Maternal/Newborn/Reproduction: Complications of Pregnancy & Childbirth

Flashcards covering complications of pregnancy and childbirth, including fetal wellbeing assessments, hyperemesis gravidarum, ectopic pregnancy, spontaneous abortion, cervical insufficiency, gestational trophoblastic disease, intrauterine fetal demise, placental issues, postpartum hemorrhage, amniotic fluid complications, preterm labor, and other related topics.

Non-Stress Test (NST)

Measures FHR in response to fetal movement, typically performed after 28 weeks on infants at risk for hypoxia. A reactive NST (reassuring) shows at least 2 accelerations of at least 15 bpm for at least 15 seconds in a 20-minute period. A non-reactive NST (non-reassuring) does not meet these criteria after at least 40 minutes.

Contraction Stress Test (CST)

Assesses fetal tolerance to labor by measuring FHR during contractions, usually performed after 34 weeks for non-reactive NST or failed BPP. A negative CST (normal) shows no late decelerations; a positive CST (abnormal) shows late decelerations present.

Biophysical Profile (BPP)

Performed after 32 weeks for high-risk pregnancies, using ultrasound alone or ultrasound plus NST. Five parameters are scored 0 or 2 points, with a score ≥8 considered normal and a score ≤4 indicating fetal compromise.

Hyperemesis Gravidarum

Severe form of nausea and vomiting during pregnancy, differentiated from morning sickness by complications like weight loss >5% of pre-pregnancy weight, dehydration, ketosis, and electrolyte imbalance.

Ectopic Pregnancy

Zygote implantation outside the uterus. Risk factors include pelvic inflammatory disease, STIs, prior tubal surgeries, and uterine fibroids. Symptoms may include unilateral lower abdominal pain and spotty vaginal bleeding; rupture can cause abdominal pain, signs of hypovolemia, and Cullen's sign.

Spontaneous Abortion

Pregnancy loss before 20 weeks, <500g fetal weight. 1st trimester losses are commonly due to fetal genetic abnormalities. Assessment includes monitoring vaginal bleeding, cramping, and vital signs. Diagnostics include HCG levels and ultrasound.

Cervical Insufficiency

Premature dilatation of the cervix, typically before 4-5 months gestation. Therapeutic management includes bed rest, pelvic rest, and cervical cerclage.

Gestational Trophoblastic Disease (GTD)

Condition involving abnormal growth of trophoblastic cells. Management includes immediate evacuation of uterine contents and monitoring of serial hCG levels for 1 year. Pregnancy is to be avoided for a year.

Intrauterine Fetal Demise (IUFD)

Fetal death at gestational age > 20 weeks. Nursing assessment includes confirming absence of fetal heart sounds via ultrasound. Management involves labor induction and monitoring for DIC.

Placenta Previa

Placenta implants near or over the cervical os. Assessment involves monitoring for painless, bright red vaginal bleeding in the 2nd or 3rd trimester. Diagnosis is by ultrasound.

Abruptio Placentae

Separation of placenta leading to compromised fetal blood supply. Assessment includes monitoring for dark red bleeding, knife-like pain, uterine tenderness, and fetal distress.

Placenta Accreta Spectrum

Placenta attaches itself too deeply into the wall of the uterus. Presents a high risk of postpartum hemorrhage and often requires a hysterectomy.

Postpartum Hemorrhage (PPH)

Early PPH is blood loss >1000 mL within the first 24 hrs postpartum. Late PPH occurs after the first 24 hours. Causes include uterine atony, retained placental fragments, and perineal lacerations.

Amniotic Fluid Emboli (AFE)

Breakage in barrier between maternal circulation and amniotic fluid. Leads to sudden onset of hypotension, hypoxia, and coagulopathy.

Disseminated Intravascular Coagulopathy (DIC)

Inappropriate coagulation leading to consumption of clotting factors. Risk factors include IUFD, placental abruption, and amniotic fluid embolism. Presents with bleeding from gums/GI/venipuncture sites/major bruising.

Premature Rupture of Membranes (PROM)

PROM—women beyond 37 weeks’ gestation, PPROM—women less than 37 weeks’ gestation. Management includes prevention of infection, monitoring for signs of labor and administering betamethasone.

Oligohydramnios

Amniotic fluid <500 mL. Diagnosed with ultrasound. Monitor fetal heart tracing for variable decels.

Polyhydramnios

Amniotic fluid >1500 mL - 2,000 mL. Monitor fundal height, abdominal discomfort, and palpation of fetal parts.

Meconium Stained Fluid

Meconium = baby’s first stool. It can be passed while in utero. Assessment includes amniotic fluid color and consistency.

Meconium Aspiration Syndrome

Inhalation of particulate meconium with amniotic fluid into lungs resulting in hypoxic stress. Nursing management includes suctioning at birth and ensuring adequate tissue perfusion.

Amnioinfusion

Infusion of fluid into the amniotic cavity. Indications include severe variable decelerations due to cord compression.

Umbilical Cord Prolapse

Partial or total occlusion of cord causing rapid fetal deterioration. Position patient to relieve cord compression and prepare for stat cesarean section.

Gestational Hypertension

Diagnosed with BP’s 140/90 x 2, 6 hours apart. > 20 weeks gestation with no symptoms/proteinuria.

Preeclampsia

20 weeks gestation with proteinuria, abnormal labs. Mild = no symptoms; Severe = symptoms, BP > 160/110

HELLP Syndrome

HELLP = Hemolysis, elevated liver enzymes, low platelets. Nursing Management - Same interventions as for severe preeclampsia. Monitor for bleeding due to decreased platelet count.

Gestational Diabetes

Caused by fetal demands, placental hormones and changes in insulin resistance due to pregnancy.

Macrosomia

A newborn who’s significantly larger than average. In gestational diabetes, extra glucose gets stored as fat and fetus becomes larger than normal.

Small for Gestational Age (SGA)

Below the 10th percentile; Weight <2,500 grams (5 lb. 8 oz.). Maternal Contributing factors include Maternal HTN, Smoking, Extremes in maternal age. Placental/Fetal Abnormal cord insertion, Placental insufficiency, Chromosome disorders

Large for Gestational Age (LGA)

Weight >90th percentile on a growth chart; weight >4,000 grams (8 lb. 13 oz.) at term. Maternal diabetes mellitus or glucose intolerance, Multiparity,Prior history of a macrosomic infant, Post-dates gestation.

Labor Induction

Stimulating contractions via medical or surgical means. Cervical ripening is performed if Bishop’s score is less than 7.

Augmentation (Labor)

Enhancing ineffective contractions after labor has begun.

Bishops Score

Used to determine favorability / ripening of cervix in vaginal examination. If high score Cervix favorable.

Dysfunctional Labor

AKA: Dystocia of labor, protracted labor. Vaguely defined as labor that lasts more than 12 hours.

Preterm Labor

Regular uterine contractions with cervical effacement and dilation between 20- and 36+6-weeks’ gestation.

Preterm Newborn

Common Characteristics - Weight <5.5 lb, Scrawny appearance, Poor muscle tone, Minimal subcutaneous fat, Undescended testes.

Postterm Labor

Pregnancy continuing past end of 42 weeks’ gestation.

Shoulder Dystocia

Fetal decent obstructed by circumference of shoulders. Risk factors: LGA, post-term, maternal DM.

McRoberts Positioning

Maternal management for shoulder dystocia. Involves hyperflexing the mother's legs tightly to her abdomen.

Operative Deliveries

Forceps- or Vacuum-Assisted Birth. Application of traction to fetal head to facilitate delivery.

Cesarean Birth

Surgical procedure to deliver baby.

Vaginal Birth After Cesarean (VBAC)

Labor and vaginal birth in a woman who has had a prior cesarean birth.

Uterine Rupture

Separation through the thickness of the uterine wall.