Hypertension
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| Chronic hypertension is classified as | >140/90 BEFORE 20 wks gestation
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| Gestation HTN is classified as | >140/90 20 wks or greater gestation
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| Mild preeclampsia has __ protein and ___ urine | +1 protein; >300 mg/24hr urine
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| T or F: Mild preeclampsia does not have weight gain r/t fluid retention | FALSE. Mild preeclampsia DOES show wt. gain r/t fluid retention
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| Mild preeclampsia has edema located in __ | Face and hands
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| What PO meds are given for mild preeclampsia? | Nifedipine, Labetolol unless BP continues to increase. Then will Tx with stronger HTNsives until Mag Sulfate is needed.
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| Mild preeclampsia PLTs may be... | Normal
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| Severe preeclampsia shows BP reading of __/__ | >160/110
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| Mild preeclampsia shows BP reading of __/__ | >140/90
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| The classic triad of sx for preeclampsia include | Edema, proteinuria, hypertension
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| Severe preeclampsia has __ protein on dipstick, __ mg/__ hours urine | 3+ protein, >500 mg/24hr urine
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| T or F: severe preeclampsia shows 2+ DTRs | False. Will have 3+/4+ DTRs since hyperreflexia a sx
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| T or F: severe preeclampsia, mother may complain of headache | True
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| Severe preeclampsia shows edema in what places? | Generalized, including face/hands
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| Mother may c/o ____ r/t fluid retention in severe preeclampsia | Weight gain
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| Oliguria presents in which HTN disorders? | Severe preeclampsia, eclampsia
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| If a mother with HTN c/o of epigastric or RUQ pain, you suspect which organ is affected? Which HTN category will these sx appear in? | Liver; epigastric/RUQ pain presents in severe preeclampsia/eclampsia
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| Scotomata refers to ___ and is seen if the mother has ___ | Blind spots; severe preeclampsia/eclampsia
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| True or false: Blurry vision is a sx of gestational hypertension | False. Blurry vision sx of severe preeclampsia/eclampsia
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| Pulmonary edema is seen in pts. with ______ | Severe preeclampsia/eclampsia
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| HELLP stands for | Hemolysis, elevated liver enzymes, low platelets
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| HELLP presents during... | Severe preeclampsia/eclampsia
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| True or false: magnesium sulfate should not be given with Pitocin d/t its toxic effects | False. Mag Sulfate can be used with Pitocin
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| True or false: Thrombocytopenia is seen in severe preeclampsia and eclampsia. Lab values show plats are < 150,000 | False. Lab values show PLT < 100,000
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| Chronic HTN is assessed during __ trimester and before __ wks | 1st, before 20 wks
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| Gestation HTN is assessed in __ trimester and after __ 20 wks | 2nd, 3rd trimester, AFTER 20 wks
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| What are recommendations for women with chronic HTN/GH? | Reduce activity, treat with antihypertensives like labetolol/procardia (aka nifedipine)
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| True or False: gestational HTN may be asymptomatic | True
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| When D/C teaching, you tell a mother that chronic HTN does __ postpartum | NOT resolve
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| What is the primary mechanism of GH? | Vasospasm; hypo-perfusion of mother's organs/placental blood flow... may affect all organ systems
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| A mother with GH explains to you that her HTN will go away by 2 wks pp. How do you respond? | Explain elevated BP goes away usually by 12 wks PP.
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| _____ is an ominous sign before seizure (eclampsia) | Epigastric pain
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| ___ therapy is used preventatively to decrease what in high risk moms? | Aspirin therapy; used to decrease vessel wall damage
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| List 6 major MATERNAL complications of preeclampsia | 1) seizures, 2) placental abruption, 3) retinal detachment, 4) renal failure, 5) cerebral hemorrhage, 5) HELLP/liver rupture
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| List 4 major FETAL complications of preeclampsia | 1) IUGR, 2) chronic hypoxemia, 3) acute hypoxemia, 4) death
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| A baby whose mother has preeclampsia will show a __ HCT level | High (d/t chronic hypoxemia)
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| When a mother is Dx with a HTNsive disorder, you must do what types of fetal tests? | Fetal US, weekly NST (non-stress test), amnio (lung maturity), doppler velocimetry (blood flow)
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| You ask the mother to count daily fetal kicks. She asks what is "normal" amount of kicks for a healthy baby. You respond... | 12 kicks/day, or track # kicks/1-2 hrs your baby usually does.
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| A mother has her Magnesium levels drawn. Results: 8.9. You know this is a __ level. | High! Normal mag levels are 4-7
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| What sort of adverse effects should you warn a mother about Mag Sulfate? | Dizzy, hot flashes, difficulty catching breath
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| How often should you draw Mag levels? | q6h
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| Activity level while on Mag should be | Strict bedrest
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| S/sx of magnesium toxicity include | Depressed RR (<12), decreased LOC, absent reflexes/clonus, urine output < 30cc/hr
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| The antidote to mag toxicity is ___ | Calcium gluconate
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| True or false: you will always see a rise in BP before HELLP presents | FALSE. 20-25% cases have HTN absent before mother presents with HELLP
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| Preterm labor is defined as | Mother going into labor before completed 37th week
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| Requirements for PTL include what type of uterine cx and cervical dilation? | Regular uterine cx (4/20min or 8/1 hr) and cervical dilation >=2
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| Risk factors for PTL include | Hx of PTL, low literacy, "rule of toos"
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| Causes of PTL | Infection, stress, trauma, multiples
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| Fetal fibronectin (fFN) does what? Why is it used diagnostically? | Attaches amniotic sac to lining of uterus. Increased levels BEFORE 35 wks shows risk of PTL
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| First thing you do with mother at risk of PTL | HYDRATION. Dehydration may encourage woman to contract
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| If rest/hydration doesn't work for PTL, then give what? | Drugs: Mag sulfate, terbutaline, nifedipine, NSAIDs (motrin)
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| Why is Mag sulfate used for PTL? | Relaxes uterus
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| Mag sulfate doses: loading vs. maintenance | 4 gm loading over 20 minutes, then 1 gm/hr
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| Terbutaline does what for PTL? | Relaxes uterus
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| Terbutaline should raise heartrate to ____ for therapeutic range | above 110
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| True or false: betamethasone requires 2 doses 24 hours apart | True
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| Why is betamethasone given to PTL moms? | Increases surfactant production of babies' lungs, help maintain inflation of lungs
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| What HIV drug is given at any stage of pregnancy to woman and NB? | AZT
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| Management of newborn delivered by HIV+ mom | Bathe on admission, treat with AZT
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| Why is C-S preferred in HIV+ mom? | Less blood exchange, more control, less trauma
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| Leading cause of PROM/PTL | Infection (#1 UTI, also dental)
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| Why does infection cause PTL? | Release of prostaglandins
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| ___ is known as infection of amniotic sac and typically has a "death smell" | Chorioamniitis
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| When should GBS be Tx? | During labor, 1 dose 4 hours BEFORE birth for baby
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| S/sx of sepsis in baby | Very cold or warm, mottled skin, poor feeding, fussy, lethargic, acts "sick"
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| S/sx of chorio in mom | Abd pain, elevated WBC
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| Predisposing factors to UTI | Hygiene, nutrition, anemia, DIABETES
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| _________ is considered teratogenic | Hyperglycemia
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| What DOES NOT cross placenta? | Insulin
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| Macrosomia is seen in mothers with | Diabetes
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| First line Tx of diabetes: | Diet, exercise, BG control
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| Second line Tx of diabetes | PO meds (Glyburide)
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| Third line Tx of diabetes | Insulin
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| S/sx of hypoglycemic babies | Shaky, poor feeding, fussy, sweating
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| Gestational DM should resolve in __ | 6 weeks
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| Important teaching points to moms with gestational diabetes (about mom and baby): | Mother's chances of getting DMII is 60%, baby 45% more likely to have Metabolic Syndrome as adults
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| Babies born from diabetic moms should have __ BG checks and if < __ give formula/colostrum | 4-6 BG checks. If <45 give formula/colostrum
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| When is gestational diabetes detected? | 2nd and 3rd trimester by GTT (glucose tolerance test). If obese, do GTT in 1st trimester
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| List maternal complications of diabetes (5) | 1) Ketoacidosis, 2) hypoglycemia, 3) INFECTION, 4) PIH, 5) hemorrhage
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| List newborn complications of diabetes (3) | Hypoglycemia, macrosomia d/t hyperinsulinemia, IUGR if diabetes + severe PIH
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