Antepartum complications gestational onset

at risk pregnancies include

spontaneous abortion, ectopic, gestational trophoblastic disease, hyperemesis gravidarum, Rh alloimmunization, ABO incompatibility

threatened abortion

cervix closed, placenta attached, pt has bleeding, cramps/contractions

imminent abortion

cervix dilated, placenta separated, pt bleeding

incomplete abortion

baby delivered, placenta still in uterus, pt bleeding

nursing care for spontaneous abortion

assess amount and appearance of bleeding, monitor VS and discomfort, assess need for Rh immune globulin, assess coping

recurrent miscarriage

3 or more consecutive losses or >=2 if AMA

follow up testing for recurrent miscarriage

genetic testing for both parents, antiphospholipid antibody syndrome, thyroid disease

what is antiphospholipid antibody syndrome

autoimmune disorder that attacks protein in the blood and leads to clots and miscarriage

ectopic pregnancy

occurs when fertilized egg has implanted another place other than the uterus's endometrium (fallopian tube, ovary, cervix)

outpatient ectopic nursing care

methotrexate IM- teach avoid sun, report severe pain or bleeding

hospital based ectopic nursing care

IV, preop, and post op- assess signs of shock, analgesics

s/s ectopic pregnancy

sharp one sided pain, syncope, referred pain to shoulder, lower abdominal pain, bleeding, low progesterone or hCG

gestational trophoblastic disease/molar pregnancy

proliferation of trophoblastic cells that create hydatiform mole

hydatiform mole

abnormal placental developments that lead to fluid-filled grape-like clusters

complete mole

ovum containing no genetic material is fertilized by normal sperm and increases risk for chorionic carcinoma

partial mole

normal ovum is fertilized by two sperm or sperm that has not divided and has not enough genetic material

characteristics of hydatiform mole

dark brown vaginal bleeding, anemia, hydropic grapelike vesicles, uterine enlargement, no FHT, elevated hCG, low MSAFP

symptoms of hydatiform mole

hyperemesis gravidarum, preeclampsia

treatment for hydatiform mole

remove placental fragments, possible hysterectomy, follow-up

hyperemesis gravidarum

excessive vomiting during pregnancy that impacts hydration and nutrition

diagnosis of hyperemesis gravidarum

problematic vomiting in 1st trimester, dehydration, ketonuria, weight loss of 5%

treatment for hyperemesis gravidarum

give vitamin B1 to prevent wernicke's encephalopathy

nursing interventions for hyperemesis gravidarum

assess, maintain fluid volume, TPN, balanced diet, relaxed/quiet environment, counsel, referral

Rh alloimmunization

Rh- mom has Rh+ fetus, maternal antibodies produced, hemolysis of fetal RBCs that leads to hyperbilirubinemia in fetus

fetal-neonatal risks for Rh alloimmunization if not treated

anemia that can cause hydrops fetalis, CHF, icterus gravis (jaundice), kernicterus (neuro damage), erythroblastosis fetalis

hydrops fetalis

swelling around fetal tissue and organs from destroyed fetal RBCs that can be lethal

antepartum management of Rh alloimmunization

antibody screening test (indirect Combs') for mom's Rh, administer Rh immune globulin IM

when should we give mom Rh immune globulin IM

prophylactic at 28 weeks if antibody screen negative, after spontaneous/induced/ectopic pregnancy, invasive procedures, or maternal trauma

monitoring fetus if mom had positive antibody screen

nonstress tests, ultrasound, amniotic fluid analysis, doppler

if severe anemia or fetal hydrops occurs in fetus,

give intrauterine blood transfusion, preterm delivery

postpartum management after birth of Rh+ infant

direct Combs- cord blood to test for antibodies

postpartum management within 72 hrs of birth

give Rhogam- can prevent sensitization up to 30 mL of Rh+ blood

postpartum management Kleihaure-Betke test

determines how much Rh+ blood is present in maternal circulation to calculate Rhogam needed

ABO incompatibility

Mom has O, baby has A/B/AB, maternal serum antibodies present in serum

what occurs with ABO incompatibility

hemolysis of fetal RBCs and hyperbilirubinemia