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Introduction to Common Complications of Pregnancy

QuestionAnswer
What are the two broad categories of pregnancy complications? *Unique to pregnancy. *Can occur at any time, but are complications when in conjunction with pregnancy
What diagnostic test can guarantee the birth of a healthy baby? NO diagnostic test can guarantee the birth of a healthy baby
What does an ultrasound require for proper visualization of the fetus? A full bladder
List the uses of ultrasounds for pregnancy: *Confirmation of pregnancy *Verification of the location of the pregnancy (uterine/ectopic) *Verification of fetal viability or death *Identification of multi-fetal gestations *Dx of fetal structural abnormalities *Gestational age of fetus
How long does an ultrasound take? 10 - 30 minutes
How is the PT positioned during an ultrasound? *Position on back with head and knees supported *Elevate head so that she can see the screen *Turn slightly to one side to prevent hypotension
What test makes use of high frequency sound waves to study the flow of blood through the umbilical artery and vessels, determining adequacy of blood flow? Doppler Ultrasound Blood Flow Assessment
What is the predominate protein in fetal plasma? Alpha-fetoprotein (AFP)
What screening determines the level of this fetal protein in the pregnant woman's serum or in a sample of amniotic fluid? Alpha-Fetoprotein Screening
What are elevated levels of Alpha-fetoprotein (AFP) associated with? neural tube defects, such as spina bifida (open spine), anencephaly (incomplete development of the skull and brain), or gastroschisis (open abdominal cavity)
What are low levels of Alpha-fetoprotein (AFP) associated with? chromosome abnormalities such as Down Syndrome or trisomy 21 or gestational trophoblastic disease (hydatidiform mole)
What can influence AFP levels? *Gestational age *Maternal weight *Multifetal pregnancy *Race *Maternal diabetes
What is a procedure by which fetal tissues are analyzed to reflect the chromosomal and genetic makeup of the fetus and is used to identify chromosomal, metabolic or DNA abnormalities? Chorionic Villus Sampling
What are the types of chorionic villus sampling techniques? *Transabdominal *Transcervical
What is an amniocentisis? The insertion of a thin needle through the abdominal and uterine walls to obtain a sample of amniotic fluid, which contains cast-off fetal cells and various other fetal products
When is EARLY amniocentesis performed? 11 to 14 weeks’ gestation.
When most amniocentesis' performed? 15 to 20 weeks’ gestation
Why are mid-trimester amniocentesis' done? *Identify chromosomal abnormalities *Fetal condition *Diagnose intrauterine infections *Investigate amniotic fluid AFP and acetylcholinesterase when there is a previously documented abnormality
Why are third trimester amniocentesis' done? *Assess fetal lung maturity and whether the fetus is likely to have respiratory complications *help test for fetal hemolytic diseases when Rh incompatibility is suspected.
What does a non-stress test (NST) determine? whether an increase in the fetal heart rate occurs when the fetus moves
How long does a non-stress test (NST) take? 40 minutes
What is a non-stress test (NST) used to identify? Identifies fetal compromise in conditions associated with poor placenta function, such as hypertension, diabetes mellitus, or post-term gestation
What is used to confirm a nonreactive non-stress test (NST) findings? Vibroacoustic Stimulation Test
How is a vibroacoustic stimulation test performed? An artificial larynx device is used to stimulate the fetus with sound; expected response is acceleration of the fetal heart rate, as in NST
What is an evaluation of the fetal heart rate response to mild uterine contractions by using an external fetal monitor? Contraction Stress Test
When is Contraction Stress Testing conducted? after 32 weeks of gestation
What test is used to determine how the fetal central nervous system reacts to hypoxemia and fetal acidosis? Biophysical Profile
What test involves the aspiration of fetal blood from the umbilical cord for prenatal diagnosis or therapy? Percutaneous Umbilical Blood Sampling
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).
Define Hyperemesis Gravidarum: Persistent, uncontrollable vomiting that begins before the 20th week of pregnancy
What is the most common cause of spontanious abortion? *Severe congenital abnormalities incompatible with life *Chromosomal defects account for about 50-60%
What are the six spontanious abortion sub-groups? *Threatened *Inevitable *Incomplete *Complete *Missed *Recurrent
What is threatened abortion? *Vaginal bleeding occurs *May be followed by rhythmic uterine cramping, persistent backache, or feelings of pelvic pressure.
What is inevitable abortion? Membranes rupture and cervix dilates
What is incomplete abortion? Some products of conception have been expelled, but some remain
What should be stopped if a threatened abortion is present? Sexual activity
What is missed abortion? fetus dies during 1st half of pregnancy but is retained in the uterus
What is recurrent abortion? defined as three or more spontaneous abortions, although some now use two or more pregnancy losses as the definition
What are some causes of ectopic pregnancy? *Scarring/abnormality in tube *Inflammation *Surgery *IUD *Hx of ectopic pregnancy
What are some manifestations of ectopic pregnancy? *Abdominal pain *Vaginal spotting *Missed period *Ruptured tube symptoms
What percentage of ectopic pregnancies occur in the fallopian tube? Although implantation can occur in the abdomen or cervix, more than 98% occur in the fallopian tube.
What is the medical management of an ectopic pregnancy with an unruptured tube? methotrexate (chemotherapeutic agent) is used to inhibit cell division in the embryo. Surgical management may involve linear salpingostomy to salvage the tube.
What is the medical management of an ectopic pregnancy with a ruptured tube? goal is to control bleeding and prevent hypovolemic shock. Salpingectomy (tube removal) and ligation of bleeding vessels may be required
What is Disseminated Intravascular Coagulation (DIC)? DIC is a life-threatening defect in coagulation that may occur with several complications of pregnancy
What is DIC associated with? abruption placentae, incomplete abortion, hypertensive disease or infectious process. May occur if the fetus is retained for a prolonged period
What are the S/Sx of DIC (Disseminated Intravascular Coagulation) *Chest pain or dyspnea *Restless and cyanotic, occasionally expectorating frothy, blood-tinged mucus
What is the medical management of DIC (Disseminated Intravascular Coagulation)? *Correct cause *Administer blood products *Oxygen therapy (High flow) *Delivery ASAP
Define placenta previa: 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
What are the three types of placenta previa? *Marginal/low lying *Partial *Total
What are the manifestations of placenta previa? *Painless vaginal bleeding *Bleeding results from tearing of the placental villi *Bleeding may not occur until labor starts
Define abruptio placentae: premature separation of a normally implanted placenta from the uterine wall.
What is the point of viability of the fetus (survive outside of mother)? 20 weeks gestation
What are the predisposing factors for abruptio placentae? *Chronic HTN or PIH *Cocaine *Premature rupture of membranes *Blunt abdominal trauma *Cigarretes *Prior Hx *Short umbilical cord
What is the nursing management of abruptio placentae? *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
Created by: Shanejqb