are not interchangeable |
| IUGR Risks to the Infant | Infants with IUGR are at high risk for hypoglycemia, problems with thermoregulation, and respiratory distress after birth. |
| Asymmetric IUGR (occurs in the third trimester) | - Uteroplacental insufficiency - Maternal Hypertension - Maternal Malnutrition - Maternal Genetic Disease - Maternal Acquired Disease - Abnormal Placentation - Multiple Gestation |
| Symmetric IUGR | Associated with neurological problems in the neonate, may be seen on the ultrasound in the second trimester |
| Symmetric IUGR | - TORCH infections - Maternal Substance Abuse - Maternal Anemia - Chromosomal abnormalities - Smoking - Teratogenic medications |
| Amniotic Fluid Disorders (Polyhydramnios) | Associated with: - Preterm labor - Birth defects - PPH - Placental abruption |
| Amniotic Fluid Disorders (Polyhydramnios) | Excessive amniotic fluid - Amniotic fluid is a protective buffer for the fetus and allows for fetal movement The cause is either unknown, from diabetes, or twin-to-twin transfusion |
| Amniotic Fluid Disorders (Polyhydramnios) Treatment | Amnioreduction (get rid of excess fluid) IV indomethacin (prior to 31 weeks) - May reduce amniotic fluid - Risk for closing the ductus arteriosus - do not give past 31 weeks (PDA is essential for baby viability after 31 weeks) Induction of labor |
| Amniotic Fluid Disorders (Oligohydramnios) | - Less amniotic fluid can be due to fetal anomalies or PROM (premature rupture of membranes) - Amnioinfusion (Infusion of LR) - Increased fluid intake - Associated with poor outcomes (Cord prolapse for example) |
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