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Pregnancy Complications

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Question
Answer
maternal mortality can be caused from ectopic pregnancy or obstertric events such as   hemorrhage, pulmonary embolism and pregnancy-induced hypertension (PIH)  
What is the major cause of perinatal (5 months before and 1 month after) mortality   prematurity  
risk factors for pregnancy complications   age (especially younger than 17), socioeconomic status (urgan poor, lack of education), primipariety (first), and multiple pregnancies  
What is the best prevention of pregnancy complications   prenatal care  
Name two pregestational disorders   cardiovascular disease and endocrine disorder (diabetes)  
Name the 4 pregestational cardiovascular diseases   rheumatic heart disease, congenital heart disease, mitral valve prolapse and peripartum cardiomyopathy (disease of the heart muscle between the last month of pregnancy and 5 months post partum)  
Why is rheumatic heart disease decreased in pregnant women   better treatment of strep infections  
Why is congenital heart disease seen more   better treatment of heart anomalies bc of survival rate  
Why are we conserned with mitral valve prolapse in pregnant women   Prevention of any infection that could travel to the heart and weaken valves, usually caused by stress. Give prophylactic IV antibiotic during labor  
Why is peripartum cardiomyopathy a concern   can be very severe, may go unnoticed until after delivery  
pregnancy increases ____ on the heart causing symptoms and risks to increase   stress  
T/F signs of cardiac decompression can be similar to normal responses to pregnancy   True (fatigue, dyspnea, palpitations, tachycardia, heart murmurs, edema and cough) Decompensation is the functional deterioration of a previously working structure or system  
What causes murmurs and palpitations   blood volume increase  
main sign of cardiac decompensation is due to ____ - b/c this is the only sign that is not a common change in pregnancy   cough - red flag b/c increasing heart alteration, heart failure, pulmonary edema (congestion)  
Class I and II heart disease in pregnancy is the milder form of heart disease, are these women able to have a normal pregnancy   yes - but need to be watched very closely - coordinate care OB with CV doctor  
Can a woman with class III & IV heart disease become pregnant   yes - but it is in their best interest not to try to have a baby  
What is the primary goal of a pregnant woman with heart disease   adaquate rest - other goals include prevention of respiratory infection (adds stress to lung), monitoring for signs of cardiac decompensation and attempt a trial of labor avoiding valsalva (closed glottis) puts pressure on thoracic cavity  
Why is diabetes worse with pregnancy   stress alters CHO metabolism (pregnancy is a diabetogenic state)  
Gestational diabetes (type III) stops once pregnancy ends but are at higher risk for mature onset diabetes - why   because they have subclinical diabetes when not pregnant, they are often overweight so need to encourage to eat well and exercise.  
what are the influences of pregnancy on diabetes (woaman already having diabetes)   changes in CHO metabolism and control of blood glucose as well as vascular disease may increase because blood gets sticky, picks up debris and at capillaries oxygenation decreases leading to ulcers, poor healing, infection and amputation  
What are some maternal complications of diabetes on pregnancy   kidney problems, retinopathy, early pregnancy increased insulin production = hypoglycemia, later in pregnancy is lack of insulin production = hyperglycemia  
How much does insulin demand increase in later pregnancy   3-5X over non pregnant level  
When is gestational diabetes picked up during pregnancy   after 26th week due to increased hyperglycemic effect, high rate of C-section  
What are some fetal complications of maternal diabetes   by 36 weeks - aged placenta, later in pregnancy placenta releases an insulin-destroying enzyme to make more glucose avail to fetus so mother uses protein  
Type I, II, or III diabetes have the most difficulty controlling blood glucose levels during pregnancy   Type 1  
Type I, II, and or III pregnant women are more likely able to control their diabetes with diet   Type II & III (these woman may go on insulin if needed), type II may use oral hypoglycemic agents, the newer ones dont have same tetratogenic effects  
what other specialists may a pregnant woman with diabetes see   endocrinologist, ophthalmologist  
Poor control of insulin can lead to oversized or undersized babies   undersized r/t placenta getting old too quickly and baby not getting adequate nutrition. Generally fetal obesity due to growth acceration (macrosomia) if insulin is under control.  
Why is it important to assess newborn of a diabetic mother for hypoglycemia shortly after birth   blood sugar can plummet after birth because glucose source is cut off and they are used to producing lots of insulin which is still in their system  
Why does a fetus of a diabetic mother have hydramnios (excess amniotic fluid)   fetus urinating higher glucose, hyperosmotic, pulls in more water  
Nurses role of taking care of a diabetic mother   assessment of disease process, education (anticipatory guidance), physhological support, and assessment of fetal well being, placental function, fetal maturity  
gestational disorders are health alterations associated with pregnancy and usually disappear when   after delivery  
T/F Premature rupture of membranes is an onset of preterm labor   Can be true -but- premature ROM occures before onset of labor even if baby is full term  
What is the primary concern for premature ROM   infection (chorioamnionitis inflammatory condition of pregnancy affecting the uterus)  
what diagnostic measures are used to determine if there has been ROM   sample fluid - nitrazine paper (measures pH amniotic fluid will be alkaline and urine acidic - and ferning test  
what is amniotic fluid   fetal urine - so if premature ROM, can be replinished and hope it seals itself off, if no infection, pregnancy can continue  
between which weeks is preterm labor   20-37  
risk factors for preterm labor   previous preterm labor, durg use (especially stimulants), genital tract infections such as bacterial vaginosis and group B streptococcus (GBS)  
____ is the term for excessive N/V   hyperemesis gravidarum - the worst morning sickness, proglonged  
Results of hyperemesis gravidarum   F&E imbalance (can affect fetus), weakness & fatigue (due to dehydration), and scant, dark urine (identification of severe problem)  
Management of hyperemesis gravidarum   dry CHO (then wait 1 hr for fluids b/c fluids trigger vomiting), antiemetics (start with smallest therapeutic dose), IV therapy (correct F&E and acid-base imbalance), potential TPN (last resort), psychological (difficulty adjusting to pregnancy)  
What is the difference between threatened abortion and imminent abortion   In an imminent abortion, the cervix had dilated, can't do anything about it, placenta starts to seperate from uterine wall.  
what is the percentage of spontaneous abortions (miscarriage)   10-30%, some women don't know they are pregnant before they miscarry  
What is the main concern of imcomplete abortion   risk of hemorrhage increased because uterus can't contract, may be a risk of infection - if cervix is open a D&C is done to expell everything and if closed then there will be an attempt to save the pregnancy  
what are some causes of incompetent cervix   multiple abortions, D&C (dilation of the cervix and curettage or scraping the uterus), possible previous large baby delivery  
What is the procedure done for an incompetent cervix   cerclage procuedure - go around cervix and drawstring it closed, remove after 37 weeks unless signs of labor b4  
What is the main cause of implantation in a site other than the endometrium (ectopic pregancy)   pelvic inflammatory disease (PID) narrowing of tube (sperm gets through but not the fertilized egg - may be caused from gonorrhea, chlamydia  
Manifestations of ectopic pregnancy   shock from internal bleeding, pain in lower left or right quandrant, pregnancy test is not a sign, may be negative  
Diagnosis of ectopic pregnancy   sonogram - if high WBC count it is probably appendicitis  
Management of ectopic pregnancy   laparascopic - removal of that poriton of the tube  
What is the early sign of hemorrhagic shock   thirst - later signs are pale, sweaty, clammy, BP drop and elevated pulse also soaking more than one pad an hour  
____ benign proliferation of trophoblastic tissue. Developing embryo implants somewhere, and the tissue surrounding it (trophoblastic tissue) starts growing uncontrollably, cutting off nutrition and necrosis occures so body calcifies to prevent infection   gestational trophoblastic disease (molar pregnancy) generally not a viable pregnancy  
Manifestations of gestational trophoblastic disease (molar pregnancy)   Bleeding. scant dark to copious full blown bright red. Fundal height bigger, N/V extreme  
treatment of gestational trophoblastic disease (molar pregnancy)   D&C or methotexate an antineoplastic which attacks fast growing tissue  
Why should women be cancelled for one year after gestational trophoblastic disease to not become pregnant   Need to monitor for tissue that may not have been removed and continue to grow for a year, this tissue can be diagnosed via hCG levels. If a woman becomes pregnant hCG levels increase and can not differenciate between tissue and fetus  
____ is a potential after gestational trophoblastic disease (molar pregnancy) and can be fatal   Choriocarcinoma - a malignant and aggressive cancer, usually of the placenta. It is characterized by early hematogenous spread to the lungs  
____ is pregnancy-induced hypertension (PIH) used to be called toxemia 5% of all pregnancies and diagnosed after 20-24 weeks gestation   preeclampsia/eclampsia  
There are three signs to pregnancy induced hypertension. Pre-eclmpsia has two and eclampsia will have all three   hypertension (>140/90), edema (>2lbs/week), and proteinuria (albumin in the urine)  
although >140/90 is diagnostic of gestational hypertension an increase of ____ systole or ____ diastole over baseline is considered   increase 30 systole or 15 diastole - especially diastole b/c indicated heart rest is stressed too (so if normal is 120/80, a pregnant 145/96 indicates hypertension due to diastole more than 15 over - not systole)  
why should blood pressure be checked if more than 2lb per week is gained   risk for pre-eclampsia, should gain 1lb per week in later pregnancy, edema follows and it is a sign if seen when awakenging in the morning  
other signs of pregnancy induced hypertension (PIH)   clonus (muscular contractions due to sudden stretching of the muscle), HA (prolonged/severe), blurred vision, and scotoma (spots in front of the eyes)  
What is the difference between mild and severe PIH (pregnancy induced hypertension)   mild - BP 140/90 - 160/110, proteinuria and edma are both 1+ or 2+, occasional HA. Severe - BP >160/110, proteinuria and edema both 3+ to 4+ and may have oliguria (kidney's shutting down), pulmonary edema and RUQ pain r/t liver congestion  
increased incidence of pregnancy induced hypertension (PIH) r/t   primigravidas, teens and over 35, hx of pre-eclampsia, multiple gestation,GTD (genetic trophoblastic disease), Rh incompatibility, and diabetes  
maternal risks of pregnancy induced hypertension (PIH)   convulsions...coma, renal failure, abruptio placentae, DIC, ruptured liver, and pulmonary embolism  
fetal-neonatal risks from pregnancy induced hypertension (PIH)   SGA related to IUGR, 10% mortality with pre and 20% with eclampsia  
What happens to blood volume in pregnancy induced hypertension (PIH)   volume doesn't change with mild but will decrease with severe, normal pregnancy will increase blood volume 30-50%  
What happens to peripheral resistance, blood pressure and hematocrit in pregnancy induced hypertension (PIH)   peripheral resistance increases where normal pregnancy it decreases, BP rises, and hematocrit rises where normal pregnancy it falls due to more fluid  
Why does BP remain unchanged in a normal pregnancy when there is a 30-50% increase in blood volume   vessles diolate in normal pregnancy - with pre-eclampsia you have vasospasm so extra fluid is pushed out and get edema - don't treat with diuretics unless have pulmonary or cerebral edema, also do not use Ace-Inhibitors  
Tx of pregnancy induced hypertension   bed rest left side (off of vena cava) decreased blood pressure and promotes diuresis due to fluid back to organs, consume extra protein and push fluids due to loss of both  
What do you assess with pregnancy induced hypertension (PIH)   BP, daily weight, proteinuria, reflexes, urine output  
After the baby is born, the mother with pregnancy induced hypertension is given what   apresoline - during pregnancy can take MgSO4  
Why is MgSO4 the drug of choice for a pregnant woman with eclampsia (Eclampsia is pregnancy-related seizure activity that is usually caused by high blood pressure)   lowers blood pressure, makes woman seizure proof  
side effects of MgSO4 - used to treat pre-eclampsia   Flushing, Muscle weakness, lack of energy, HA, N/V, fluid in lungs, chest pain slurred speech and blurry vision. Hypotension hypocalcemia, arrhythmia and asystole  
What is the antidote for MgSO4   Calcium  
What does HELLP syndrome stand for and when is it seen   people with pre-eclampsia are at risk. H=hemolysis. EL= Elevated Liver enzymes. LP = Low Platelets  
Elevated Liver enzymes in HELLP sndrome cause   intra-arterial lesions, platelet aggregation, fibrin accumulation, microemboli in hepatic vasculature and eschemia  


   






 
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