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Chronic Hypertension
Diagnosed before 20 weeks gestation
Gestational Hypertension
diagnosed after 20 weeks gestation
BP= 140/90
NO proteinuria present
25% of women with GHTN will develop preeclampsia
Preeclampsia
Diagnosed after 20 weeks gestation
BP= 140/90
YES proteinuria
PLUS one more...(thrombocytopenia, visual changes, pulmonary edema, proteinuria, impaired liver function, renal insufficiency )
needs to be assessed 2 different occasions
Patho of Preeclampsia
bad remodeling
decreased perfusion--->hypoxia(placental)
endothelial cell dysfunction(organ dmg)
vasospasms
Signs and Symptoms of Preeclampsia
visual disturbance
edema
increased BP
headache
back pain
Severe Preeclampsia
ADD 20 to BP---> 160/110
patients are hospitalized
give betamethasone, dexamethasone for lung maturity
preform frequent assessments(edema, visual change, sob, q10vitals)
Eclampsia
Preeclampsia with seizures(tonic clonic)
HELLP Syndrome
variant of preeclampsia
H-hemolysis
EL-Elevated Liver enzymes
LP- Low platelets
DONT give epidural(bleeding)
Magnesium sulfate
smooth muscle relaxer; vasodilates
main purpose: PREVENT SEIZURES
therapeutic dose: 4-7 meq/L
S+S of Magnesium toxicity
low O2 sat and RR(12)
drop in BP
Pulmonary edema
Obtuse
Antidote to Magnesium Sulfate
calcium gluconate
PUSH over 10 MIN
Pre Types of Diabetes in Pregnancy
DMI and II
poor controlled glucose
leads to....miscarriage and fetal defects
Gestational types of Diabetes
A1: diet controlled
A2: med controlled
--->effects 2nd and 3rd trimesters
Increased insulin resistance in what
pregnancy
what crosses placenta and what doesn't?
glucose crosses
insulin doesn't
insulin need increase or decrease in 1st trimester?
decrease in first semester
Insulin resistance increases in what trimesters?
2nd and 3rd
placental hormones act as insulin antagonist
What happens to insulin needs after birth?
insulin needs decrease
Give 1/2 dose insulin
Counterindicated Drugs in Pregnancy
ACE inhibitors
Furosemides
ARB's
PKU
phenylketonuria(can't metabolize protein)
-genetic disorder; deficient in enzyme phenylalanine hydroxylase
Impact: retardation, impaired function development
diet: fruits, veggies, bread, juice
(bad) meats, beans, dairy
NO breastfeeding
Spontaneous Miscarriage
loss of pregnancy during the first 20 weeks of gestation
Types of Miscarriage
Threatened
Inevitable
Incomplete
Complete
Missed
Threatened
HR detected
potentially reversible
vaginal bleeding
cervix not dilates
Inevitable
maybe FHR
bleeding
cervix dilated
no expulsion of POC
Incomplete
no HR
Some POC expelled
cervix dilated
Complete
spontaneous and complete expulsion of POC
Missed
death of fetus before 20 weeks
POC remains
Ectopic Pregnancy
pregnancy outside the uterus
Usually tubal
TX: methotrexate or surgery
Concerning pain for ectopic pregnancy
referred shoulder pain = acute rupture
Hydatidiform mole
molar pregnancy
rapidly diving trophoblast(looks like ball of hair teeth and tissue)
Concern with hydatidiform mole
increases chance of gestational choriocarcinoma
DONT become pregnant for 1 year
Placenta previa
placenta implantation partially or fully covers cervix
-WILL cause bleeding
No vaginal exams
How is placental previa diagnosed?
with ultrasound
Abruptio Placentae
detachment of placenta from uterine wall(full or partial)
MED EMERGENCY
after 20 weeks
Signs and Symptoms of Abruptio Placentae
board like fundus
hypovolemic shock
intense pain
fetal distress
DIC
disseminated intravascular coagulation
bleeding everywhere
clots and bleeds at same time
depletion of fibrin and plts
NEVER a primary diagnoses(treat underlying cause)
TX for DIC
transfusions
IV fluids
Cryoprecipitate(repletes coagulation factors)
SIPE
preeclampsia with chronic hypertension before pregnancy
makes all symptoms worse
Chronic Hypertension diagnoses
before 20 weeks gestation and 12 weeks after birth
Preterm Labor
anything before 37 weeks
Low birth weight
less than 5.5 pounds
Risk factors for preterm labor
previous preterm labor
multiple gestations
smoking
preeclampsia
Signs and Symptoms of PLT
vaginal discharge
contractions
pain
cramping
lower back pain
abdominal pressure
Meds for PTL
betamethasone
dexamethasone
magnesium sulfate
Betamethasone
matures lung by increasing surfactant
give doses 24 hours apart
given at 24 -36.6 weeks gestation
Dexamethasone
same as betamethasone
give doses 12 hours apart
given at 24-36.6 weeks gestation
Diagnoses for PTL
Fetal Fibronectin Test
Fetal Fibronectin Test
test for glycoprotein found in amniotic fluid
used to predict who will NOT go into PTL
atypical:24-34 weeks
Counterindications for FFN
sex in last 24 hours
cervix dilation past 3cm
PPROM
bleeding
Drugs the manage PTL
Nifidipine(procardia) - relax smooth muscle by inhibiting Ca
-lowers uterine activity
Terbutaline(beta-adrenergic antagonist) - relaxes smooth muscle
-inhibits uterine activity
main purpose of Nifidipine and Terbutaline
delay labor and allow steroids administration
Tocolytics
nifidipine
terbutaline
Side effects of Tocolytics
tachycardia
flushing
hypotension
dizziness
PROM
rupture of the membrane after 37 weeks before onset of labor
PPROM
rupture of membrane before 37 weeks
risk of PROM/PPROM
previous happening
smoking
UTI
antepartum bleeding
GBS
Group B Streptococcus
most common infections when it comes to complications of labor
TX: penicillin and ampicillin
Chorioamnionitis
infection of amnion cavity
Diagnoses of chorio
TEMP >100.4 F
tachycardia
smelly fluid
Risk for Chorio
prolonged labor
prolonged PROM
procedures
TX for Chorio
ampicillin/gentamycin
for allergy: cefazolin/gentamycin
Induction
stimulation of uterine contractions
augumentation
stimulation of ineffective uterine contractions after the spontaneous onset of labor to manage labor dystocia
Bishop Score
(1) higher #'s equal labor will happen spontaneously
(5) needs induction
(3) induction won't succeed
Meds for Cervical Ripening
Misoprostol(Cytotec) oral or vaginal(if vagina bleeding don't go that route)
Cervidil that tape thingy with chemical laced on it
Amniotomy
artificial rupture of membrane
shortens labor up to 2 hours
TX for pitcoin excess
IV fluids(LR,NS)
stop pitcoin
oxygen
IV fluid bolus
Hemorrhage
failure of homeostasis from delivery
criteria: 1000ml or 1L lost of blood
Causes: uterine atony/retained placenta/ lacerations
Meds for 3rd stage of labor and other
Pitcoin
Misoprostol
Methergine
Hemabate
cordclamping
cord traction with fundal massage
Tranexamic
for PPH
inhibits clot breakdown to reduce bleeding
Signs and Symptoms of Hemorrhagic Shock
1st: tachycardia
last: hypotension
oliguria
tachypnea
anxious/agitated
sluggish cap refill
crystalloids/blood
Shoulder Dystocia
shoulders too big; causing injury at cervix
50% have no risk factors
Interventions for Shoulder Dystocia prevention
McRoberts maneuver: abduction and flexion of thigh(looks like squatting laying down) - open up passageway
Suprapubic Pressure: apply fist to side of pubic bone to manipulate fetal position
Umbilical cord prolapse
occurs when cord is below presenting part of fetus
impact: hypoxia/cord compression
TX for cord prolapse
manual exam to relieve pressure
SIMS/Telenburg/Knee to chest position
emergency c-section if interventions don't work
c-section stuff
elective
unplanned
scheduled
Incisions: horizontal/vertical/t-shaped
Vaginal birth after c-section
only allowed with low-transverse uterine incision
which is that horizontal one
Meds for Hypertension
Labetalol: BB/counterindications: asthma; heart disease; CHF
Nifedepine: CCB/smooth muscle relaxant/ also used in PTL
Hydralazine: vasodilator/counterindications: CAD/festus effects: tachycardia and late decels
Low dose ASA: given at 12-28 weeks gestation/ could prevent or delay preeclampsia
GTT
3 hours gtt is gold standard
tested after failure of the glucose challenge
subinvolution
failure of uterus to return to non-pregnant state
causes: retained placenta/infection/multpile gestation/ prolonged labor/obesity
