OB chapter 25 Notecards (Complete, with EVOLVE)

A pregnant woman at 36 weeks of gestation is admitted to the high-risk pregnancy unit with hypertension. Assessment findings indicate severe preeclampsia. The nurse should:

Expect a maintenance dose of intravenous magnesium sulfate to be about 2 g/hr.

Preeclampsia Therapeutic management

**Activity restrictions**: rest frequently, not full bed rest, for mild. A lateral position for at least an hour and a half a day decreases pressure on vena cava thereby increasing cardiac return and circulatory volume and improving perfusion of the women's vital organs and the placenta. **Blood pressure**: Same arm, same position, two to four ties a day. **Weight**: Weigh each morning, same scale **Urinalysis** A urine dipstick test for protein, using the first voided midstream specimen, should be performed daily. **Fetal Assessment**: because vasoconstriction can reduce placental flow , women will have increased fetal assessments to observe for fetal compromise as evidence by decreased fetal movement. **Diet**: Should have ample protein and calories, regular diet without salt or fluid restrictions is usually prescribed.

Interventions for Seizures

**Prevention of Injury:** - Side rails should be padded - Oxygen and Suction equipment should be assembled - Preeclampsia tray or box should be in room - Typical contents medium plastic airway, ambu bag with mask ophthalmoscope, a tourniquet, reflex hammer, syringes and needles Medications that should be available include magnesium sulfate, sodium bicarbonate, heparin, epinephrine, phetytoin, calcium gluconate. **Support for the family:** - Acknowledge that the seizure indicates worsening of the condition and that it will be necessary for the physician to determine future management, which may include delivery of the infant asap.

Preeclampsia (Planning)

- Perform actions that minimize risk of seizures - Monitor for signs of impending seizures - Consult the physician - Support the family - Monitor for signs of magnesium toxicity - Consult with a physician if toxicity occurs - Perform action that reduce possibility of toxicity

Placenta Previa

-1 in 300 births. more common in older women c-sections, suctioned abortions. Higher risk in patients who smoke and use cocaine while pregnant, more likely if fetus is male. -Sudden onset of painless uterine bleeding in last half of pregnancy resulting from tearing in villi from uterine wall as the lower uterine segment thins. Bleeding is painless cause doesn't create pressure on surrounding tissue and may not occur to actual labor. *** unless the location and position of the placenta are verified by ultrasound, no manual vaginal examinations should be performed and administration of oxytocin should be postponed to prevent strong contractions that could result in sudden placental separation and hemorrhage.

Chronic Hypertension

-A diagnosis of chronic hypertension is made if evidence suggests that hypertension preceded the pregnancy or when a woman is hypertensive before 20 weeks.

The three most common hemorrhagic complication in EARLY PREGNANCY

-Abortion -Ectopic pregnancy - blood incompatibilities.

For hemorrhagic conditions in late pregnancy you need to:

-Assess: Amount and nature of bleeding, pain, condition of fetus, uterine contractions, obstetric history, length of gestation, laboratory data. -Monitor for signs of hypovolemic shock. (Fetal tachycardia, Maternal tach, decreased bp,increased resp rate, Low o2 sat, Cool, pale skin) -Monitor fetus -Promote tissue oxygenation (lateral position head of bed flat to increase cardiac return.) -Collaborate with physician for fluid replacement -prepare women for surgery Provide emotional support -Evaluate

Preeclampsia

-Condition in which hypertension develops during th elast half of the pregnancy in women who previously had normal bp, renal impairment may cause proteinuria. only known cure is birth.

Prenatal Assessment and Management

-Doppler studies allow evaluation of cardiac functions and blood flow in fetal vessels. -Generalized fetal edema, ascites, and enlarged heart, or hydramnios occurs when the fetus is very anemic. -Percutaneous umbilical blood sampling (PUBS), or cordocentesis, allows invasive sampling of fetal blood from cord vessels to determine the degree of erythrocyte destruction.

The most common pregnancy related complications are?

-Hemorrhagic conditions that occur in early pregnancy -hemorrhagic complications of the placenta in late pregnancy -Hyperemesis gravidarum -Hypertensive disorders -Blood incompatibilities.

Hydratidiform Mole (Clinical manifestations)

-Higher levels of beta-hCG _characteristics "snowstorm" ultrasounds -Uterus larger than expected -Vaginal bleeding -Excessive nausea and vomitting.

Preeclampsia (Psychosocial Assessment)

-If condition is mild and gestation period is early the woman may have been intructed to reduce activity, she may be hospitalized complicating care for other children. -Many families do not understand seriousness of this disease because the woman feels well after its onset especially if it does not advance rapidly.

Postpartum Management

-If the mother is Rh negative, umbilical cord blood is taken at delivery to determine blood type, Rh factor, and antibody tighter of the newborn. -Rh negative, unsensitized mothers who give birth to Rh positive infants are given an intramuscular injection of RhoGAM within 72 hours after delivery of an Rh positive infant, Rh antigens present in her blood are destroyed before she forms antibodies to the Rh factor

Abruptio Placentae

-In most cases bleeding occurs behind the placenta but the margins remain intact, causing formation of hematoma. -Patient presenting symptoms needs to be hospitalized immediately. Evaluation focus needs to be on cardiovascular status. -Bed rest is rare due to risks to fetal death. Immediate delivery if necessary signs of fetal compromise exist or if the mother exhibits signs of excessive bleeding, either obvious or concealed. *** women who have experienced abdominal trauma such as a wreck may be observed up to 24 hours due to that being the length it take abruptio placentae to develop.***

Hemolysis Elevated Liver Enzymes and Low Platelets (HELLP) Syndrome

-Life threatening occurrence, which complicates about 10% of pregnancies. Half affected by preeclampsia although hypertension may be absent. May occur during the postpartum period. -Prominent Symptom is pain in the right upper quadrant, lower right chest, or the mid epigastric area may also be tenderness because of liver distention, severe edema. It is important to avoid traumatizing the liver by abdominal palpation and to use care in transporting the woman. Sudden increase in abdominal could lead to rupture of a subcapsular hematoma. -Woman should be monitored in a center with intensive care settings. Magnesium-Seizures. Hydralazine-BP. -If woman is near term and has a favorable cervix induction of labor is preferred to avoid bleeding and clotting complications that are more likely to occur with a c-section. Anesthesia likely to be complicated by laryngeal edema (intubation difficulties) low platelet clouts that may reduce safety of epidural block, and coagulation abnormalities that can impact safety of pudendal blocks. C-Section birth may be necessary if the woman is far from term or has an unfavorable cervix.

Preeclampsia

-Major cause in perinatal death. risk factors include obesity, and pregnancy diabetes. Most likely to occur in first pregnancy, African-Americans, positive family history, chronic hypertension, and renal disease. ** The presence of immunologic or genetic disorders such as lupus or clotting disorders adds to the risk.***

Abruptio Placentae

-Maternal use of cocaine which cause vasoconstriction in the endometrial arteries is the leading cause. -Other risk factors include; maternal hypertension, cigarette smoking, multigravida status, short umbilical cord, abdominal trauma, premature rupture of membranes. Clinical manifestations: -Bleeding -Uterine tenderness (firm) -uterine irritability -Abdominal or low back pain (sudden and severe) -High uterine resting tone.

Preeclampsia (intrapartum management)

-Most seizures occur during labor in the first 24 hours after birth. Continuously monitor decreased fetal oxygenation and imminent seizures. -Mother should be kept in lateral position to promote circulation through the placenta. -Effort should focus on controlling pain that can cause agitation and precipitate seizures. -Oxytocin to stimulate uterine contractions and magnesium sulfate to prevent seizures, often administered simultaneously during labor. -Opiate analgesics may be administered provide comfort and reduce pain that could precipitate a seizure. **A Pediatrician, neonatololigist, or neonatal nurse practitioner must be available to care for the newborn at birth. Neonatal resuscitation team is often called to birth.**

Preeclampsia

-Result of generalized vasospasm. -Early and regular prenatal care with attention to pattern of weight gain and monitoring of bp and urinary protein level may minimize maternal and fetal morbidity. -The first indication is usually hypertension. BP should be measured with patient seated and arm supported. *** When the retina is examined, vascular constriction and narrowing of the small arteries are obvious in most women with preeclampsia, if severe preeclampsia lab studies may identify liver, renal,and hepatic dysfunction***

Incompatibility Between Maternal and Fetal Blood

-Rh factor antibodies present in mother cross the placenta and destroy fetal erythrocytes. -Fetus becomes deficient in RBC's which are needed to transport oxygen to fetal tissue. -As RBCs are destroyed fetal bilirubin levels increase which can lead to neurologic disease. The entire syndrome is termed Erythroblastosis fetalis. -Fetus may become so anemic that generalized fetal edema results and can end in fetal congestive heart failure.

Abruptio Placentae

-Separation of a normally implanted placenta before the fetus is born occurs in cases of bleeding and formation of hematoma on the maternal side of the placenta, as the clot expands, further separation occurs. -Hemorrhage may be apparent of hidden. severity is determined by size of hematoma. -Fetal vessels are disrupted and placental separation occurs resulting in maternal and fetal bleeding.

Types of abortions

-Spontaneous -induced

Severe Preeclampsia

-Systolic bp is 160 or greater, the diastolic is 110 or greater. -Immediate delivery is usual decision even if gestation is less than 34 weeks due to disease severity. -A decreased volume of amniotic fluid is significant b/c indicated reduced placental blood flow, even is BP is not high. **Antepartum Management**: improve placental blood flow and fetal oxygen and to prevent seizures. **Bed Rest**: lateral position, kept quiet area. **Anti hypertensive Medications** **Anticonvulsant medications** Magnesium sulfate administered y IV infusion, not risk-free, fetal mag levels are nearly identical to the mothers . Therapeutic serum level is 4 to 8 mg/dL, adverse reactions only when levels become to high (most important is CNS depression) Excreted solely by kidneys.

Preeclampsia (Assessment)

-Weigh the woman on admission and daily, -check vital signs, auscultate the chest at least every 4 hours for moist breath sounds that indicate pulmonary edema, -check urine for protein every 4 hours, -apply external fetal monitor to identify changes in fetal heart rate, variability or non reassuring patterns, -consider maternal medications, -check reflexes, -determine if clonus is present.

Prenatal Assessment and management

-Women should have a blood test to determine blood type and rh factor at initial prenatal visit. A coombs test to determine whether they've been sensitized as a result of previous exposure to Rh positive blood. If test is negative repeat it at 28 weeks. -RhoGAM is administered to the unsensititized Rh negative women at 28 weeks to prevent sensitization. -If test is positive it is repeated at frequent intervals to determine whether the antibody titer is rising, which indicates that the process is continuing and the fetus will be in jeopardy -Amniocentesis may be performed to determine Rh factor of fetus and to evaluate change in optical density of amniotic fluid. If fluid remains low it may indicate the fetus is Rh negative or that the fetus is Rh positive but in no jeopardy.

Diseases that cause DIC (Disseminated introvascular coagulation)

1. Infusion of tissue thromboplastin into the circulation which consumes or uses up clotting factors such as fibrinogen and platelettes: Abruptio placentae and prolonged retension cause this because the placenta is a rich source of thromboplastin 2. Endothelial damage: Severe preeclampsia and HELLP syndrome 3. Nonspecific effects of some diseases: Such as maternal sepsis and amniotic fluid embolism

What two broad categories are pregnancy complications divided into?

1. those related to the pregnancy and not seen at other times 2. Those that could occur at any time but also occur concurrently with pregnancy.

For hemorrhagic conditions in early pregnancy you need to:

1.Assess gestation length, bleeding, description, location, severity of pain, how long bleeding episode lasted, amount lost in measurment such as tablespoon or cups. cramping, vital signs, urine output. Hypovolemia/ hypovolemic shock, infection. Diet: Needs foods high in iron (red meat, liver, spinach, egg yolks, carrots, raisins), vitamin C (citus fruits, brocoli, strawberries) Fluid intake (2500 mL/day).

A woman is admitted to the maternity unit with preeclampsia. She is started on magnesium sulfate IV, a urinary catheter is inserted, and she is put on bed rest. The nurse understands it is important to monitor urinary output hourly. It is important that the client have an output of at least

30 mL

Which of the following women are at higher risk for an ectopic pregnancy? (Select all that apply). A. History of pelvic infection Correct B. Had a tubal ligation 1 year ago Correct C.History of hormonal implants for contraception 4 years ago D. Conception was by assisted reproduction Correct E. Use of alcohol during the first 2 weeks of the pregnancy F. History of intrauterine contraceptive device Correct G. Had five therapeutic abortions C

A,B,D,F,G

Select all the signs and symptoms listed that may indicate hypovolemic shock. A. Fetal tachycardia Correct B. Maternal bradycardia C. Decreased blood pressure Correct D. Cold and clammy skin Correct E. Increased urinary output

A,C,D

The loss of the pregnancy before the fetus is viable or capable of living outside the uterus is termed a(n) _________________

Abortion

Inevitable abortion

Abortion can not be stopped and usually occurs when membranes rupture and the cervix dilates. Experienced as loss of fluid from vagina and subsequent uterine contractions and active bleeding.

A woman in labor has a long history of uncontrolled hypertension. The hypertension has continued throughout the pregnancy and labor. The nurse is aware that the woman is at high risk for which complication?

Abruptio placentae

Hemorrhagic conditions of late pregnancy

After 20 weeks; disorders of the placenta. 1.Placenta previa 2. Abruptio Placentae

DIC

Allows excess bleeding in areas such as IV sights, gums, incesions, or the nose and from expected sights. Priority in treatment is to correct the cause Observe for bleeding from unexpected sights if coagulation studies are severely abnormal an epidural block may be contraindicated

Postpartum Management

Assess mothers blood loss and signs of shock because hypovolemia caused by preeclampsia may be aggravated by blood loss. Continue for at least 48 hours. Administration of magnesium is usually continued for 24 hours. Signs that a woman is recovering: - urinary output of 4-6 liters a day - decrease protein in urine - return of blood pressure to normal, usually in 2 weeks

Although the cause of preeclampsia is not understood, there are several factors known to increase a woman's risk. Select all the following that are risk factors for preeclampsia. A. Underweight B. Prepregnancy diabetes Correct C. First baby Correct D. Women between the ages of 20 to 30 E. African-American Correct F. Multifetal pregnancy Correct G. Family history Correct

B,C,E,F,G

Placenta Previa

Evaluate amount of hemorrhage. Home care: -no evidence of bleed present, able to maintain bed rest, located short distance from hospital, emergency systems available 24/7, can verbalize risks associated. -Be able to assess color and amount of vaginal bleeding, especially after urination or bowel movement., Assess fetal movement (kicks), assess uterine activity at prescribed intervals ** report a decrease in fetal movement or increase in contractions!***

Ectopic Pregnancy (incidents and etiology)

Can occur due to previous pelvic infection, inflamation, or surgery. Pelvic infection often caused by clamidia and gonarhea. Surgery; failed tubual ligation Conceived with assisted reproduction Intrauterine contraceptive devices Delayed or premature ovulation

During the nursing assessment at a routine prenatal visit, the woman's blood pressure was significantly higher than the last visit. Because of this finding, the nurse should:

Check the urine for presence of protein (The two classic signs of preeclampsia are hypertension and proteinuria. Edema in the feet is common in most pregnancies. Edema with preeclampsia may continue up the legs to the hands and face)

Reccurent spontanous abortion (therapuetic management)

Examination of reproductive system to determin anatomic defects, if normal genetic screening is the next step.

Preeclampsia Symptoms

Dangerous for 2 reasons: 1. can develop and worsen rapidly 2. earliest symptom are often not notcied by women. BY the time symptoms are noticed disease may of progressed to an advanced state and valuable treatment time lost. -Symptoms such as; headaches, drowiness, or mental confusion indicate poor cerebral perfusion and may be a precursor to seizures. Visual disturbances such as blurred vision or double may indicate arterial spasms and edema in the retina. (decreased urinary output, numbness in hands/feet)

When a pregnant woman progresses from preeclampsia to generalized seizures that cannot be attributed to other causes, it is called

Eclampsia

When doing a chart review of a client with preeclampsia, the nurse noted that the client was assessed with +3 edema. This indicates:

Edema of lower extremities, face, hands, and sacral area

Threatened abortion

First sign is vaginal bleeding. Can be brief or last for weeks. Accompanied by uterine cramping, persistent backache, or feelings of pelvic pressure. Added together are more associated with loss of pregnancy.

Hypertensive disorders of pregnancy

Four categories: -Gestational hypertension: blood pressure elevations after 20 weeks not accompanied by proteinuria, may advance to preeclampsia. -Preeclampsia: Systolic pressure of 140 or greater or a diastolic of 90 or greater after 20 weeks. Usually accompanied by edema -Eclampsia: Progression of preeclampsia to generalized seizures, may occur postpartum. -Chronic hypertension: Elevated blood pressure existed before pregnancy or before 20 weeks.

Reccurent spontaneous abortion (considerations)

Grief may last from 6 months to 1 year or even longer.

END OF EVOLVE: The acronym for hemolysis, elevated liver enzyme levels, and low platelets that describes a life-threatening occurrence during pregnancy is __________________.

HELLP

A woman diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At the present time, she is at greatest risk for:

Hemorrhage.

During pregnancy a woman has an indirect Coombs test done. The nurse can teach her that this test will show

Her previous exposure to Rh-positive blood. (Rh-negative women should have an indirect Coombs test to determine whether they are sensitized (have developed antibodies) as a result of previous exposure to Rh-positive blood.)

A 20-week-pregnant client attending her first prenatal visit tells the nurse at the maternity clinic that she has had vaginal bleeding and excessive nausea and vomiting for the past 3 days. The nurse assesses her blood pressure at 142/95 mm Hg, pulse 86 bpm, respirations 16 breaths/min. When the nurse helps the client onto the examining table, the abdomen looks larger than normal for a 20-week pregnancy. The nurse is aware that these are signs of:

Hydatidiform mole

Placenta Previa

Implantation of placenta in lower uterus , placenta is closer to internal cervical . Three classifications: 1.Total: placenta completely covers internal cervical os 2. partial: the lower border of placenta is within 3 cm of internal cervical os but does not completely cover os 3. Marginal: (Low-lying) implanted in the lower uterus. Lower border is usually more than 3 cm from internal cervical os. Common appears to move upward and away from internal os as fetus grows.

ABO Incompatibility

Incompatibility occurs when mothers blood type O and fetus is type A, B, or AB. A, B, or AB contain a protein component that is not present in type O. -Type O can develop and antibody for A and B naturally as an exposure to antigens in the foods that they eat or to infection by gram negative bacteria. -Some type O develop high serum antibody titers before pregnancy. -The igG antibodies cross the placental barrier and cause hemolysis of fetal RBCs. Although the first fetus ca be affected, ABO incompatibility is less severe than Rh incompatibility because the primary antibodies of the ABO system are IgM, which do not readily cross the placenta.

An abortion is usually ________________ when the membranes rupture and the cervix dilates.

Inevitable

Placenta Previa

Inpatient care: -Periodic electronic fetal monitoring is necessary to determine whether the fetal heart activity changes in association with fetal compromise. -Change in Fetal activity,vaginal bleeding, or signs of preterm labor need to be reported to the physician immediately. -If changes occur and fetus is greater than 36 weeks, delivery may be induced due to maturity of lungs. -Immediate delivery regardless of fetal age may be initiated if bleeding is excessive and women starts to demonstrate signs of hypovolemia.

The nurse is admitting 37-week-pregnant woman with severe preeclampsia. When choosing a room for her, the nurse would put her in the:

Last room at the end of the hall, close to the nurses' station.

Abortion

Loss of pregnancy before the fetus is viable, or capable of living outside the uterus. (Less than 20 weeks and weighing less than 500g)

Interventions for Magnesium Toxicity

Magnesium excess depresses the entire CNS, including the brainstem. Signs: - Respitory rate less than 12 - Maternal O2 sat less than 95 - Absence of DTR's - Sweating, Flushing - Altered Sensorium - Hypotension - Serum Magnesium above 8mg/dL **Calcium opposes the effects of magnesium (1 gram of calcium gluconate at 1mL per minute)**

Hydratidiform Mole (therapuetic managment)

Medical management includes two phases: 1. evacuation of trophoblastic tissue of the mole 2. continuous follow up to detect malignant changes Before evacuation a complete blood count, laboratory assessment of coagulation, blood type screening and cross matching are performed in case of a transfusion needed. After tissue removal IV oxytocin is administered to contract the uterus. Follow up care is important usually up to 6 months to ensure recurrence doesn't happen.

Perinatologist

Medical specialist in high-risk pregnancy care from about 20 weeks of gestation through 4 weeks postpartum.

Ectopic Pregnancy (Clinical Manifestations)

Missed period Abdominal pain Vaginal Spotting If occuring in distal end of tube intermittent abdominal pain and small amounts of vaginal bledding occur not present until several weeks into the pregnancy If occuring in proximal end rupture may occur as early as two weeks characterized by sudden severe pain in one of the lower quadrants of the abdomen. Radiating pain under the scapula may indicate bleeding into the abdomen. Hypovolemic shock is major concern because signs of shock may be rapid and extensive without bleeding

Rh factor incompatibility can occur only in which of the following situations?

Mother is Rh-negative, father is Rh-positive (Rh incompatibility during pregnancy is possible only when the mother is Rh-negative and the fetus is Rh-positive. For the fetus to be Rh-positive, the father must be Rh-positive. Rh-negative blood is an autosomal recessive trait and a person must inherit the same gene from both parents.)

Inevitable abortion (Therapeutic management)

Natural expulsion usually common but can progress to: Vacuum curettage(removal of uterine contents with a vacuum curet). If pregnancy is more advanced D&C may be performed. (Dilation and curettage; stretching the cervical os to permit suctioning or scraping the uterine walls)

Threatened abortion

No evidence to support physical activity restrictions to stop spontaneous abortion. Limit sexual activity. Count the number of perineal pads used and any evidence of tissue passage which would indicate advancement beyond threatened abortion.

A woman is admitted with a diagnosis of missed abortion. After taking her blood pressure, the nurse notices petechiae on the woman's arm where the cuff was located. The nurse's next action should be to:

Notify the health care provider. (One major complication of missed abortion is disseminated intravascular coagulation (DIC). This may be manifested by small areas of hemorrhaging. The health care provider needs to be notified.)

During labor, a woman suddenly complains of increasing pain, and the electronic monitor shows no uterine activity. The abdomen is boardlike and tender and the fetal heart tones show late decelerations. The nurse should:

Notify the health care provider. (With abruptio placentae, the uterus may become exceedingly firm and tender. Because of decreased blood flow, the fetus will show signs of hypoxia. An immediate cesarean birth may be necessary; therefore the health care provider should be notified.)

Complete abortion

Occurs when all the products of conception are expelled from uterus. No additional intervention is required unless excessive bleeding or infection develops.

Incomplete abortion

Occurs when some but not all of the products of conception are expelled from the uterus. Manifests as: -active uterine bleeding -severe abdominal cramping. often passage is no larger than a ping pong ball.

Missed abortion

Occurs when the fetus dies during the first half of pregnancy but is retained in the uterus. Early symptoms of pregnancy disappear. Uterus stops growing

Gestational thropholastic disease( Hydratidiform Mole)

Occurs when tropoblasts develop abnormally. Results in fatal chromosomal defect. Fluid filled villi rapidly grow large enough to fill uterus to the size of an advance pregnancy. Mole can be complete with no fetus present or partial in which fetal tissues or membranes are present. May undergo malignant change and metastasize to sites such as lungs, vagina, liver, and brain. COmplete mole is thought to occur when the ovum is fertilized by a sperm that duplicates its own chromosomes Partial mole, maternal contribution is usually present but the paternal contribution is doubled.

Preeclampsia Therapeutic management

Only cure is delivery. -If fetus is less than 34 weeks, steroids are given to accelerate fetal lung maturity. Delayed birth for 48 hours. -Vaginal birth is preferred b/c of the mulitsystem impairments. -Categorized as either mild or severe. HOME MANAGEMENT: -If condition is mild, not good candidate for labor induction. Bed rest, home blood pressure monitoring, and follow up visits every 3-4 days. -Report symptoms such as; visual disturbance, headache, epigastric pain, and reduced fetal movement.

Hyperemesis Gravidarum

Persistent uncontrolled vomiting that begins in the first few weeks of pregnancy and may continue throughout pregnancy. Can have serious consequences and is resposible for: -loss of 5% or more of pregnancy weight, dehydration, acidosis from starvation, elevated levels of blood and urine ketones. -Cause is not known but occurs more commonly in unmarried white women, during first pregnancies and multifetal pregnancies. Can also occur due to fetal allergen.

Therapeutic Management of Eclampsia

Potentially preventable extension of severe preeclampsia marked by one or more generalized seizures of times occurring before hospitalization. Generalized seizures: - facial twitching, rigidity of the body, tonic clonic movements that begin and last up to a minute. Breathing stops and resumes with a long noisy inhalation, patient is in a coma and unlikely to remember when she resumes consciousness. Transit fetal heart rate patterns such as, bradycardia, loss of variability, late decelerations may be non reassuring. -Because eclampsia stimulates uterine irritability, woman should be monitored for ruptured membranes, signs of labor, or abruptio placentae. Aspiration of gastric contents is the leading cause of maternal morbility after an eclampitc seizure. Suction equipment should be immediately available.

A condition in which hypertension develops during the last half of pregnancy in a woman who previously had normal blood pressure is called ___________________.

Preeclampsia

Spontaneous Abortion

Pregnancy termination without action taken by the woman or another person -threatened -inevitable -incomplete -complete -missed -recurrent

Signs of a threatened abortion are noted in a woman at 8 weeks of gestation. Which of the following is an appropriate management approach for this type of abortion?

Prepare the woman for an ultrasound to determine the integrity of the gestational sac.

Incomplete abortion (therapeutic management)

Retained tissue prevents the uterus from contracting firmly, thereby allowing profuse bleeding from uterine blood vessels. D&C may be performed for larger amounts of fetal tissue following IV administration of oxytocin or IM administration of methylergonovine to contract uterus and control bleeding. *** D&C may not be performed if pregnancy has advanced beyond 14 weeks because of danger of excessive bleeding****

A pregnant woman at 14 weeks of gestation is admitted to the hospital with a diagnosis of hyperemesis gravidarum. The primary goal of her treatment at this time would be to:

Reverse fluid, electrolyte, and acid-base imbalances that are present.

A woman with severe preeclampsia is being treated with an IV infusion of magnesium sulfate. This treatment will be evaluated as successful if:

Seizures do not occur.

EVOLVE: A woman has just had a spontaneous abortion. She asks the nurse, "Why did this happen?" The nurse is aware that the most common cause of spontaneous abortion is:

Severe congenital abnormalities.

A woman has just been admitted to the maternity unit with a diagnosis of incomplete abortion. The physician has written the following orders: (1) NPO (2) Type and crossmatch for two units of blood. (3) Start intravenous line and run Ringer's lactate at 150 mL/hr. (4) Administer Pitocin, 10 units intramuscular. (5) Acetaminophen and codeine (Tylenol with Codeine #3), every 3 to 4 hours as needed for pain (6) Bed rest with bathroom privileges Which order should the nurse carry out first for this patient?

Start the IV and draw blood to send for the type and crossmatch.

A 32-week-pregnant woman calls the prenatal clinic complaining of bleeding without pain or contractions. The nurse should:

Tell her to go to the hospital to be evaluated

Hyperemesis Gravidarum

Treatment occurs primarily in home with meds used for morning sickness. Drug therapy may be required if vomiting becomes severe -Promethazine -Diphenhydramine -Histamine receptor antagonists -Gastric acid inhibitors -Metoclopramide -Ondansetron Food portions should be small and not overwhelming in smell.Soups and liquids should be taken between meals to avoid distending the stomach and triggering vomiting. Sitting upright after meals reduces gastric re-flux. Many patients receive a lack of sympathy.

Missed abortion (therapeutic management)

Ultrasound examination confirms fetal death. Decline in placental hormone production. first trimester: D&C perfomed Second trimester: D&E may be performed or vaginal delivery. Major complications: Infection and disseminated intravascular coagulation.

Postictal

Unresponsive state after a seizure.

Recurrent spontaneous abortion

Usually defined as three or more spontaneous abortions and some use two or more pregnancy losses as a definition now. Primary cause believed to be genetic or chromosomal abnormalities and anomalies of the reproductive tract. Inadequate luteal phase, and systemic diseases such as lupus and diabetes mellitus have been implicated. Some sexually transmitted diseases.

A pregnant woman should be taught that the first sign of a threatened abortion is usually

Vaginal bleeding

Threatened abortion

Vaginal blood may be brownish or red. Obtain information such as; length of gestation, onset,amount, cramping, backache, or abdominal pain. Beta-human chorionic gonadotropin levels are normal for estimated gestational age to determine if pregnancy is likely to continue.

Disseminated intravascular coagulation

also called consumptive coagulopathy: life threatening defect in coagulation that may occur with several complications such as abruptio placentae or hypertension While anticoagulation is occurring inappropriate coagulation is also occurring in the micro circulation Tiny clots form in tiny blood vessels blocking blood flow to organs and causing ischemia

Ectopic Pregnancy

implantation of fertilized ovum in area outside the uterian cavity 98% occur in fallopian tubes. Also called a disaster of reproduction