RHOGAM

Given to Rh- mothers with Rh+ fetus prevetning antibidies forming against the Rh factor of mom.  Given at any time that there is bleeding in pregnancy and @ 28 weeks gestation then again after delivery

• Hemolysis Elevated Liver Enzymes Low Platelets
• approx 12% of women with PIH get this (basically a severe form of eclampsia)
• Symtoms:RUQ pain, proteinuria, aspirtaion pneumonia, fetus quits growing, epigastric pain or lower chestpain. Also n/v, general maliase, severe edema, distended liver and s/s of preeclampsia, 
• Labs: hemolysis of RBC's, thrombocytopenia (below 100k), elevated alainine aminotransferase and serum asparate amino transferase
• interventions: monitor VS, FHR, s/s of hemorrhage, hypoglycemia, hyponatremia, subscapular liver hematoma, renal failure, dimly lit room, IV with dextrose c hypoglycemia, fresh frozen plasma, pure platelets, IV dextrose, no epidural, get infant out!

• habitual- spontaneous loss of 3 or more consecutive pregnancies
• inevitable- membranes rupture and cervix dilates.  Imminent that miscarriage will occur.
• missed- uterus retains porducts of conception 2 or more months after fetus died.  Prolonged retention of conception may cause DIC
• septic- infection accompanies abortion s/a with lack of sterile technique during therapeutic abortion
• lab work: HCG, H&H, WBC, clotting factors
• interventions: pad count, vag rest, bed rest, VS, emotional suport D&C if needed

• causes: low iron diet, heavy menses, unwise wt reduction, recent pregnancy <2yrs
• symptoms: fatigue, h/a, pica, pallor
• Treatment: prenatal vitamins, diet rich in dark green leafy veggies, meat, legumes, ferrous sulfate Rx ingested with OJ

• Causes- multiple pregnancies, use of hydantoin, oral contraceptives, gastric bypass
• Symptoms- severe fatigue, SOB, diarrhea, anorexia, nausea, h/a, forgetfulness, irritabillity
• treatment- supplement with 400microgram of folic acid, green leafy veggies, oranges, dried beans

• Causes- inherited anemia by an abnormal amino acid. Bactiuria is common in prgnancy with Sickle Cell
• Symptoms- severe abdominal pain, unusual swelling of fingers and toes, chronic anemia, pallor, muscle spasms, leg pains, painful swollen joints, fever, vomiting, hematuria, seizures, coma, paralysis
• Treatment- sckle cell screening, periodic exchange transfusions of RBC, control HGB levels, increase fluids, O2, no iron, penicillin, flu shot (influenza B), folic acid,, CBC, VS, FHR, hypotonic slaine IV solution

• symptoms- SOB c less than normal exertion, excessive fatigue, cough, cyanosis of nail beds/lips, edema, irreg pulse,  difficult/rapid respirations,possible chest pain,
• complications- preterm labor, increased risk for blood clots, HTN, increased risk for miscarriage. for baby- possible placental perfusion, IUGR, fetal mortalitiy
• treatment: ECG, bedrest, O2, epidural, heart cath, swan ganz catheter, no pushing during delivery, forceps use or vacuum extractor, lay on left side, TEDS postpartum, antibiotic prophylactically, early ambulation

• causes- women of color, multiple prgenancies, primiparas <20 or >40, hydramnios, low socioeconomic background, underlying heart disease, diabetes with vessel or renal involvement, essential hypertension
• assess for- edema,
  BP >140/90, proteinuria 1-2+, wt gain more than 2lb a wk in 2nd trimester, 1lb wk third trimester, monitor urine output for oliguria, visual disturbances, hepatic disfunction, epigastric pain pulmonary or cardiac involvement, hyperreflexia
• treatment- monitor antiplatelet therapy, promote bedrest, nutrition and emotional support, admin prescribed meds, frequent BP, dly HCT, FHR, US, magnesium levels, test for fetla lung maturity
  

• same as preeclampsia but more severe form
• monitor and treat the same but also look for seizures or coma
• fetus quits devleoping with seizure
• C-section delivery or possible induction if parameters allow
• possible fetal demise

• Uses- prevent seizure activity, inhibit uterine contractions
• method of delivery- infused piggyback, loading dose for rapid therapeutic level, infused over slow rate and dose post loading dose
• Clacium gluconate at bedside in case of mag overdose
• watch for signs of resp distress (less than 12/min)
• monitor I&O (at least 30 out every hour to continue)
• monitor deep tendon reflexes (at least a +1)
• max rate 150mg/min

• history of pregnancy and trauma
• ng, foley, hip roll to prevent supine HTN
• IV with large bore needle (18g)
• Lactated ringers, correct low HTN with ephedrine or dopamine
• monitor liver enzymes, abd bleed (paracentesis), bladder (cath to assess for blood)
• choking- chest thrust only
• burns- fluid and electrolyte loss, treat with IV.  Burns heal  fster in prgenancy
• postmortem C-section- <20min of death and fetus >24wk, fetus best survived within 5 minutes of death
• tetanus, rabies are ok to give
• call poison control,
• rhogam if Rh-,
• monitor contractions (may have to give tocolytic to stop)