Ch.7 from notes

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silvisaj44
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Ch.7 from notes
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2013-02-17 15:23:38
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maternity
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  1. gestational complications
    • terms
    • premature labor
    • preterm birth
    • late preterm infant
    • mod. preterm infant
    • very preterm infant
    • low birth weight infant
    • very low birth weight infant
    • extremely low birth weight infant
  2. PTL
    • preterm labor
    • labor that occurs btwn 20-36 weeks gestation
    • #1 cause for neonate mortality
    • #2 cause for infant cause of mortality
  3. pathophysiological pathway to preterm labor
    abnormal uterine distention: multifetal pregnancy, plyhydramnios, structural uterine anomolies:uterine contraction, premature rupture of membranes.

    decidual hemorrhage:abruption, thromnin activation:uterine contraction, premature rupture of membranes.

    activation of maternal fetal HPA axis: prostaglandin production, placental estrogen, stress: uterine contraction, premature rupture of membranes

    infection: uterine contractions, breakdown of membranes and cervix: uterine contraction, premature rupture of membranes
  4. management of preterm labor
    • tocolytic drugs (meds that help control uterine contractions)
    • bed rest
    • intravenous hydration (can get pulmonary edema)
    • antibiotic therapy
    • corticosteroid therapy (to the babys benefit)
    • ex: betamethasone steroid to help mature fetal lungs
  5. common tocolytic drugs
    magnesium sulfate, nifedipine, terbutaline

    magnesium sulfate: depresses myometrium contractility, relaxes smooth muscle of the uterus.

    nifedipine: inhibits smooth muscle contractions of uterus by blocking calcium availability for muscle contraction, can delay delivery for 48-72 hrs

    terbutaline: beta 2 adrenergic effects to suppress uterine activity, can delay delivery for 3 days
  6. fetal fibronectin
    test to tell us if there is any protein in the cervix, if the test is positive then the mom will go into labor within the next 2 weeks
  7. premature labor: factors that allow delivery preterm
    • -dilation greater than 4 cm
    • -at risk for pregnancy inducted hypertension
    • -lethal fetal anomaly-baby will die anyways
    • -severe maternal disease
    • -hemorrhage
    • -acute fetal distress
  8. cerclage
    purse string suture placed cervically to reinforce a weak cervix
  9. premature rupture of membranes
    rupture of the chorioamniotic membranes before the onset of labor
  10. preterm premature rupture of membranes (PPROM)
    rupture of membranes with a premature gestation less than 37 weeks
  11. prolonged rupture of membranes
    • greater than 24 hours
    • -baby at risk for infection
    • -dry birth
  12. spontaneous rupture of membranes
    • SROM
    • -before onset of labor (term)
  13. chorioamnionitis
    amniotic fluid infection
  14. endmetritis
    postpartal infection of endometrium which causes scar tissue
  15. maternal risk factors
    • -previous PPROM
    • -previous preterm delivery
    • -bleeding
    • -multiple gestation
    • -STD's
    • -smoking
    • -maternal infection: chorioamnionitis and endometritis
  16. fetal/neonate risks
    • -respiratory distress with PPROM
    • -fetal sepsis-ascending pathogens
    • -malpresentation
    • -prolapsed cord-because cord can come first which is bad
    • -non reassuring FHR
    • -premature birth
    • -cord compression-baby not getting o2
    • -fetal deformities if PPROM is less than 26 weeks
  17. incompetent cervix
    mechanical defect in the cervix that results in painless cervical dilation and ballooning of the membranes into the vagina following by expulsion of a premature fetus during the second trimester

    • -cerclage (18-20 weeks)may be placed prophylactically before cervical dilation or as needed
    • -remove sutures if membranes rupture to decrease infection
  18. multiple gestations
    pregnancies with more than 1 fetus
  19. monozygotic twins
    • from one zygote that divides in the first week of gestation
    • -identical
    • -same gender
  20. dizygotic twins
    • -fertilization of 2 eggs
    • -may have same or different genders
    • -placental types: monochorionic-1 chorion and dichorionic-2 chronions
  21. maternal risks for multiple gestation
    • -preterm labor and delivery is 50% greater
    • -PPROM
    • -HTN, preeclampsia
    • -gestational diabetes
    • -antepartum, hemorrhage, abruptio placenta, placenta previa (placenta covers cervix)
    • -anemia
    • -SOB, etc
    • -pulmonary edema
    • -cesarean birth
  22. fetal/neonatal risks
    • -increased morbidity and mortality rates
    • -low birth weights
    • -decreased intrauterine grown (IUGR)
    • -increased fetal anomalies
    • -prematurity
    • -abnormal presentations
    • -increased cord incidents
  23. hyperemesis gravidarum
    • vomiting during pregnancy that is so severe it leads to dehydration, electrolyte and acid base imbalance and starvation ketosis.
    • -due to rising chorionic gonadotropin and or estrogen levels
  24. diabetes mellitus
    chronic metabolic disease characterized by hyperglycemia as a result of limited or no insulin production
  25. type 1 diabetes
    result of autoimmunity of beta cells of the pancreas resulting in absolute insulin deficiency and is managed within insulin
  26. type 2 diabetes
    • insulin resistance and inadequate insulin production
    • -most prevalent form of diabetes
    • -increasing because of obesity
    • -controlled with diet, exercise and oral glycemic agents
    • -oral hypoglycemic agents are not recommended for use during pregnancy in type 2 diatetic women
  27. gestational diabetes
    diabetes that begins during pregnancy (increased maternal adipose in mom, or increased hormones from placenta)
  28. maternal risks for pregestational diabetes
    • hypoglycemia
    • HTN, preeclampsia
    • preterm labor
    • spontaneous abortion
    • polyhydramnios
    • oligohydramnios
    • c section
    • infection-because of delayed would healing
    • induction of labor
  29. neonate risks of diabetes
    • hypoglycemia
    • hypocalcemia/hypo magnesemia
    • IUGR
    • RDS-resp. disease syndrome
    • polycythemia (ruddy(
    • hyperbilirubinemia
    • prematurity
    • congenital defects(mainly heart probs)
    • cardiomyopathy
    • macrosomia
    • stillbirth
  30. hypertensive disorders
    • chronic hypertension
    • preeclampsia (protein uria), eclampsia(diff.= seizures with eclampsia)
    • preeclampsia superimposed on chronic HTN
    • gestational hypertension/pregnancy induced hypertension
  31. PIH
    • pregnancy induced hypertension
    • -includes preeclampsia (most common PIH)
    • -primigravidas>multiparas
    • -obesity
    • -multiple gestation
    • -family history
    • -diabetes mellitus
    • -seen more in teens less than 10 and greater in woman over 35
    • -most often seen last 10 weeks of gestation, during labor or first 12-18 hours after delivery
  32. preeclampsia
    • patho: increase arterial BP
    • increased peripheral vascular resistance, vasospasms with arteriole vasoconstriction=decrease GFR and deacrease blood flow to all organs
    • -cardinal symptoms: hypertension and proteinuria
  33. preeclampsia (2 categories)
    • mild: preeclampsia: BP increased to 140/90 or greater
    • -proteinurea 1+-2+
    • -generalized edema of face, hands, ankles

    • severe: preeclampsia: BP 160/100 or greater
    • -proteinurea 3+-4+
    • -oliguria-urine output less than 500 ml in 24 hours
    • -increased generalized edema
    • -frontal H/A, blurred vision, N/V, EPIGASTRIC PAINNNNNNN (cardinal sign of seizures)
  34. chronic hypertension
    before 20th week of gestation may put the woman at high risk for developing preeclampsia
  35. preeclampsia-eclampsia
    pre: systemic disease with hypertension accompanied by proteinuria after 20th week of gestataction

    eclampsia: convulsive stage
  36. preeclampsia superimposed on chronic hypertension
    hypertensive women who develop new onset proteinuria before 20th week gestation or sudden uncontrolled hypertension
  37. gestational hypertension
    high blood pressure detected for the first time after mid pregnancy without proteinuria
  38. HELLP SYNDROME
    • hemolysis, elevated liver enzymes, low platelets
    • -complication of severe preeclampsia
    • -only cure is to deliver
  39. placenta previa
    • occurs when placenta attaches to the lower segment of the uterus, near or over the internal os
    • -low lying
    • -marginal
    • -partial
    • -total
    • -symptoms: painless bright bleeding
    • -treatment is dependent on degree of previa
  40. implications of placenta previa
    if marginal or low lying-woman may be allowed to labor

    changes in FHR and meconium staining of amniotic fluid

    if profuse bleeding-fetus is compromised, suffers hypoxia

    FHR imperative on admission-if non reassuring FHR=c section
  41. nursing implications of placenta previa
    • -ultrasound
    • -if no bleeding-bed rest with BRP
    • -no vaginal exams because you can puncture the placenta
    • -monitor blood loss, pain, contactions, fetal heart rate
    • -Maternal VS
    • -labs
    • -H&H, urine, Rh, T&C
    • -have 2 units of blood on hold
    • -iv
    • -anticipate c section
  42. Abruptio Placentae
    • -premature separation of normally implanted placenta, may be marginal, partial or complete
    • -signs: vaginal bleeding(may not have), hypertonus, hypercontractility, abdominal pain or back pain
    • -sudden and severe
    • -uterine tenderness
    • -uterine contractions
  43. maternal implications of abruptio placentae
    • -hemorrhage
    • -DIC
    • -preterm delivery
    • -shock
    • -renal failure
  44. fetal implications
    • -perinatal mortality
    • -anemia
    • -hypoxia
    • -brain damage
    • -demise
  45. placenta accreta
    • abnormal implantation of the placenta
    • -roots grow deep into the muscle wall of the uterus
  46. placenta accrete
    invasion of trophoblast is beyond normal boundary
  47. placenta increta
    invasion of the trophoblast extends into uterine myometrium
  48. placenta percreta
    invasion of the trophoblast extents into the uterine musculature and can adhere to other pelvic organs
  49. abortion
    • -induced
    • -elective
    • -therapeutic
    • -spontaneous
  50. ectopic pregnancy
    • develops as a result of the blastocyte implanting somewhere other than the endometrial lining of the uterus
    • -majority in the fallopian tube
  51. hydatiform mole
    benign proliferating growth of the trophoblast in which the chorionic villi develop...grapelike clusters without a viable fetus
  52. TORCH
    toxoplasmosis, other, rubella, cytomegalovirus, herpes simplex virus

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