Complications of Pregnancy & Childbirth

Flashcards covering complications of pregnancy, childbirth, and assessments of fetal wellbeing, including definitions of key terms and conditions.

Non-Stress Test (NST)

Measures Fetal Heart Rate (FHR) in response to movement, performed after 28 weeks on infants at risk for hypoxia.

Reactive (reassuring) NST

At least 2 accelerations of at least 15 bpm for at least 15 seconds in a 20-minute period during a Non-Stress Test.

Non-reactive (non-reassuring) NST

Does not meet acceleration criteria for a reactive NST after at least 40 minutes.

Contraction Stress Test (CST)

Assesses fetal tolerance to labor by measuring FHR during contractions, performed after 34 weeks for non-reactive NST or failed BPP.

Negative (normal) CST

No late decelerations present during a Contraction Stress Test.

Positive (abnormal) CST

Late decelerations are present during a Contraction Stress Test.

Biophysical Profile (BPP)

Performed after 32 weeks for high-risk pregnancies, utilizing ultrasound alone or ultrasound plus NST, with 5 parameters scored 0 or 2 points.

Normal BPP Score

A score of ≥8 in a Biophysical Profile indicates normal fetal wellbeing.

Fetal Compromise (BPP Score)

A score of ≤4 in a Biophysical Profile indicates fetal compromise.

Hyperemesis Gravidarum

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

Risk factors for Hyperemesis Gravidarum

Elevated HCG levels, multiple fetus gestations, or molar pregnancy.

Ectopic Pregnancy

Zygote implantation outside the uterus, most commonly in the fallopian tube.

Risk factors for Ectopic Pregnancy

Obstruction to or slowing passage of ovum, pelvic inflammatory disease, STIs, history of tubal ligation/ablations/IUD, prior ectopic pregnancies, uterine fibroids.

Symptoms of Unruptured Ectopic Pregnancy

Usually presents at 6-8 weeks of gestation with unilateral lower abdominal pain, possibly spotty vaginal bleeding.

Symptoms of Ruptured Ectopic Pregnancy

Abdominal pain/tenderness, signs of hypovolemia, and Cullen’s sign.

Cullen’s sign

Bluish discoloration around the umbilicus, indicative of intra-abdominal hemorrhage, frequently associated with ruptured ectopic pregnancies.

Therapeutic Management for Ruptured Ectopic Pregnancy

Immediate laparoscopy with salpingotomy, attempting to salvage the fallopian tube.

Therapeutic Management for Unruptured Ectopic Pregnancy

Medications such as Methotrexate, Prostaglandins, Misoprostol, Actinomycin; also, Rh immunoglobin if the woman is Rh negative.

Spontaneous Abortion

Pregnancy loss before 20 weeks, or with fetal weight less than 500g.

Causes of Spontaneous Abortion

First trimester commonly due to fetal genetic abnormalities (80%); second trimester more likely related to maternal conditions.

Surgical Management of Abortion

Includes aspiration, dilation, evacuation, or induction procedures.

Medical Management of Abortion

Involves induction/evacuation using medications like Methotrexate, Misoprostol (Cytotec), Mifepristone; or for hemorrhage, Carboprost (Hemabate) or Methylergonovine (Methergine).

Cervical Insufficiency

Premature dilatation of the cervix, typically occurring before 4-5 months gestation, possibly due to cervical damage.

Therapeutic Management for Cervical Insufficiency

Bed rest, pelvic rest, avoidance of heavy lifting, and cervical cerclage.

Cervical Cerclage

A procedure involving placing a suture around the open cervix to narrow the cervical canal.

Gestational Trophoblastic Disease (GTD) / Hydatidiform Mole

A condition with two types (complete and partial), where the complete type has a higher risk of choriocarcinoma; exact cause is unknown.

Therapeutic Management for GTD

Immediate evacuation of uterine contents (D&C), monitoring of serial hCG levels for 1 year, and avoidance of pregnancy for a year.

Intrauterine Fetal Demise (IUFD)

Fetal intrauterine death at gestational age greater than 20+0 weeks.

Risk of DIC in IUFD

Disseminated Intravascular Coagulopathy (DIC) is a significant risk associated with intrauterine fetal demise.

Placenta Previa

Placenta implants near or over the cervical os, resulting in bleeding as the placenta separates from the internal cervical os.

Classification of Placenta Previa

Can be classified as marginal/low-lying, partial/incomplete, or complete/total.

Symptoms of Placenta Previa

Painless, bright red vaginal bleeding in the 2nd or 3rd trimester, with spontaneous cessation then recurrence; non-tender uterus of normal tone.

Abruptio Placentae

Separation of the placenta from the uterine wall, leading to compromised fetal blood supply, with causes including hypertension, drug use, or trauma.

Grades of Abruptio Placentae

Classified by amount of separation/blood loss: Mild (Grade 1), Moderate (Grade 2), and Severe (Grade 3).

Mild Abruptio Placentae (Grade 1)

10-20% placental separation and <500mL blood loss.

Moderate Abruptio Placentae (Grade 2)

20-50% placental separation and 1,000-1,500mL blood loss.

Severe Abruptio Placentae (Grade 3)

50% placental separation and >1,500mL blood loss.

Symptoms of Abruptio Placentae

Dark red bleeding, knife-like pain, uterine tenderness, contractions, decreased fetal movement, abnormal FHR, maternal hypotension/tachycardia.

Placenta Accreta Spectrum

A condition where the placenta attaches itself too deeply into the wall of the uterus, with unknown etiology, carrying a high risk of postpartum hemorrhage.

Postpartum Hemorrhage (PPH)

Blood loss >1000 mL within the first 24 hours postpartum (early PPH) or after 24 hours (late PPH).

Early PPH

Blood loss >1000 mL within the first 24 hours postpartum.

Late PPH

Postpartum hemorrhage occurring after the first 24 hours.

Risk Factors for PPH

Extended 2nd stage of labor, instrument-assisted delivery, LGA fetus, induction/augmentation, obesity.

Most Common Causes of Early PPH

Uterine atony, retained placental fragments, and perineal lacerations.

Most Common Cause of Late PPH

Retained placental fragments.

PPH Assessment (Uterus)

Bleeding with a boggy uterus suggests atony, while bleeding with a firm, contracted uterus suggests lacerations or tears.

Therapeutic Management of PPH

Diagnosing the cause, type and cross for blood transfusion, dilation and evacuation (D&E) for retained fragments, repair of lacerations, and for uterine atony: fundal massage, keeping the bladder empty, fluid replacement, and oxytocic agents.

Oxytocic Agents for Uterine Atony

Methylergonovine (Methergine) and oxytocin are commonly used medications.

Amniotic Fluid Emboli (AFE)

A obstetric emergency due to a breakage in the barrier between maternal circulation and amniotic fluid, leading to sudden onset of hypotension, hypoxia, and coagulopathy.

Symptoms of AFE

Difficulty breathing, hypotension, cyanosis, seizures, tachycardia, coagulation failure, DIC, pulmonary edema, uterine atony with subsequent hemorrhage, ARDS, cardiac arrest.

Disseminated Intravascular Coagulopathy (DIC)

Inappropriate coagulation leading to the consumption of clotting factors.

Perinatal Risk Factors for DIC

Intrauterine Fetal Demise (IUFD), Placental Abruption, Retained Placenta, and Amniotic Fluid Embolism.

Premature Rupture of Membranes (PROM)

Rupture of membranes in women beyond 37 weeks’ gestation, with labor usually beginning within 1-2 hours.

Preterm Premature Rupture of Membranes (PPROM)

Rupture of membranes in women less than 37 weeks’ gestation.

Risk Factors for PPROM

GBS colonization, chorioamnionitis, polyhydramnios, multiple fetus gestation, and small maternal stature.

Management for PPROM

Prevention of infection (IV and PO antibiotics like Ampicillin), Betamethasone/possibly magnesium sulfate, monitoring for signs of labor (no tocolysis), and avoidance of vaginal exams.

Oligohydramnios

Amniotic fluid volume less than 500 mL or a 50% reduction.

Risk Factors for Oligohydramnios

Placental insufficiency, pregnancy past the due date, extremes of maternal age, PPROM, and fetal renal problems.

Risks associated with Oligohydramnios

Increased risk of perinatal morbidity and mortality, decreased fetal movement, reduced fluid for practices like breathing/swallowing, and increased risk of cord compression.

Amnioinfusion for Oligohydramnios

Administered only if in labor and experiencing recurrent variable decelerations due to cord compression related to oligohydramnios.

Polyhydramnios

Amniotic fluid volume greater than 1500 mL to 2,000 mL.

Risk Factors for Polyhydramnios

Maternal diabetes and fetal esophageal/tracheal malformation.

Therapeutic Management for Polyhydramnios

Close monitoring, removal of fluid, and indomethacin (which decreases fluid by decreasing fetal urinary output).

Meconium Stained Fluid

Occurs when meconium (baby’s first stool) is passed while in utero, resulting in amniotic fluid that is green, brown, or thick.

Risk Factors for Meconium Stained Fluid

Pregnancy extending past the due date, or anything that causes stress to the baby (e.g., placental insufficiency, maternal drug use, maternal medical conditions like HTN/DM).

Meconium Aspiration Syndrome (MAS)

Inhalation of particulate meconium with amniotic fluid into the lungs, resulting in hypoxic stress.

Symptoms of MAS

Barrel-shaped chest, prolonged tachypnea, increasing respiratory distress, intercostal retractions, end expiratory grunting, and cyanosis.

Amnioinfusion

A procedure indicated for severe variable decelerations due to cord compression (such as with oligohydramnios) or thick meconium fluid.

Umbilical Cord Prolapse

An obstetric emergency characterized by partial or total occlusion of the umbilical cord, leading to rapid fetal deterioration.

Risk Factors for Umbilical Cord Prolapse

Polyhydramnios, malpresentation, or a small fetus (SGA or Preterm).

Nursing Management for Umbilical Cord Prolapse

Prompt identification of fetal compromise, positioning the patient to relieve cord compression, manually holding the presenting part off the umbilical cord, and preparation for a stat cesarean section.

Gestational Hypertension (PIH)

Diagnosed with blood pressures of 140/90 x 2, measured 6 hours apart, occurring after 20 weeks gestation with no symptoms or proteinuria.

Preeclampsia

Diagnosed with blood pressures of 140/90 x 2, occurring after 20 weeks gestation, accompanied by proteinuria and possibly abnormal labs.

Mild Preeclampsia

Preeclampsia without symptoms such as headache, blurry vision, epigastric pain, hyperreflexia, or worsening edema to hands/face.

Severe Preeclampsia

Preeclampsia with symptoms and blood pressure greater than 160/110.

Eclampsia

Preeclampsia accompanied by seizures.

Chronic Hypertension (in pregnancy)

Diagnosed with blood pressures of 140/90 x 2, occurring before 20 weeks gestation.

Risk Factors for Hypertensive Disorders of Pregnancy

Obesity, extremes of maternal age, multiple fetus gestation, and a history of hypertension.

Complications of Hypertensive Disorders of Pregnancy

Low birth weight (SGA), placental abruption/fetal death, preterm delivery, and HELLP syndrome.

PO Maintenance Meds for HTN in Pregnancy

Nifedipine and Labetolol are used for maintenance.

IV Push Meds for Severe HTN in Pregnancy

Labetolol and Hydralazine (Apresoline) are used to lower severe range blood pressures.

Magnesium Sulfate (in HTN Pregnancy)

Administered to prevent seizures.

Calcium Gluconate (in HTN Pregnancy)

Administered in case of magnesium toxicity.

HELLP Syndrome

Characterized by Hemolysis, Elevated Liver enzymes, and Low Platelets, carrying similar risk factors and management to severe preeclampsia.

Pregestational Diabetes

Diabetes diagnosed before 20 weeks of gestation.

Gestational Diabetes

Diabetes diagnosed after 20 weeks of gestation.

Risk Factors for Gestational Diabetes

Obesity and multiple fetus gestation.

Causes of Gestational Diabetes

Fetal demands, placental hormones (estrogen, cortisol, human placental lactogen), and changes in insulin resistance due to pregnancy.

Maternal Complications of Gestational Diabetes

Preterm labor, injuries due to delivering a large fetus, increased risk for cesarean section, and similar complications to Type 2 DM.

Fetal Complications of Gestational Diabetes

Increased risk of deformities, LGA (Large for Gestational Age), polyhydramnios, birth trauma, and difficulty maintaining glucose after delivery.

Optimal Pre-prandial Glucose (Gestational Diabetes)

95 mg/dl or less before a meal.

Optimal 1-hour Postprandial Glucose (Gestational Diabetes)

140 mg/dl or less one hour after a meal.

Optimal 2-hour Postprandial Glucose (Gestational Diabetes)

120 mg/dl or less two hours after a meal.

Appropriate for Gestational Age (AGA)

Approximately 80% of newborns; presenting with normal height, weight, head circumference, and body mass index.

Small for Gestational Age (SGA)

Newborns below the 10th percentile for weight, or weighing less than 2,500 grams (5 lb. 8 oz.).

Intrauterine Growth Retardation (IUGR)

Severe growth restriction, defined as less than the 5th percentile for gestational age.

Large for Gestational Age (LGA)

Newborns with weight greater than the 90th percentile on a growth chart, or weighing more than 4,000 grams (8 lb. 13 oz.) at term.

Maternal Factors for SGA

Maternal HTN, smoking, extremes in maternal age (

Placental/Fetal Factors for SGA

Abnormal cord insertion, placental insufficiency, previa, chronic abruption, chromosome disorders, fetal infection, fetal anomalies, and multiple fetal gestation.

Characteristics of SGA Newborns

Head disproportionately large, wasted appearance of extremities, loose dry skin, reduced subcutaneous fat stores, decreased breast tissue, scaphoid abdomen, wide skull sutures, poor muscle tone over buttocks and cheeks, and a thin umbilical cord.