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OB Exam 3
OB Chapter 19
| Question | Answer |
|---|---|
| abortion | a variety of ways in medical and legal literature but at its basic level is the expulsion or extraction of an embryo or fetus before it is viable |
| eclampsia | hallmark neurologic complication of preeclampsia, with the new onset of generalized, tonic–clonic seizure activity |
| ectopic pregnancy | any pregnancy in which the fertilized ovum implants outside the main cavity of the uterus, including the fallopian tubes, cervix, ovary, and the abdominal cavity |
| Gestational trophoblastic disease | spectrum of benign and malignant disorders that are created from abnormal trophoblastic tissue |
| oligohydramnios | decreased amount of amniotic fluid expected for gestational age and is associated with poor pregnancy outcomes |
| placenta accreta | includes three conditions |
| Accreta is | a condition in which the placenta attaches itself too deeply into the wall of the uterus but does not penetrate the uterine muscle |
| Placenta increta is | when the placenta invades the myometrium |
| placenta percreta occurs when | it has extended through the myometrium, uterine serosa, and adjacent tissue |
| placenta previa | exists when the placenta is inserted wholly or partly into the lower uterine segment of the uterus, partially or completely covering the internal cervical opening |
| placental abruption | early separation of a normally implanted placenta after the 20th week of gestation prior to birth, which leads to hemorrhage |
| polyhydramnios | condition in which there is an excessive volume of amniotic fluid (more than 2,000 mL) surrounding the fetus between 32 and 36 weeks’ gestation |
| preeclampsia | new-onset hypertension accompanied by proteinuria and/or maternal organ dysfunction that targets the cardiovascular, hepatic, renal, and central nervous systems |
| What is a high-risk pregnancy? | A condition threatens the health of the mother, fetus, or pregnancy |
| incidence of high risk pregnancies | 1 in 4 women |
| When do you assess risk factors for high risk pregnancies | first prenatal visit and continues with each subsequent visit because factors may be identified in later visits that were not apparent during earlier visits |
| What factors make a pregnancy high-risk? | Biophysical Psychosocial Sociodemographic Environmental |
| Biophysical factors making it high risk | Genetics Medical conditions (Diabetes) Nutrition |
| Psychosocial factors making it high risk | Substance use History of violence Cultural practices |
| Sociodemographic factors making it high risk | Poverty Ethnicity Parity Single |
| Environmental factors making it high risk | Radiation Pollution Pesticides |
| How do we deal with modifiable risks | Education / Intervention Follow-Up Close monitoring |
| How do we deal with nonmodifiable risks | Determine need for additional testing Consider referral to specialty medicine |
| types of high risk bleeding conditions | Bleeding in EARLY pregnancy Bleeding in LATE pregnancy |
| Causes of Early Pregnancy Bleeding | Miscarriage or Abortion Ectopic Pregnancy Cervical Insufficiency Molar Pregnancy |
| Abortions / Miscarriages are the | most common complication of early pregnancy |
| 80% of abortions happen | before 20th week |
| abortions/miscarriage causes in 1st trimester | abortions/miscarriage |
| abortions/miscarriage causes in 2nd trimester | ectopic pregnancies |
| Abortion / Miscarriage: Manifestations/Assessment | Varying degrees of vaginal bleeding, low back pain, abdominal cramping, and passage of products of conception tissue may be reported |
| Management of abortions and miscarriage – Provide Support | Pain relief Surgical need? prep for D&C Expectant mgmt? Meds…. Emotional – grief support, referral, guilt Blood type & screen for Rh status |
| types of miscarriages | threatened, inevitable, incomplete, complete |
| threatened miscarriages | vaginal bleeding closed cervical os fetal cardiac activity |
| inevitable miscarriages | vaginal bleeding dilated cervical os products of conception may be seen or felt at or above cervical os |
| incomplete miscarriages | vaginal bleeding dilated cervical os some products of conception expelled and some remain |
| complete miscarriages | vaginal bleeding closed cervical os products of conception completely expelled |
| Abortion / Miscarriage: Therapeutic Management | misoprostol mifepristone PGE2 Rho(D) immunoglobulin RhoGAM |
| misoprostol | Stimulates uterine contractions to terminate a pregnancy |
| mifepristone | Acts as a progesterone antagonist, allowing prostaglandins to stimulate uterine contractions; causes the endometrium to slough |
| PGE2 | Stimulates uterine contractions, causing expulsion of uterine contents; expels uterine contents in fetal death or spontaneous abortion during the second trimester |
| Rho(D) immunoglobulin RhoGAM | Suppresses immune response to prevent isoimmunization in nonsensitized Rh-negative patients exposed to Rh-positive blood after abortion, miscarriage, or pregnancy |
| Ectopic Pregnancy: Assessment | health history and physical exam to determine risk factors look for signs: missed menstrual period, adnexal fullness, and tenderness may indicate an unruptured tubal pregnancy |
| Ectopic Pregnancy: nursing management | pain management, providing medication, offering support, and providing education about treatment and follow-up provide medication therapy: methotrexate provide pre op and post op care provide emotional support prevent future ectopic pregnancies |
| Ectopic Pregnancy: therapeutic management | hcG levels & transvaginal ultrasound early / unruptured - give methotrexate late / ruptured - surgery to remove fallopian tube (e.g., salpingectomy) |
| signs of ectopic pregnancy | sudden, severe abdominal or pelvic pain dizziness or fainting pain in the shoulders due to leakage of blood into abdomen affecting diaphragm pain in lower back |
| Gestational Trophoblastic Disease: Hydatidiform mole | Benign neoplasm of the chorion in which chorionic villi degenerate and become transparent vesicles |
| Gestational Trophoblastic Disease: Choriocarcinoma | abnormal hyperproliferation of trophoblastic cells that would normally develop into the placenta during pregnancy |
| Hydatidiform mole can lead to | Choriocarcinoma |
| GTD assessment findings | hCG levels are high Vaginal bleeding Pelvic pressure or pain Enlarged uterus hyperemesis gravidarum |
| GTD nursing management | prepare for D & C education & emotional support strict adherence to follow-up!!! |
| GTD therapeutic management | obtain hCG levels transvaginal US surgery to evacuate tissue |
| Cervical Insufficiency is commonly a cause of | Late miscarriage (e.g., after 12 weeks) Pregnancy loss Preterm labor |
| Cervical Insufficiency: assessment | painless dilation pink spotting (light) pelvic pressure / fullness |
| Cervical Insufficiency: management | assess fetal heart rate / activity education on sx of PTL prepare for cerclage |
| Cervical Insufficiency: therapeutic management | cerclage |
| cerclage | involves using a heavy purse-string suture to secure and reinforce the internal os of the cervix |
| Causes of Bleeding in LATE pregnancy | Placental previa Placental abruption |
| Placenta Previa is when | Placenta implants in lower part of uterus (e.g., lower uterine segment) |
| types of placenta placements | normal placenta low lying placenta placenta previa |
| low lying placenta | the placental edge being less than 2 cm from the internal os but does not cover it |
| whos at risk for placenta previa | birthing person with high number of children high parity high maternal age previous c section endometriosis |
| placenta previa assessment | ***painless, bright red bleeding May be intermittent FHR usually normal |
| placenta previa management | depends on gest & sx severity Lab values like hgb and hct Assess need for corticosteroids for babies lungs to mature more quickly Modify activity, pelvic rest Educate & support Birth is ALWAYS C-Section |
| Placental Abruption is when | Placenta detaches from the uterine lining Detachment can be partial or complete |
| who is at risk for placental abruption | obstetric hemorrhage, need for blood transfusions, emergency hysterectomy, disseminated intravascular coagulation (DIC), Sheehan syndrome or postpartum gland necrosis, and renal failure |
| placental abruption results from | premature placental separation and rupture of maternal blood vessels in the decidua basalis, which leads to bleeding between the decidua and placenta |
| why is placental abruption a problem | significant cause of second- or third-trimester bleeding with a high mortality rate |
| Placental Abruption: Nursing Assessment | *** dark red or port wine bleeding Knife-like pain Board-like or rigid abdomen Fetal distress or absent FHTs |
| Placental Abruption: Nursing Management | Medical emergency Monitor fetus & mom Intrauterine resuscitation to increase perfusion Watch for DIC & shock Prep for CS Educate & support |
| Hyperemesis Gravidarum is a complication of | pregnancy – usually in 1st and 2nd trimesters |
| what is Hyperemesis Gravidarum | The severe form of morning sickness Persistent and uncontrollable nausea and vomiting |
| when does Hyperemesis Gravidarum peak | Peaks between 8-12 weeks of pregnancy and resolves by 20th week |
| Hyperemesis Gravidarum can result in | Need for hospitalization Anxiety & depression Work performance impairment Consideration of termination of pregnancy |
| Hyperemesis Gravidarum assessment | Persistent & uncontrolled nausea and vomiting Weight loss, ketosis, electrolyte imbalances, nutritional deficiencies |
| Hyperemesis Gravidarum management | assess vital signs (BP / HR) monitor labs (urinalysis, electrolyte levels) give fluids and antiemetics education and emotional support |
| Hyperemesis Gravidarum therapeutic management | IV fluids & NPO status Antiemetics (Diclegis, Phenergan, Zofran) If really severe, parenteral nutrition |
| Hypertensive Disorders of Pregnancy | Chronic HTN, Gestational HTN, Preeclampsia, HELLP, SIPE (Chronic HTN with Superimposed Preeclampsia) |
| Hypertensive Disorders of Pregnancy | Chronic HTN Gestational HTN |
| Chronic HTN | blood pressure exceeding 140/90 mm Hg before pregnancy or before 20 weeks’ gestation antiHTN therapy initiated if chronic hypertension is detected with a blood pressure reading of 140/90 because of the long-term sequelae of stroke or acute renal failure |
| Gestational HTN | hypertension (higher than 140/90 mm Hg) in a previously normotensive patient without proteinuria after 20 weeks’ gestation resolving by 12 weeks’ postpartum |
| how is gestational HTN diagnosed | on at least two occasions at least 4 to 6 hours apart after the 20th week of gestation in patients known to be normotensive prior to this time and prior to pregnanc |
| Preeclampsia etiology | is still changing |
| two stage event of preeclampsia | Vasospasm Hypoperfusion |
| generalized vasospasm resulting in | increased peripheral resistance, hypertension, and poor tissue perfusion in all organ systems |
| hypoperfusion | kidney injury (present how?) liver injury (present how?) neuro injury (present how?) |
| therapeutic management of preeclampsia | includes preconception counseling, perinatal blood pressure control and monitoring, prenatal aspirin therapy, betamethasone for patients prior to 34 weeks’ gestation, parenteral magnesium sulfate prophylaxis, and follow-up of postpartum blood pressures |
| Care of the patient with preeclampsia varies depending on | the severity of their condition and its effects on the fetus |
| Preeclampsia Without Severe Features - HOME | No renal or liver impairment or coagulopathies Bedrest, kick counts, BP monitoring, limit Na+ in diet |
| Preeclampsia Without Severe Features - HOSPITAL | Keep pregnant as long as possible for fetus Monitor for hyperreflexia, headaches, BPs & labs |
| Preeclampsia With Severe Features - HOSPITAL | May develop quickly – treated aggressively to stabilize dyad for birth Goal – control HTN, prevent seizures, prevent morbidity/mortality |
| Therapeutic Management of Preeclampsia: antihypertensives | manage BP: Labetelol Nifedipine Hydralazine |
| Therapeutic Management of Preeclampsia: Magnesium Sulfate | ** Gold Standard** for preventing & treating seizure activity |
| with magnesium sulfate, | V piggyback CNS depressant Vasodilation = warmth, flushing, diaphoresis Watch for toxicity!! |
| Watch for toxicity for magnesium sulfate | VS; Strict Is/Os; lung assessment; CNS; severe features Antidote – Calcium Gluconate |
| eclampsia premonitory signs/sx | headache; blurred vision; abd pain; altered mental status |
| eclampsia features | tonic contraction respirations stop; hypotension; vomiting or incontinence |
| eclampsia Immediate Care | ABCs, suction, O2 Side rails up Mag sulfate, IVF Prepare for delivery of baby |
| Hypertensive Disorders - Nursing Focused Assessment: questions to ask | How are you feeling? How is your vision? Do you have a headache? Do you have any flank pain? Have you been peeing? Have you noticed any increased swelling? |
| Hypertensive Disorders - Nursing Focused Assessment: physical assessment | BP Signs of Edema Listen to heart / lungs Extremity assessment Reflexes Clonus Proteinuria Severe Features |
| HELLP syndrome is a variant of | preeclampsia |
| HELLP syndrome occurs in | up to 20% of people with severe features of preeclampsia |
| HELLP syndrome is characterized by | abnormal vascular tone, vasospasm, and coagulation defects |
| HELLP syndrome patients are at increased risk for | Cerebral hemorrhage Retinal detachment Hematoma/liver rupture DIC Placental abruption Death |
| Nursing assessment & mgmt. for HELLP syndrome | same as for preeclampsia |
| Multifetal Pregnancies Risks: | Preterm labor Polyhydraminos Hyperemesis gravidarum congenital anomalies twin-to-twin transfusion syndrome intrauterine growth restriction conjoined twins |
| prenatal care for Multifetal Pregnancies | Serial ultrasounds, biophysical profiles, and nonstress tests |
| Multifetal Pregnancies L&D | c section most common |
| nursing assessment for Multifetal Pregnancies | fetal movement, fundal height measurements, nausea, fatigue, weight gain |
| Pre-labor Rupture of Membranes (PROM) happens at | >37 weeks gestation |
| Pre term Pre-labor Rupture of Membranes (PROM) happens at | <37 weeks gestation |
| Therapeutic management of PROM | depends on gestational age nothing in vagina expectant management if fetal lungs immature - consider corticosteroids |
| nursing assessment of PROM | Risk factors Sx of labor Fetal monitoring Amniotic fluid characteristics & POC testing |
| Nursing management of PROM | Infection prevention Uterine ctx? Education & support Discharge home (PPROM) if no labor within 48 hours |
Created by:
leh195