High Risk Pregnancy Pt 2

Hypertension During Pregnancy

• HTN classified as SBP>140 or
a DBP>90
• Elevated BP taken 2 separate
occasions, 4 hours apart for
diagnosis

Hypertension During Pregnancy Labs

urine protein, serum
creatinine to assess kidney
involvement; liver enzymes

Hypertension During Pregnancy Classification

• Gestational

• Preeclampsia

• Eclampsia

• Preexisting

• Superimposed

Preeclampsia

• Develops after 20 weeks
• No prior diagnosis of HTN
• Elevated blood pressure, proteinuria, edema
• Management Goal: maintain pregnancy to at least 37 weeks

Home Care for Mild Preeclampsia

Activity, diet restrictions

Monitor fetal activity

BP monitoring

Follow-up appointments

Hospital precautions Mild Preeclampsia

severe
headache, abdominal pain,
contractions, spotting,
and/or decreased fetal
movement

Hospital Care for Preeclampsia

Fetal monitoring

Maternal assessment

Bedrest

Labs

Foley cath for strict I&Os

Darkened room

Seizure precautions

Anti-HTN meds

IV magnesium sulfate

Tx-delivery

Eclampsia S/S

• Persistent headache
• Blurred vision
• Photophobia
• Epigastric pain
• Hyperreflexia
• AMS

Eclampsia Interventions

• Control external stimuli
• Magnesium Sulfate
• Seizure Management

Once stabilized decision is made about the delivery

Magnesium Sulfate

Depresses CNS, prevent seizures in eclampsia and severe preeclampsia.

Monitor in Magnesium Sulfate

BP,

Pulse, RR,

DTR, LOC,

Urinary output (indwelling urinary catheter for accuracy),

HA, visual disturbances,

epigastric pain, uterine contractions,

Fetal HR and activity

Monitor for signs of magnesium sulfate toxicity.

• Absence of patellar deep tendon reflexes
• Urine output less than 30 mL/hr
• Respirations less than 12/min
• Decreased level of consciousness
• Cardiac dysrhythmias

If magnesium toxicity is suspected:

• Immediately discontinue infusion.
• Administer antidote calcium gluconate
• Prepare for actions to prevent respiratory or cardiac arrest.

HELLP Syndrome

H- Hemolysis

EL- Elevated liver enzymes

LP- Low platelet count

Variant of severe preeclampsia

Miscarriage: Spontaneous Abortion S/S

Uterine bleeding, uterine
contractions (cramping),
abdominal pain

Classifications of miscarriages

Types: threatened,
inevitable, incomplete,
complete, missed, recurrent

Miscarriage Risk factors

Chromosomal 25%,
maternal illness, age,
infections, malnutrition,
trauma, substance use

Expected Diagnostics/procedures Miscarriage

hCG,

WBC,

HGB,

HCT,

US,

D&C/D&E

Meds Miscarriage

Analgesics, antibiotics,
prostaglandins or oxytocin,
RhoGAM

Types of Spontaneous Abortion

Threatened- Vaginal bleeding

Inevitable- Membranes rupture, cervix dilates

Incomplete- Some conception expels, some remain

Cervical Insufficiency

May be acquired or congenital
Diagnosis:
• OB history
• Speculum examination
• Measurement of cervical length via US
TX: cervical cerclage placement

Blunt abdominal trauma:

• Risk of placental abruption

• Blunt, Penetrating, Thoracic

• Violence

Primary Survey Trauma

CABDs (compressions, airway, breathing, defibrillation

Secondary Survey Trauma

Begin after immediate resuscitation and
stabilization
Complete assessment of mother and fetus
EFM, assess for fetal-maternal
hemorrhage (increased risk following
trauma)

S/S of Hypovolemic Shock

Increased pulse, RR

Low BP

Weak, thready pulse

Cool, moist skin (Late)

Pallor/Cyanosis (Late)

Low urinary output (<30mL/hr)

Low Hgb, Hct

Restlessness, agitation, concentration

Placental Abruption

Premature
separation of
the placenta
from the
uterus.

Placental Abruption Risk Factors

• Maternal
hypertension
• Cocaine use
• Blunt
abdominal
trauma
• Maternal
battering
• Smoking
• Hx placental
abruption
• Hx PROM
• Multifetal
pregnancy

Placental Abruption S/S

• Sudden onset
of uterine pain
with dark red
vaginal
bleeding
• Board-like
abdomen
• Contractions
• Fetal distress
• Hypovolemic
shock
• Non-reassuring
signs on EFM
strip

Placental Abruption Management

• Depends on
many factors
• Fluid
resuscitation
• Oxygen 10L via
mask
• Assess urine
output
• Immediate
delivery is the
management
of choice if
term

Placental Abruption Diagnosis & Deliver

Diagnosis:
• Based on clinical presentation

Delivery:
• Vaginal or cesarean