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What are the leading causes of maternal death in the USA?
- Gestational Hypertension
- Pulmonary Embolism
Contributing related to maternal death include:
- age under 20 / over 35
- lack of prenatal care
- low educational attainment
- unmarried status
- non-white race
Leading cause of death in neonates is _____.
- congenital anomalies
- ch.9 page 190
What are daily fetal movement counts?
- "KICK COUNTS"
- counting fetal movement for 1-2 hours daily - should be 10 or more
If no fetal movement is felt by the woman for a period of _____ hours, she should be evaluated ASAP.
Ultrasonography is more useful after what trimester?
after the first trimester, when the pregnant uterus becomes an abdominal organ
What technique/testing equipment is used for the BPP test?
What are some of the items measured by the BPP?
- Fetal breathing movements
- Gross body movements
- Fetal tone
- Reactive fetal heartbeat
- Amniotic fluid volume
What are the normal measurements for Fetal breathing movements?
> or equal to 1 episode in a 30 minute period, lasting more than 30 seconds
What is the normal range of fetal body movements for the BPP profile?
3 or more body/limb movements in 30 minutes
What indicates normal fetal tone for the BPP profile?
>1 active extension with return to flexion of fetal limbs or trunk (hand flexion counts as well)
What is a normal reactive fetal heart rate for a BPP test?
greater than 2 accelerations(>15 beats/min) in 20 minutes - each lasting > 15 seconds & associated with fetal movement
A non-stress test is also an indication of what?
Fetal well being
What is a normal level of qualitative amniotic fluid volume n the BPP test?
> 1 pocket of fluid measuring >1cm in perpendicular planes
What test can indicate impending fetal death?
- BPP Profile
- (Biophysical profile)
An amniocentesis may be done at ____ weeks gestation.
Increased levels of AFP can indicate what?
neural tube defects (spina bifida)
Decreased levels of AFP may indicate what?
The PUB test is done to look for what? and is done when?
in the second & third trimesters
The CVS test is done at ___ weeks.
The MSAFP test is done when and for what?
- 15-22 weeks
- can detect abdominal wall defects and/or neural tube defects
- (maternal serum AFP)
A glucose test is done at _____ weeks to screen for gestational diabetes.
How often should pre-natal visits be scheduled?
- monthly until 28 weeks
- then every 2 weeks until 36 week
- then weekly till delivery
How is Hepatitis C contracted?
What complication may occur from Hepatitis C?
If an infant is born to a mother who tests positive for Hep C, what actions should be taken?
Child should be vaccinated at 12-18 months of age
At 18-30 weeks - where should the fundus be when measured in centimeters ?
Should be the same number of weeks gestation as height. Variations may indicated IURG or other issues.
What agent is used to reverse sedatives?
When is the use of Narcan contraindicated?
when a baby is born to mother who is addicted to drugs and has been using during pregnancy - Narcan can cause these neonates to have seizures
What must be administered before an Epidural?
- IV bolus of fluids
- 500-1000 mL for a single fetus
- 2000ml for twins
What are some contraindications for an epidural?
- Tattoo at injection site
- Coagulation/bleeding disorders
- Low platelet count
- Cardiac issues
What is Duramorph?
are there any side effects?
- synthetic morphine used in epidurals
- side effect is itching - give Beneadryl
Why is hypothermia a side effect of child birth?
the combination of vasodilation combined with the effects of analgesia and anesthesia
High blood pressure is the main factor of what outcome?
Chronic HTN is classified as what?
BP exceeding 140/90 (at least on 2 occasions)
Before 20 weeks gestation
Medication is indicated to treat a BP reading of what ?
160/110 or higher
A woman with a BP of 140/90 requires what nursing intervention?
HTN will damage what organs?
brain, liver, kidneys, placenta - usually from hemorrhage
What are some HTN disorders ?
- Chronic HTN
- Gestational HTN
A BP of 140/90 after 20 weeks gestation is defined as what?
- Gestational HTN
- No proteins found in urine
- will return to normal approx. 12 weeks after birth
Complaints of right upper quadrant pain coupled with high blood pressure could indicate what?
Define preeclampsia :
- occurs after 20 weeks gestation
- includes gestational HTN & proteins in the urine
S/S of severe Preeclampsia:
- BP > 160/110
- + 500mg of proteinurea
- Blurred vision
- Pulmonary edema
- Low platelets (<100,000 mm2)
- Epigastritis or RUQ pain
Eclampsia includes what symptom:
- Onset of seizures
- Edema in hands & feet
What treatment is given to treat seizures associated with eclampsia?
- Magnesium Sulfate
What is the antidote for Magnesium Sulfate?
What is an AE of magnesium sulfate toxicity?
- Nausea, warmth, flushing, slurred speech
- Decreased breathing <12/ minute
- Urine <30 mL/hour
- Absence of deep tendon reflexes
What is HELLP syndrome?
- found in sever preeclampsia patients (22-36 weeks)
- Hemolysis = low hematocrit
- Liver enzymes = NV, RUQ pain, LDH, AST
- Platelets = <100,000cell/mm3
What is used to treat HELLP syndrome?
Magnesium Sulfate -
What is a complication of eclampsia?
What is placenta previa?
placental implanted in lower uterus
Hypothyroid can out a mother at risk for what complications?
- Preterm birth
- Low birth weight
- Neonatal mortality
Untreated hypothyroidism untreated can lead to?
- Placenta abruption
- Still birth
- Fetal neurological disorders if hormones are too low
Mothers with diabetes mellitus are at risk for what?
- Preterm birth
- Macrosomia (large baby)
- Congenital anomalies with high glycemnia
Nursing care for diabetic mothers:
- Diet & exercise
- Insulin therapy
- Monitor glucose levels
- Fetal surveillance
What is he only PO med approved for diabetics?
Metformin used with diet & exercise to control Type II diabetes
What is a side effect for baby when born to a mom on metformin?
What may change about insulin doses in the pregnant woman?
May be doubled or tripled in the 2nd & 3rd trimesters.
What are side effects of a mother with cardiovascular disease?
- Preterm labor/ birth is more prevalent
- Incidences of congenital heart lesions increased if mothers has a congenital heart disease
Iron deficiency is also know as ____.
How would you treat sickle cell hemoglobinopathy?
- Pain medication
very painful disorder
What common ailment is experienced in the first trimester of pregnancy?
Mothers with epilepsy are at risk for what?
- not taking medication
- increase risk of bleeding & abruptio placenta
How are mothers with Multiple Sclerosis treated?
bed rest & steroids for acute exacerbations
may develop during pregnancy and resolve after birth
What is uterine atony?
- marked hypotonia of uterus
- #1 reason for postpartum hemorrhage
What would a slow trickle of blood with a firm uterus indicate?
possible lacerations of the genital tract
What is an inversion of the uterus?
- turns inside out
- potentially life threatening
What is a pelvic hematoma? what are the s/s?
collection of blood in the connective tissue - may be vulvar, vaginal, or retroperitoneal.
Pain is the most common s/s
What types of birth are associated with pelvic hematomas?
What is a s/s of a subinvoluted uterus?
- Late postpartum bleeding
- Prolonged lochia discharge
- Irregular or excessive bleeding
How long does it take the fundus to drop?
About ten days - one finger per day
What is one of the first signs of postpartum hemorrhage?
Tachycardia while trying to compensate for blood volume loss
What fluids are given to help increase blood volume?
- Lactaded Ringer's
- Normal Saline
- Packed Red Blood cells
Medication for managing bleeding?
urinary output of less then 30mL/ hour could be a sign of what?
blood loss in postpartum bleeding
What is disseminated intravascular coagulation?
DIC pathogenic form of clotting - consumes large amounts of clotting factors, including platelets, fibrinogen, prothrombin, and factor V & VII
What is endometritis ?
infection of the lining of the uterus
What are s/s of DIC?
spontaneous bleeding from gums or nose, petechiae from the BP cuff, excessive bleeding following a venipuncture
What is the antidote for Heprin?
What is a puerpal infection?
any infection of the genital canal within 28 days after abortion or birth