Term
| What are the 3 top causes of fetal death? |
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Definition
#1=choromosomal anomalies
#2=prematurity
#3=effects of maternal complications
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Term
| What is the #1 cause of bacterial related death of newborns? |
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Definition
Group B Strep
30% of women are infected, testing occurs in the 3rd trimester. Reponsible for 5-20% of newborn death (Shari's lecture) |
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Term
| What is the tx for a + Group B Strep test in the 3rd trimester? |
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Definition
| Antibx during labor; 2 doses 4 hours before delivery |
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Term
| What are the electronic fetal monitoring tests and assessments? |
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Definition
EFM (electronic fetal monitoring)
NST (Non stress tests)
FHR (fetal heart rate) tracing
Internal monitoring (fetal heart rate, have to have ruptured membranes to perform) |
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Term
| What is electronic external fetal monitoring reliable for? |
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Definition
| Reliable only for contraction frequency, not absolute for fetal HR or contraction stretch/effectiveness |
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Term
| What are NST's and FHR tracing used for? |
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Definition
| Indicates fetal well being if reactive. Look for vaiability, accels, decels in the fetal heart rate. |
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Term
| Daily fetal movement counts, how are they performed and by who? |
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Definition
| By Mom. Teach mom to look for decreased/no fetal movement during normal fetal active periods. Teach mom that baby does have a schedule and movements may be slowed/absent during fetal sleep cycle. |
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Term
| What is internal fetal monitoring reliable for and when? |
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Definition
Reliable for fetal heart rate but only when membranes are ruptured.
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Term
| What is the goal for fetal monitoring? |
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Definition
| Identifying uteroplacental insufficiency |
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Term
| What is uteroplacental insufficiency |
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Definition
| A gradual decline in quality of the placenta and its ability to perfuse adequately to the fetus creating a threat to fetal growth and oxygenation indicating a need for early delivery. |
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Term
| What is chorionic villi sampling? |
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Definition
| A test performed between 10 and 12 weeks gestation where a small tissue specimen is removed from the placenta. It is used to detect genetic and choromosomal anomalies. Risks include vaginal spotting, miscarriage, hemorrhage, and rupture of membranes. |
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Term
| What is MSAFP (maternal serum alpha-fetoprotein) test? |
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Definition
| A blood test done between 15-22 weeks gestation (16-18 ideally) to detect levels of alpha fetal protein in the mom's blood stream. This is then used to determine the risk for a NTD (neural tube defect) and Down's syndrome in the fetus. Gestational age is the most important factor, if the actual age is 'off' from what is reported the test is not as accurate and can give false results. |
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Term
| What is an amniocentesis and what is it used for? |
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Definition
Aspiration of amniotic fluid. Done under u/s guidance. Used in early pregnancy to detect chromosomal abnormalities in the fetus. Used in late pregnancy to determine lung maturity.
Risks:
in early pregnancy: miscarriage
in late pregnancy: inducing contractions |
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Term
| What is the L/S ratio and how is it tested? |
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Definition
| Lecithin/sphingomyelin ratio used to assess fetal lung maturity. 2:1 ratio indicates mature surfactant production. Found in amniotic fluid, tested via amniocentisis |
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Term
| What are the TORCH infections that are screened for during pregnancy? |
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Definition
Toxoplasmosis-kitty litter disease: can be tx
Other-syphyllis, gonorrhea, hep B, varicella, HIV
Rubella-can cause fetal malformations 50-60% if acquired in first trimester. Mom immunized after delivery cannot conveive w/in 3 months of immunization.
Cytomegalovirus-most women are immune from childhood congenital CMV is devestating; no effective theraputic actions-causes multi system disorders including hearing loss and mental retardation.
Herpes: If lesions present during labor c/s is birth choice to avoid transmission to baby. |
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Term
| What is gestational hypertension? |
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Definition
| High BP (>140 systolic or >90 diastolic) that onsets at 20+ weeks pg without proteinuria and returns to baseline by 12 weeks postpartum. |
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Term
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Definition
| A vasospastic systemic disorder in pregnancy where HTN is present with proteinuria. Onset is 20+ weeks gestation, it can range from mild (no organ dysfunction) to severe (BP > 160 sys 110 dys and proteinuria at or > +2). |
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Term
| What are the tx for mild and severe pre-eclampsia? |
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Definition
Mild: Tx is at home, normally limited to bedrest and frequent monitoring w/OB.
Severe: Tx is hospitalization, medication to tx BP, fetal monitoring, daily labs for liver/kidney function and platlets. Also frequent urine checks for protein. +2 is worrisome, 300mg in a 24 hour urine catch is 'magic number' for diagnosis of proteinuria. |
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Term
| What is eclampsia and how is it treated? |
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Definition
| The onset of seizure activity or coma in a woman dx with pre-e. Can occur during pg, labor, or 72 hrs postpartum. Vasospasm response of the brain in the pre-e woman causes the seizure. Immediate goal is secure airway, note seizure activity, administer o2 (10L via face mask), IV mag sulfate is given to prevent more seizures. Diazepam can be given w/additional mag sulfate if initial tx is not successful. Aspiration is the leading cause of maternal morbidity post eclamptic seizure. Assess uterine activity, cervical status and fetal status post convulsion. |
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Term
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Definition
| A variant of pre-e that includes hepatic dysfunction. Hemolysis Elevated Liver enzymes and Low Platlets (<100k) are the dx criteria. Occurs in 20% of severe pre-e cases; mostly in older caucasian multiparous women. 90% of women experience malaise for several days. Epigastric/RUQ abd pain is also noted by 65% of women w/HELLP. |
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Term
| What are some of the complications of HELLP? |
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Definition
| Renal failure, pulmonary edema, ruptured liver hematoma, DIC, placental abruption, preterm birth. |
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Term
| What is a molar pregnancy? What does it put the Mom at r/f in the future? |
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Definition
| Grape like clusters of fluid filled cysts rather than a viable zygote. Growth rate exceeds normal pg growth. 20% of women dx w/molar pregnancy will develop genetic trophoblastic tumors in the future. Women should avoid pg for 1 year post molar pregnancy. |
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Term
| What tests make up the biophysical profile? How is it scored? |
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Definition
| Non stress test, fetal breathing movements, fetal tone, gross body movements, amniotic fluid volume. 0-2 points each, total score of 10 possible. All but NST are done via u/s. BPP is an acurate indicator of impending fetal demise. Abnormal BPP and oligohydramnios are indications for induction. |
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Term
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Definition
| Disseminated Intravascular Coagulation: Consumptive coagulopathy is a pathologic form of clotthing. An overactivation of the clotthing cascade results in widespread clotting, bleeding (internal and external) and ischemia. Secondary dx in response to a disease, injury, sepsis. Severe Eclampsia, HELLP, and sepsis can trigger DIC. |
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Term
| What are the nursing interventions for a pg woman w/DIC? |
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Definition
| Careful assessments for signs of bleeding, monitoring of urinary output, assessing vital signs frequently. Supportive measures: keep pg woman on a side tilt to maximize blood to the uterus. O2 via rebreathing mask at 8-10L/per protocol or order. Blood administration as ordered. Fetal assessments to determine fetal well being. "Cure" is normally birth/resolution of coagulation abnormalities. |
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Term
| What are the expected outcomes and nursing interventions for PIH? |
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Definition
| Teach the woman to recognize and report s/s of worsening PIH. Compliance to medical regime to decrease progression of disease and risk to mom/baby. Goal is to avoid eclampsia and give birth to a healthy infant. |
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Term
| What are the most common complications of early pregnancy? |
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Definition
| Bleeding caused by miscarriage or implantation (light, no harm to fetus). Cervical incompetence (premature dilation). Ectopic pregnancy (implantation of the fetus in the fallopian tubes, not viable pregnancy-hemorrhage risk). Molar pregnancy. |
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Term
| What is a molar pregnancy and what is mom at risk for post molar pregnancy? |
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Definition
| Gestational neoplasm due to fertilization of an egg w/no nucleus. Leads to a grape like cluster of fluid filled cysts. Grows rapidly. 20% of women will go on to have a genetic trophoblastic tumor in the future. Recommendation is: no pregnancy for 1 year post molar pregnancy ending. |
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Term
| What are the complications that can cause late pregnancy (>/= 20 weeks) bleeding? |
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Definition
Placenta previa: implantation of placenta over or near cervix. If cervix dilates, placenta can/does tear away.
Abruptio placenta: Placenta detaches from the uterine wall before fetus has been delivered. |
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Term
| What are the types and s/s of placenta previa |
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Definition
Placenta is covering part of the cervix: Marginal, partial or total are the types related to how much of the cervix is covered by placenta.
S/S: Painless uterine bleeding. If contx occur placenta pulls away from the uterine wall causing bleeding. C/S devliery is indicated w/placenta previa. |
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Term
| What are the types and s/s of abuptio placenta? |
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Definition
Types: Marginal, partial, complete. Relates to how much of the placenta has detached.
S/S: Abd pain, uterine irritability, bleeding (may be 'hidden'/ internal, or external/vaginal) uterine tenderness. |
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Term
| What are the diagnostic tests for diabetes in pregnancy? |
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Definition
One hour glucose tolerance test: 24-28 weeks gestation. If failure:
Three hour fasting glucose tolerance test. Fasting blood draw, injestion of 100g glucose, levels drawn at 1,2, 3 hours later. Diabetes dx if 2 of the 3 are failing levels. |
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Term
| What is the risk to moms with Gestational Diabetes in the future? |
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Definition
| 50% chance of developing DM2 within 2/decades |
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Term
| What are the risks associated with diabetes in pregnancy (gestational/Type 2) |
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Definition
| Increased risk for pre-eclampsia. Hydraminos risk 10x higher. Macrosomia/Fetus large for gestational age. Increased rate of c/s delivery. High glucose levels cross the placenta can increase fetal o2 needs and lead to hypoxia. After birth: Baby often becomes hypoglycemic due to reduced available glucose and high insulin levels. |
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Term
| What is the risk to the baby in a pregnancy with pre-existing vascular damage due to Diabetes? |
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Definition
| That the baby will be small for gestational age due to decreased perfusion from the placenta. |
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Term
| What are baby blues and what duration is normal? |
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Definition
| Normal hormonal highs and lows r/t birth and quickly changing hormones. Onset around 3 days post partum. Duration: approx 1 week |
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Term
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Definition
| When the 'baby blues' linger for longer than 1 weeks, 10-15% occurence rate. Irritability, feelings of guilt and being overwhelmed-progressively worsens. |
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Term
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Definition
| Post partum depression + delusion. Thoughts of harming self or child. |
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Term
| What is the main concern with type 1 diabetes in pregnancy? |
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Definition
| It is very difficult to control glucose levels adequately during pregnancy. |
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