What are SnSs of Gonorhea and what are it's associated pregnancy risks?
Most women are asymptomatic
burning pee
purulent yellow-green d/c
bleeding
Complications include:
--PROM
--preterm
--chorioamnionitis
--neonatal sepsis
--IUGR
--Maternal pp sepsis
T/F Syphilis can cross the placental barrier only during the 2nd trimester
False, you fiend! It can cross at any time during prenancy!
Can cause PTD(preterm delivery), deformity, neuro defects, stillbirth, death.
Tx with penis-ill'n.
What are the viral STIs?
HPV: Most prevalent in ambulatory care setting. Can be transmitted without body fluid exchange making it the most boring of STIs to contract. Can cause resperitory papillomas in fetus.
HSV I & II: Herpes=painful blisters on your naughty parts. Transmission to fetus 30-50% if aquired close to delivery. If transmitted, 50-60% mortality if complications are neurological.
HIV
HepB
What are the TORCH nfxns?
Pathogens capable of crossing placenta.
Toxoplasma
Other nfxns (hepatitis, syphilis)
Rubella
Cytomegalovirus
HSV
Effects of TORCH on fetus/neonate?
T: SAB (), v birth weight, hepatospenomegaly, anema, neuros
O: HepB
R: deafness, eye defects, CnS problems, severe cardiac malformations
C LBW/IUGR, hearing impairment, microcephaly, CNSs
H: fatality, neuros.
What are some SnSs of ectopic pregnancy?
Missed period.
Abd pain, diffuse one side, low
Vaginal spotting
Rupture-->abd pain (see above)
vBhCG levels
No gestational sac on ultra sound u/s.
How do you Tx ectopic pregnancies?
Methotrexate: cancer drug (tetarogenic) so it attacks rapidly dividing cells (zygote/embrio)
Surgery to remove
What is the difference between a complete and partial mole?
Complete: egg lacks nucleus, then gets fertilized. Vasculature of placenta looks like a cluster of white grapes. These are hydropic vessles and are diagnostic of gestational trophoblastic disease (GTD).
Partial: Two sperm fertilize one egg-->3 chromos/pair
Both can lead to choriocarcinoma and must be treated with chemo, but most common with complete.
Usually seen in late 1st, early 2nd TM aeb dark "prune juice" bleeding.
SnSs of GTD
Vaginal bleeding (prune juicy)
cramping
passing of hydropic vesicles
^ hCG levels
^n/v
SnSs of preecampsia, but if <20wks, think GTD.
Nursing Tx of GTD?
Remove mole
Monitor hCG for 6mo to detect neoplasia
NO PREGNANCY FOR 1 YEAR to reduce risk of choriocarcinoma.
What is a cerclage procedure?
Used to mechanically close an incompetent cervix, which can also be treated with:
bed rest
progesterone supplements
antibiotics
anti-inflamatories (may cause closure of patent ductus arteriosus and v amniotic fluid)
What is the biggest risk factor for developing hyperemesis and how do you treat it?
^hCG levels
Tx with:
zogran, ginger, genergan, reglan
replace fluids/e-lytes/nutrition (esp vit B).
Unisom
Fast relief of symptoms by 3L fluid over 24 hours.
How do you diagnose preeclampsia?
HTN after 20 weeks gestation + proteinuria > 300mg in 24hrs or >30mg/dL (at least 1+ on dipstick) in 2 or more random samples collects 6 hours apart.
If <20wks, think GTD.
What not to comfuse for preeclampsia...
Chronic HTN with superimposed preeclampsia: Preexisting HTN with developement of proteinuria in the 1st 20 weeks of gestation. 25% HTN patient will develope superimposed preeclampsia (the proteinuria component).
Gestational HTN: HTN for first time after 20 weeks gestation but without proteinuria. Diagnosis is made pp.
What are risk factors for developing PreE?
nulliparity
1st kid w/new dad
obesity
Hx of preE
DM
African American
Multiple feti.
What are some pathophys characteristics of preE?
2nd half of pregnancy
diffuse vasospasm and endothelial damage/swelling
edema
microinarction
microhemorrhage
reduces organ perfusion
What organs are primarily affected by PreE?
brain: HA not relieved with Tylenol because cerebral edema/hemorrhage. Also look for hyperreflexia.
kidney: oliguria, v CC, calcium clearance, and uric acid. ^ protein in urine.
Coagulation disorders: Not an organ, but didn't want to make a new card just for this. thrombocytopenia activated by coagulation cascade-->depletion of available platelets-->v platelet count-->possible hemorrhage.
Adverse effects of HTN on pregnancy?
SGA
fetal hypoxia
abruption
prematurity
Home management of HTN/PreE
Bed rest, left lateral is best
monitor BP, weight, and urine protein daily.
NSTs
CBCs, LFTs, serum creatinine, uric acid
Mg++ sulfate (for s/z, does not address HTN)
fluid restriction
Hydralizine (for HTN)
DELIVERY (only cure)
SnSs of mag sulfate?
CNS depression
Treat with calcium gluconate wide open.
What can trigger a PreE s/z?
cerebral:
--vasospasm
--hemorrhage
--ischemia
--edema
Urgent care for sz?
abcs
lower HOB and turn head to side, prepare for suction
doc time, duration, type of sz.
call md.
padded side rails.
MgSO4
What does HELLP syndrome stand for?
Peace, truth, and the American way. Or maybe its...
Hemolysis
Elevated Liver Enzymes
Low Platelets
The above occur as a result of severe preeclampsia.
When are neonates at greatest risk for hyperbilirubinema/jaundice?
1st 24hrs.
What is a Coombs test and what is the difference between direct and indirect?
Tests for Rh antibodies
Indirect: Tested on mom. Looks for IgG antibodies in blood
Critical value is 1:16 or <
Direct: Tested on baby. Will look for presence of antibodies or RBC surface
What are some treatments for blood type incompatabilities?
Phototherapy
transfuse
RhoGAM (@28 wks if unsensitized, w/in 72hrs post delivery if sensitized)
When is RoGAM appropriate?
after birth of Rh+ baby
after abortion
after ectopic
after invasive procedure during pregnancy
after maternal trauma, but w/in 72hrs.
What is polyhydramnios?
>2000mL amniotic fluid
uterine distention
dyspnea
edema of lower extremities
Tx with amniocentesis
What is Oligohydramnios?
<500mL fluid during 2nd/3rd TM
Risks include:
--cord compression
--deformities
--pulmonary hypoplasia
Tx with amnioinfusion
Author
alyn217
ID
172620
Card Set
Mom/Baby
Description
Family Planning, Infections, GDM, and Preeclampsia