1230 Unit 2 Part 2
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| painless cervical dilation with bulging of fetal membranes and parts through the external os in the second trimester; pregnancy loss is frequently inevitable | cervical insufficiency
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| standard treatment for cervical insufficiency; performed between 14 and 26 weeks gestation | cervical cerclage (stitch the cervix)
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| hydatidiform mole or molar pregancy (benign), and gestational trophoblastic neoplasia (malignant) | gestational trophoblastic disease
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| two types of molar pregnancies; both involve errors in chromosomal duplicationd uring fertilization; some features of a malignancy | partial and complete
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| risk factors of molar pregnancy: | history of previous gestational trophoblastic disease; extremees of age; young women in early teens and older women near the end of reproductive lives are at highest risk
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| clinical manifestations of molar pregnancy | most common signe - vaginal bleeding; hCG level is usually higher than expected for gestational age; transvaginal ultrasound to confirm
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| treatment of molar pregnancy | evacuation of the uterus; continued follow-up care for 1 year (may develop cancer)
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| nursing care for molar pregnancy | woman at risk for several complications; monitor frequently for vag bleeding; check condition of uterine fundus; administer oxytocin as ordered; DIC (no clotting from any vessels); trophoblastic embolus or pulmonary edema secondary to fluid overload
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| condition in which the placenta is implanted close to or covers the cervical os; exact cause is not known | placenta previa
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| things that increase risk for placenta previa | history of elective abortions, multiparity (multiple deliveries), advanced maternal age (older than 35), previous cesarean birth or uterine incisions, maternal smoking, prior placenta previa
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| Placenta previa is classified according to the degree to which the placenta covers the cervix. | total (rarely resolves - completely covers cervix); partial (sometimes resolves); marginal (sometimes resolves)
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| clinical manifestations of placenta previa | painless, bright red bleeding (1st episode usually between 27 and 32 weeks gestation); transvaginal ultrasound
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| Total placenta previa is associated with: | atypical fetal presentations (breech or transverse)
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| treatment for placenta previa | imediate cesarean deliver is a life-saving measure for the woman and the baby (if massive bleeding occurs); Kleihauer-Betke test; RhoGam; NSTs
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| A ____________ delivery is necessary in all cases of total placenta previa. | cesarean
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| nursing care for placenta previa | careful observation; IV access at all times; assess for signs of shock (from bleeding); LISTEN TO FETAL HEART RATE AT LEASE EVERY 4 HOURS)
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| Postpartum care for placenta previa | normal postpartum care; assess for signs of infection and mehorrhage (pad count)
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| prematue separation of a normally implated placenta; cause is unknown | abruptio placentae
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| risk factors for abruptio placentae | elevated blood pressure; preeclampsia and pre-existing chronic hypertension; advanced maternal age (>35); multiparity; history of cesarean delivery; trauma; smoking; alcohol; cocaine; preterm premature rupture of membranes
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| abruptio placentea classified by: | whether bleeding is concealed (more dangerous) or apparent; whether degree of abruption is partial or complete
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| maternal complications with abruptio placentea: | hemorrhagic shock, DIC, uterine rupture, renal failure, death
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| fetal complications with abruptio placentea | relate to the degree of placental separation and maturity of fetus; hypoxia, anemia, growth retardation, death
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| clinical manifestations of abruptio placentea | abdomen will harden and not release; based on s/s of patient; pain has sudden onset and is constant; ultrasound
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| treatment of abruptio placentea | vaginal delivery is preferred for small abruptions
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| nursing care for abruptio placentea | careful monitoring; watch for signs of shock; continuous EFM; prepare for emergency cesarean if ordered; monitor for postpartum hemorrhage and condinue to observe for signs of DIC after the birth
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| abrutpio placentea assessment | though OB history; acut bleeding episode; obtain fetal heart rate and apply the EFM; evaluate the woman's pain
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| second leading cuase of maternal morbidity and mortality; not only dangerous for the woman, but also puts the fetus at risk | hypertensive disorders in pregnancy (gestational HTN, preeclampsia/eclampsia; chronic HTN; preeclampsia superimposed on chronic HTN)
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| term used to describe elevated blood pressure (>140/90) that develops for the first time during pregnancy; can be transient or chronic | gestational hypertension
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| serious condition in which the blood pressure rises to 140/90 or higher accompanied by proteinuria; may develop into eclampsia; may have presence of seizure activity or coma; exposure to trophoblastic tissue appears to be the triggering factor | preeclampsia
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| tests for preeclampsia | there are no diagnostic tests available
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| more likely to develop preeclampsia and are 2-3 times more likely to die from it or eclampsia | African-American women
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| Primary problem underlying development of preeclampsia is generalized : | vasospasm
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| categorized as mild or sever, seizures are tonic-clonic and only rarely progress to status epilepticus; edema is significant if it is nondependent or if it involves the face and hands | preeclampsia
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| severe form of preeclampsia; greatly increases the mortality associated with preeclampsia | HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelets)
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| treatment of preeclampsia | primary goal - to deliver baby and restore the woman to a healthy state; preventing maternal seizures; magnesium sulfate (ther. level is 4-8 mg/dL)
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| When giving magnesium sulfate, monitor the reflexes and respiratory rate of the woman receiving it at frequent intervals; high risk for antepartum complications 24-48 hours after deliver; antidote for magnesium sulfate: | Calcium gluconate
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| nursing care for HELLP | frequent monitoring of woman of fetus; auscultate lungs evry 2 hours; weigh woman daily; report HA, visual changes, epigastric pain; assess deep tendon reflexes; implement seizure precautions; woman on bed rest; adequate nutrition; phychosocial needs; NST
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| high blood pressure present before the woman becomes pregnant | chronic hypertension
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| chronic hypertension and experiencing proteinuria | preeclampsia superimposed on chronic hypertension
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| treatment and nursing care with preeclampsia superimposed with chronic hypertension | prenatal visits at more frequent intervals; fetal surveillance is an area of intense focus; methyldopa (Aldomet) is the drug of choice for maintenance therapy
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| refers to a pregnacy in which the woman is carrying more than one fetus | multiple gestation
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| twins are at risk for: | twin-to-twin transfusion syndrom (TTTS); conjoined; experience growth restriction; be born prematurely
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| woman's risk with multifetal pregnancy | postpartum hemorrhage; increases fetal nutrient demands; maternal anemia
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| nursing care with multifetal pregnancy | increased emphasis on woman's diet, multivitamin and iron supplements, rest; teach symptoms of preterm labor; perform fetal movement counts daily after 32 weeks gestation
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| incompatibilities between the woman's blood and the fetus' blood can cause problems for the fetus - the two types are: | Rh imcompatibility and ABO incompatibility
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| Rh incompatibility | isoimmunization; fetus develops hemolytic anemia; anti-D immunoglobulin (RhoGam); woman will have no symptoms; fetus may be severely affected (miscarriage); treatment is RhoGam
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| To give RhoGam, woman must be: | Rh negative; must not have anti-D antibodies; infant must be Rh-positive; direct Coomb's test must be weakly reactie or negative
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| ABO incompatibility | another cause of hemolytic disease of newborn; most frequently arises when the woman's blood type is O and the baby's is A, B, or AB; much less severe form than Rh incompatibility; fetus rarely requires exchange transfusion
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