High-Risk Pregnancy By Lucy
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| Hyperemesis Gravidarum | Excessive nausea, vomiting, dehydration, reduced delivery of blood, oxygen, and nutrients to the fetus, and can affect fetal growth.
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| Treatment for Hyperemesis Gravidarum | Correct dehydration and electrolyte or acid-base imbalance. Antiemetic drugs: Fenergyn, Zofran, Reglan, and Ginger. In extreme cases: TPN and hospitalization.
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| Types of Spontaneous Abortions | Nonintentional: Threatened, inevitable, incomplete, complete, missed, and recurrent.
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| Threatened Abortion | S/SX: Vaginal bleeding, uterine cramping. persistent backache, pelvic pressure, and cervix is closed,
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| Inevitable abortion | S/SX: ROM, cervix dilated, active heavy bleeding, and dilation and curettage (D&C) if tissue remains or heavy bleeding.
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| Incomplete Abortion | S/SX: Severe abdominal cramping, active uterine bleeding, cervix dilated, passing placental and fetal tissue, some produce of conception expelled, some remain.
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| Treatment for Incomplete Abortion | Cardiovascular status stabilazation, IV, Blood, D & C followed by IV Pitocin or IM Methergine, D & C not usually after 14 wks due to excessive bleeding potential; Pitocin or prostaglandin.
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| Recurrent Abortion | S/SX: 3 or more consecutive spontaneous abortions, most to do with genetic, chromosomal abnormalities, or reproductive tract problems. endocrine, immunologic factors, systemic disease (lupus, STD's, syphilis)
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| Management of Recurrent Abortions | ID the cause, if incompetent cervix, do cerclage. Call immediately if labor starts, or ROM.
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| Causes of Ectopic Pregnancy | 95% occur in fallopian tube. Implantation outside of the uterine cavity. scarring or tubal deformity may result from: Hormonal abnormalities, inflammation, infection, adhesions, congenital defects, and endometriosis.
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| S/Sx of Ectopic Pregnancy | hCG+, pain, vaginal bleeding, dizziness, or faiting, low BP, and lower back pain.
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| Diagnosis of Ectopic Pregnancy | Ultrasonography, lower than normal hCG, and lower progesterone levels.
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| Management of Ectopic Pregnancy | Hemorrhage is major concern. Medical management if tube not ruptured; goal-preserve tube. Methotrexate to inhibit cell division. If tube ruptures: May have sudden severe lower abdominal pain, vaginal bleeding, S/SX of hypovolemic shock, & shoulder pain.
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| Nursing care for Ectopic Pregnancy | Identify, prevent blood loss, hypovolemic shock, pain control, psychological support, and educate on drugs used.
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| Hydatidiform Mole | Gestational Trophoblastic Disease(molar pregnancy). Pathologic proliferation of throphoblastic cells, development of vesicles(fluid filled,grape like). May cause hemorrhage, hypertension, clotting abnomalities, choriocarcinoma(15-20%).
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| Manifestations of hydatidiform Mole | Bleeding, rapid uterine growth, failure to detect fetal heart activity, signs of hyperemesis gravidarum, unusually early development of GH, higher than expected levels of hCG, A distinct snowstorm pattern on ultrasound and no evidence of developing fetus.
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| Diagnosis of Hydatidiform Mole | Transvaginal ultrasound and hCG levels are high.
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| Management of Hydatidiform Mole | Lab work, vacum aspiration and D&C (maybe hysterectomy), followed by Pitocin. Examine tissue for malignant changes, chest X-Ray. F/U hCG levels every 1-2 weeks till normal; then q 1-2 months X 1yr. No pregnancy for 1 year.
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| Placenta Previa | Abnormal implantation of placenta. Bright painless bleeding usually seen in the last 2 months.
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| Treatment of Placenta Previa | Goal: identify cause of bleeding. Treatment: Bed rest with BRP, no vaginal exams, monitor blood loss, fetal monitoring, labs, IV LR, blood shuld be available (usu. 2 units), and mom will have a C-section.
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| Abruptio Placentae | Sudden onset, premature separatin of placenta before fetus is born, perinatal mortality if seperation 20-40%, full seperation = fetal demise.
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| S/Sx of Abruptio Placentae | Vaginal bleeding, abdominal/low back pain, increase in fundal height, uterine irritability and tenderness, frequent UC, high resting tone:firm abdomen (board-like), nonreassuring FHR pattern.
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| Management of Abruptio Placentae | To the hospital!!, evaluate immediately si S/Sx, may see tocolytics, bedrest ifmild, if fetal compromise, maternal shock, need to deliver.
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| Disseminated Intravascular Coagulation (DIC) | Blood clotting mechanisms are activated throughout the body instead of being localized to an are of injury. Overtime, the clotting proteins become used up and are unavailable during times of real injury.
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| S/Sx of DIC | Increased uncontrolled bleeding, depleting of platelets, and clotting factors. Organ damage-emboli formation. Tissue hypoxia and necrosis.
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| Tests for DIC | Serum fibrinogen, prothrombin (PT), partial thromboplastin time (PTT), platelet count, D-dimer (+).
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| Treatment for DIC | Platelets, heparin (not with trauma), FFP, and Cryprecipitate.
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