OB Week 8

Gestational Diabetes Mellitus, Miscarriage, Shock, DIC, MEWS (maternal early warning signs), PPH (Postpartum Hemorrhage), Bleeding

What is gestational diabetes mellitus (GDM)?

Carbohydrate intolerance that develops during pregnancy

What is the mainstay of treatment for gestational diabetes?

Dietary modification

What fasting blood glucose level is recommended for GDM management?

Less than 95 mg/dL (often <80 mg/dL in stricter guidelines)

What two-hour postmeal glucose level is recommended for GDM?

Less than 120 mg/dL.

What medication is the gold standard for GDM blood glucose control?

Insulin

What test is recommended by ACOG at 6–12 weeks postpartum for women with GDM?

A 2-hour glucose tolerance test (GTT)

When should NSTs (nonstress tests) begin for women with pregestational diabetes?

At 32 weeks’ gestation

What is the optimal birth timing for pregestational diabetes?

Between 38.5 and 40 weeks

What fasting blood glucose range is considered normal for pregestational diabetes?

60–105 mg/dL

What are fetal risks associated with maternal hyperglycemia?

Macrosomia, shoulder dystocia, and hypoglycemia

What are maternal complications of pregestational diabetes?

Hypertension, preeclampsia, polyhydramnios, and infection

What fetal weight defines macrosomia?

4,000–4,500 grams

What fetal condition is linked to maternal hyperglycemia during pregnancy?

Congenital malformations and macrosomia

What condition increases risk for shoulder dystocia?

Fetal macrosomia

What symptom in a newborn is associated with maternal GDM?

Hypoglycemia

What maternal condition increases the risk of IUFD?

Poor glycemic control in pregestational diabetes

Which type of exercise is recommended for overweight women with GDM?

Moderate exercise

What is the primary nursing goal in managing GDM?

Maintain maternal euglycemia to prevent fetal complications

What psychological symptom is common in women newly diagnosed with GDM?

Anxiety

What educational strategy helps manage anxiety in pregnant women with GDM?

Providing written materials and emotional support

What defines an early pregnancy loss?

Loss before 12 weeks’ gestation

What percentage of early pregnancy losses are due to chromosomal abnormalities?

About 50%

What term should be avoided when discussing miscarriage with clients?

Spontaneous abortion

What are the five types of spontaneous abortion (miscarriage)?

Threatened, inevitable, missed, incomplete, septic

What are common causes of miscarriage?

Chromosomal abnormalities, alcohol, caffeine, and toxins

What are clinical signs of spontaneous abortion?

Uterine bleeding, contractions, and abdominal pain

When is a loss considered a “late pregnancy loss”?

Between 12 and 19 6/7 weeks

What lifestyle factor increases miscarriage risk?

Regular heavy alcohol use

What is the most common cause of early pregnancy loss?

Chromosomal abnormalities

What laboratory tests are ordered for bleeding in early pregnancy?

hCG levels and ultrasound

What is reduced cervical competence?

Premature dilation of the cervix leading to pregnancy loss

What is a common treatment for cervical insufficiency?

Cerclage

What nursing intervention supports a patient after cerclage?

Bed rest and monitoring for contractions

What medication may be given to prevent preterm contractions with cervical incompetence?

Tocolytics

What other treatments may accompany cerclage?

Hydration and antibiotics

Where does ectopic pregnancy most commonly occur?

Fallopian tube

What percentage of pregnancies are ectopic?

About 1–2%

When do symptoms of ectopic pregnancy usually appear?

Between 6–8 weeks gestation

What are signs of ectopic pregnancy?

Abdominal pain, vaginal bleeding, and missed menses

What diagnostic test confirms ectopic pregnancy?

Transvaginal ultrasound

What are major causes of third-trimester bleeding?

Placenta previa and placental abruption

What is placenta previa?

Placental implantation over or near the cervical os

What symptom distinguishes placenta previa?

Painless bright red vaginal bleeding

What is placental abruption?

Premature separation of the placenta from the uterine wall

What are signs of placental abruption?

Dark red bleeding, abdominal pain, and uterine tenderness

What type of bleeding is associated with placenta previa?

Bright red

What is the priority goal for a patient with placenta previa?

Restore maternal hemodynamic stability

What diagnostic test is preferred for placenta previa?

Transabdominal ultrasound

Which exam is contraindicated in placenta previa?

Digital vaginal exam

What maternal vital sign change may indicate hemorrhage?

Tachycardia

What activity should be avoided with placenta previa?

Sexual intercourse

What is the first-line fluid for maternal bleeding emergencies?

Lactated Ringer’s solution

What are two nursing priorities during hemorrhage?

Maintain oxygenation and fluid volume

What is the recommended maternal positioning during bleeding episodes?

Left lateral position

What blood test should be ordered for bleeding patients?

Type and screen

What medication may be used for neuroprotection during preterm bleeding?

Magnesium sulfate

When does early postpartum hemorrhage occur?

Within 24 hours of birth

When does late postpartum hemorrhage occur?

After 24 hours and up to 12 weeks postpartum

What is the most common cause of PPH?

Uterine atony

What percentage of PPH cases are caused by uterine atony?

About 90%

How much blood loss defines postpartum hemorrhage?

≥1000 mL or signs of hypovolemia within 24 hours

What is a late sign of PPH?

Hypotension

What is the first nursing action when PPH is suspected?

Fundal massage

What factor can worsen PPH by displacing the uterus?

Full bladder

What uterotonic is contraindicated in hypertension?

Methergine (Methylergonovine)

What uterotonic is contraindicated in asthma?

Hemabate (Carboprost)

What rectal medication can be used for uterine atony?

Misoprostol (Cytotec)

What IV medication helps reduce PPH by stabilizing clots?

Tranexamic acid (TXA)

What is the goal of PPH management?

Maintain perfusion and treat the cause

What is “quantification of blood loss” (QBL)?

Measuring actual blood loss to assess severity of PPH

What surgical intervention may be required for uncontrolled PPH?

Hysterectomy

What nursing assessment detects uterine atony?

Checking if the fundus is boggy or firm

What amount of blood loss can occur before vital signs change?

30–40% of total blood volume

What is a critical early warning sign of PPH?

Restlessness or anxiety

What IV fluid is used during PPH resuscitation?

Isotonic crystalloids like LR or normal saline

What systolic BP triggers MEWS alert?

<90 or >160 bpm

What diastolic BP triggers MEWS alert?

>100 bpm

What heart rate range triggers MEWS alert?

<50 or >120 HR

What respiratory rate triggers MEWS alert?

<10 or >30 breaths per minute

What oxygen saturation triggers MEWS alert?

<95%

What urine output level triggers MEWS alert?

<35 mL/hr for 2 hours

What neurological symptom triggers MEWS alert?

Agitation, confusion, or unresponsiveness

What is the purpose of MEWS?

Early recognition of maternal deterioration

What causes hemorrhagic shock in pregnancy?

Severe blood loss compromising organ perfusion

What percentage of blood loss may occur before shock signs appear?

Up to 40%

What is the immediate treatment for hemorrhagic shock?

Rapid transfusion and control of bleeding

What does DIC stand for?

Disseminated Intravascular Coagulation

What happens to clotting factors in DIC?

They are consumed excessively

What is a common cause of DIC in obstetrics?

Placental abruption or severe hemorrhage

What lab findings are typical in DIC?

Low platelets, prolonged PT and aPTT, low fibrinogen

What is the main nursing goal in DIC?

Support perfusion and correct underlying cause

What interventions may be required to manage DIC bleeding?

Blood products and clotting factors

In placenta previa, what nursing action is contraindicated?

Performing a vaginal exam

In placental abruption, what describes uterine tone?

Firm or rigid.

What are nursing priorities for a bleeding pregnant client?

Assess vitals, monitor FHR, establish IV access

What is the expected fetal heart rate range in a stable fetus?

110–160 bpm

What finding 2 days post-transfusion indicates complications?

Urine output <30 mL/hr and fever

What maternal vital sign is a late indicator of hemorrhage?

Low blood pressure

What does bright red bleeding with no pain suggest?

Placenta previa

What does dark red bleeding with abdominal pain suggest?

Placental abruption