high risk pregnancy conditions

define cervical incompetence/cervical insufficiency

mechanical defect in cervix which causes premature cervical ripening

previous cervical trauma such as a D&C or cauterization or congential structural defects of the uterus/cervix can cause

cervical incompetency

define cervical cerclage/cervical stitch

sutures placed to reinforce the cervix

when are cervical stitches removed

near term

when are cervical stitches given prophylatically (if there is a hx of cervical incompetency)

12 and 16 weeks

what three things should the nurse monitor post op from cervical cerclage

uterine activity, leaking fluid, or infection

define an ectopic pregnancy

implantation of fertilized egg somewhere other than the uterus

an ectopic tubal pregnancy is a

medical emergency

when do S/S of an ectopic pregnancy typically start

~ 6-8 weeks

what is a significant cause of maternal death when regarding ectopic pregnancy

hemorrhage

what is the #1 risk factor for an ectopic pregnancy

tubular obstruction

hx of STIs, pelvic inflammatory disease, and endometriosis are common causes of

ectopic pregnancy

use of a contraceptive IUD and assisted reproduction are some causes of

ectopic pregnancy

what is a key sign someone may have an ectopic pregnancy that the nurse should look for

lower quadrant tenderness with a palpable mass

what are the 3 S/S of ectopic pregnancy rupture

adnexal pain, referred should pain, vaginal bleeding

define adnexal pain

pain in ovaries or fallopian tubes

when you hear referred shoulder pain think

internal bleeding

what are the nursing interventions for someone who has an ectopic pregnancy

start large bore IV, notify HCP, prep patient for abd US

what are 2 things to prepare the patient for concerning the medical management of an ectopic pregnancy

transvaginal US, possible laprascopy

if the patient is stable with an unruptured ectopic pregnancy the nurse can expect an order for what medication

methotrexate

if the patient has a ruptured ectopic pregnancy the nurse can expect to do what 3 things

explain procedures and get signed consents, get type and cross, observe for shock

if a patient comes in with a ruptured ectopic pregnancy and there is already a type and cross done the nurse can anticipate an order for

two units of PRBCs

methotrexate is what kind of agent

chemotherapeutic

when handling methotrexate the nurse should use what PPE

double gloves

when drawing up methotrexate in a syringe it is very important not to

expell air from the syringe

what patient teaching is important for a patient being given methotrexate (specifically for bathroom)

urine is considered toxic for 72 hours > flush twice with lid closed

what are some AE of methotrexate

N/V, transient abd pain

what 4 things should be avoided while on methotrexate

alcohol, folic acid, NSAIDs, and sunlight

define gestational trophoblastic disease/molar pregnancy

the fertilized egg develops into abnormal placental tissue instead of a normal baby

with gestational trophoblastic disease/molar pregnancy is there an embryo present

rarely

what is gestational trophoblastic disease/molar pregnancy characterized by

placenta becomes cluster of fluid filled grape like cysts

gestational trophoblastic disease/molar pregnancy can predispose patient to what kind of CA

choriocarcinoma

what hormone level will be extremely high in a molar pregnancy

hCG

high levels of hCG in a molar pregnancy lead to what common S/S

hyperemesis

besides hyperemesis what is a common sign that someone may be experiencing molar pregnancy

uterus larger than expected for gestational age

when someone is experiencing a molar pregnancy they have vaginal bleeding in the 1st trimester which varies from

brown discharge to profuse hemorrhage

on an US a molar pregnancy displays what kind of pattern

snowstorm

what is another important sign of molar pregnancy besides hyperemesis or uterus size

development of preeclampsia before 24 weeks

a malignant change in a molar pregnancy to choriocarcinoma can lead to metastasis to what 4 organs

lungs, liver, vagina, and brain

what is critical to avoid as a nurse when you have a patient who has gestational trophoblastic disease/molar pregnancy

uterine stimulation

what 5 orders should the nurse anticipate for someone who has an evacuation of trophoblastic tissue (D&C) scheduled

CBC, type and screen, coag status, CXR, CT or MRI (metastasis)

what procedure is utilized to evacuate trophoblastic tissue

D&C

how long after a gestational trophoblastic disease/molar pregnancy should a pregnancy be prevented

one year

how often will hCG levels be checked following a molar pregnancy

q2mo for 6 mo

if hCG levels rise after treatment for molar pregnancy this indicates _________; and is treated with _________

malignancy; methotrexate

when preparing a patient who had a molar pregnancy for d/c, what are 3 important S/S to educate them on and tell them to report immediately

bright red vaginal bleeding, temperature >100.4, foul smelling vaginal d/c

define placenta previa

implantation of the placenta lower in the uterus

define partial placental previa

when the placenta partially covers the cervical os

define total/complete placental previa

placenta completely covers cervical os

the bleeding associated with placenta previa is characterized as

painless and bright red

with placenta previa the uterus is usually

soft, relaxed, non-tender

a

a

is vaginal bleeding with placenta previa dangerous

rarely

what is ALWAYS contraindicated with placenta previa

vaginal exam

why are vaginal exams contraindicated with placenta previa

can cause placental separation or tear placenta

what is utilized to determine placental placement

US

management of placenta previa is based on

condition of mother and fetus

if the mother is stable and there is no fetal compromise the main priority is (preterm labor)

delaying birth

what medications will be given to a mom with placenta previa and why

corticosteroids > mature fetal lungs

if managing placenta previa at home they are under strict orders for

bed rest

if the mother or fetus is not stable where will mom be and what will be monitored

admitted to hospital > monitor mom/fetus for compromise

if mother or fetus is not stable with placenta previa and one becomes compromised it usually results in

emergency c-section

define placental abruption

placenta separates from uterine wall early

when does placental abruption typically occur

3rd trimester or labor

placental abruption is considered an

obstetric emergency

HTN disorders, high gravidity, abd trauma, PROM and a short umbilical cord are associated with

placental abruption

how does cocaine abuse factor into placental abruption

vasoconstriction to endometrial arteries

bleeding, uterine tenderness, localized pain are S/S of

placental abruption

what is a key S/S of placental abruption

rigid, board like abd

FHR abnormalities, S/S of shock, IUPC having increased resting tone are S/S of

placental abruption

what social problems should a nurse assess for a patient with a placental abruption

IPV and cocaine use

strict bed rest, monitor FHR, side lying position, quantify blood loss, monitor for S/S of DIC are nursing interventions for what pregnancy condition

placental abruption

if there is only a mild placental abruption with a fetus <34 weeks with no S/S of distress the HCP will order conservative management with what 4 things

bed rest, possible tocolytics, corticosteroids, Rhogam prn

what is disseminated intravascular coagulation (DIC)

widespread clotting > depletion of clotting factors > uncontrolled bleeding

DIC is ______-_________

life threatening

is there a cure for DIC

no

what are the 5 main causes of DIC

placental abruption, incomplete/missed abortion, endoethelial damage, maternal sepsis, amniotic fluid embolism

what are 2 things that can cause endothelial damage

severe preeclampsia and HELLP syndrome

increased miscarriage, preterm labor, preeclampsia, infection, postpartum hemorrhage and IUGR is associated with what pregnancy condition

anemia

what is the total iron requirement for a single fetus pregnancy

1000mg/day

what are some primary sources of iron during pregnancy (natural)

meat, fish, chicken, liver, leafy green vegetables

ferrous sulfate iron supplements should be taken on a(n) ________ stomach and with ______ to increase absorption

empty; orange juice

pallor, fatigue, lethargy, and HAs are S/S of

anemia

what are key S/S of iron deficiency anemia

inflammation of the lips and tongue

what is another name for DIC

consumptive coagulopathy