OB-Comp Antepartum

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Author:
MeganM
ID:
295625
Filename:
OB-Comp Antepartum
Updated:
2015-02-15 15:24:58
Tags:
Complicated Antepartum
Folders:
TAMHSC,OB,Exam 2
Description:
Comp Antepartum
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  1. Teach pt to watch for this after a D&C.
    • Heavy bleeding,
    • fever,
    • chills,
    • foul-smelling discharge,
    • abdominal tenderness
  2. Vaginal bleeding, cramping, backache,
    cervix closed.
    Threatened abortion
  3. Vaginal bleeding, cramping, dilatation of
    the internal cervical os
    Imminent Abortion
  4. Products of conception retained; usually
    the placenta, cervical os open
    Incomplete Abortion
  5. All the products of conception are
    expelled, cervical os may be closed
    Complete abortion
  6. The fetus dies in utero but is not
    expelled
    Missed abortion
  7. Some causes of spontaneous abortion.
    • chromosomal abnormalities
    • abnormalities of the reproductive tract or placenta
    • maternal diseases and infections
  8. Treatment for ectopic pregnancy.
    • 1. Assess appearance and amount of vaginal bleeding
    • 2. Assess BP, pulse and respirations for signs of shock
    • 3. Prepare the patient for emergency surgery if the ectopic has ruptured
    • 4. Establish IV therapy and blood transfusion capability
    • 5. Assess emotional needs of the couple and family and provide support
    • 6. Some ectopics may be treated with methotrexate* and close monitoring  (serial hCG levels)
    • 7. Give Rh immune globulin to Rh negative woman
  9. Methotrexate dosing for ectopic pregnancy.
    1 mg/kg IM for 1-3 doses.
  10. Develops from an anuclear ovum (“empty
    egg”)
    Fertilized by a haploid sperm (23X) and duplicates to become 46XX of total paternal origin
    No embryonic or fetal tissue are found
    Complete mole
  11. Normal ovum fertilized by two sperm
    Results in triploid karyotype (69 chromosomes)
    Identifiable fetal parts may be present
    Partial mole
  12. Similar to complete mole, but involves
    myometrium
    Invasive mole
  13. Invasive, malignant trophoblastic disease
    Metastatic, can be fatal
    choriocarcinoma
  14. S/S of Gestational Trophoblastic Disese (molar pregnancy)
    • Vaginal bleeding, often brownish (“prune
    • juice”)
    • Passage of hydropic vesicles
    • Anemia (due to loss of blood)
    • Uterine enlargement greater than expected
    • Markedly elevated serum hCG levels
    • Severe hyperemesis gravidarum
    • Absence of fetal heart tones
  15. What is hyperemesis gravidarum r/t?
    • rising chorionic gonadotropin and
    • estrogen levels
  16. What is gestational HTN?
    • HTN (BP >140/90) detected for the first time after mid-pregnancy (20 weeks) without
    • proteinuria
  17. When is gestational HTN confirmed?
    • If/when BP returns to normal by the 12th week
    • postpartum
    • *if does not rtn to normal, chronic HTN is diagnosed
  18. Preeclampsia is a systemic disease characterized by?
    • HTN (BP > 140/90),
    • proteinuria > 300 mg/24 hours or 1+ dipstick after the 20th week of gestation
  19. How is chronic HTN managed during pregnancy?
    • Methyldopa
    • or Labetalol
  20. What is Chronic HTN with Superimposed Preeclampsia?
    • New-onset proteinuria > 300 mg/24 hours in hypertensive women but NO proteinuria
    • BEFORE 20 weeks gestation
    • Sudden increase in proteinuria or hypertension in women with hypertension AND
    • proteinuria BEFORE 20 weeks gestation
  21. What can occur as a complication of severe eclampsia?
    • HELLP syndrome:
    • Hemolysis
    • Eevated Liver enzymes
    • Low Platelets
  22. Symptoms of HELLP syndrome.
    • flu-like, 
    • nausea,
    • vomiting,
    • epigastric pain
  23. What are the 3 questions you should ask in a pregnant woman, especially with s/s of preeclampsia?
    1) Do you have a headache?

    2) Are you having any visual disturbances?

    3) Are you having any right upper quadrant or epigastric pain?
  24. S/S of preeclampsia.
    • Persistant hypertension
    • CNS symptoms:
    •     Headache
    •     Visual disturbances
    •     Hyperreflexia and clonus
    •     Seizure (1/400 of mild preeclamptics; 2%
    •     of severe)
    •     Stroke (rare)
    • Liver involvement manifested by:
    •     RUQ or epigastric pain
    •     Nausea and vomiting
    •     “I just don’t feel good”
    •     Dyspnea (related to pulmonary edema)
  25. Antihypertensive therapy is usually initiated
    when SBP is ≥______mmHg and/or DBP is ≥_______
    Target goal: SBP _______; DBP
    • 160
    • 105 to 110
    • 140-150
    • 90-100
  26. Delivery is recommended
    for any patient with preeclampsia at least __ weeks gestation
    37
  27. If pt with preeclampsia is <37 weeks, what is the expected management?
    • Restricted activity  (although there is no evidence that supports that complete bedrest
    • improves outcome)
    • Daily fetal movement counts
    • Nonstress test and/or biophysical profile
    • Ultrasound to evaluate growth and AFI
    • Umbilical artery flow study (if growth is a concern)
    • Repeat laboratory evaluation once or twice weekly
    • Platelet count, serum creatinine, serum AST
    • Antenatal corticosteroids to promote fetal lung maturity in women less than 34 weeks gestation
  28. Care during a seizure.
    • Call for help
    • Ensure airway and breathing
    • Remain with patient
    • Prevent injury
    • Record time, length, type of seizure activity
  29. After seizure care.
    • IV access
    • Administer MgSO4
    • Assess maternal and fetal status
    • Suction if needed
    • Supplemental O2
    • Patient will be stabilized then deliver
  30. Hypertensive Disorders of Pregnancy: Fetal Risks.
    • Prematurity
    • Intrauterine
    • Growth Retardation
    • Low birth weight
    • Fetal intolerance to labor due to decreased placental perfusion
    • Stillbirth
  31. Why do pregnant women need to do the glucose test at 24-28 weeks?
    • In the second half of pregnancy, the
    • placental hormone hPL (human placental lactogen) causes maternal peripheral resistance to insulin
    • This ensures that there is glucose for the developing fetus
    • Mother metabolizes fat for energy and produces ketones as a result
  32. Gestational diabetes is diagnosed if two or more of the following values are met or exceeded:
    • Fasting =  95mg/dl
    • 1 hour = 180 mg/dl
    • 2 hour = 155 mg/dl
    • 3 hour = 140 mg/dl
  33. Goal for glucose monitioring.
    • Fastings < or = 95
    • 2 hour postprandials < or = 120
  34. Medication for diabetes management.
    • Glyburide (oral agent)
    • Insulin (injectable)
    • -Need for insulin will increase as pregnancy advances
  35. Effects of pregnancy on woman with heart disease.
    • Blood pressure drops during 2nd trimester in response to decreased systemic vascular resistance
    • 30% to 50% increase in intravascular                volume and cardiac output
    • Increase of heart rate by 15-20 bpm
    • Increased risk of thromboembolism
    • Dramatic volume shifts occur after delivery
    • Cardiac output may increase an additional 50% during labor

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