High-Risk Pregnancy and Childbirth

Flashcards to review key concepts related to high-risk pregnancy and childbirth.

High-risk pregnancy (at-risk pregnancy)

Physiologic or psychological factors that could significantly increase the chances for mortality or morbidity of the client or fetus.

Amniocentesis

A prenatal test involving the insertion of a needle through the maternal abdominal wall into the amniotic sac to withdraw amniotic fluid, used to determine genetic disorders, metabolic defects, and fetal lung maturity.

Instruct client to empty their bladder before the test

An important nursing consideration for amniocentesis to prevent bladder rupture.

Risks of Amniocentesis

Maternal hemorrhage, miscarriage, fetal injury, infection, Rh isoimmunization, abruptio placentae, amniotic fluid emboli, premature ROM

Ultrasonic Scanning (US)

Uses high-frequency sound waves to visualize intrauterine activity and structures, confirm gestational age, estimate date of delivery, and evaluate AF volume.

Transvaginal US

Performed during the 1st trimester to determine the length of the Cervix.

Oxytocin (Pitocin) Challenge Test = OCT = Contraction Stress Test = CST

Provides information on how well the placenta is providing oxygen to the fetus and determines fetal ability to tolerate labor.

Persistent late decelerations with more than 50% of the contractions

What does an OCT classified as positive indicate?

Nonstress Test = NST

Assess placental function and oxygenation and determine fetal well-being by evaluating FHR response to movement.

Reactive NST = Normal = Negative – indicates a healthy fetus. Result requires 2 or more FHR accelerations in association with fetal movement during a 20-min. period

Normal finding of NST

Fetal Biophysical Profile = FBP

A noninvasive assessment of the fetus using US and EFM that includes fetal breathing movements, fetal tone, AFI, and FHR patterns via a NST.

Percutaneous Umbilical Blood Sampling= PUBS

A prenatal diagnostic procedure that takes a small blood sample from a fetus's umbilical cord to assess fetal health, detect genetic abnormalities, and evaluate the effectiveness of intrauterine treatments.

Chorionic villus sampling = CVS

Procedure done to detects genetic abnormalities in early pregnancy around 10-13 weeks gestation

MSAFP = Maternal Serum Alpha-Fetaprotein (AFP)

Glycoprotein produced in the fetal liver, GI tract, and yolk sac used as a screening tool to detect fetal neural tube defects and open abdominal wall defects early in pregnancy.

Abortion = AB = Ab

Natural or artificial termination of a pregnancy before 20 week’s gestation (or weighs <500g).

Complete abortion

loss of all products of conception.

Threatened abortion

Occurs early in pregnancy, the female experiences intermittent bleeding (spotting) with or without noticeable backache and abdominal cramping; but cervix remains closed.

Incomplete abortion

loss of some of the products of conception occurs, with part of the products retained (most often placenta is retained).

Missed abortion

Products of conception are retained in utero after fetal death.

Induced abortion

Abortions that are done intentionally.

Therapeutic abortion

Legal termination of pregnancy under a HCPs direction for the purpose of safeguarding the health of the mother.

Criminal Abortion = Illegal Abortion

Defined as an intervention in pregnancy performed without medical or legal justification and carries major risks such as hemorrhage and infection.

Symptoms of Ectopic Pregnancy

Vaginal spotting to bleeding 2 to 3 weeks after missed menstrual period, unilateral pain with referred shoulder pain, and possible signs and symptoms of shock.

Methotrexate

medication used in early ectopic pregnancy to treat the condition without surgery by interfering with folic acid metabolism.

Gestational Trophoblastic Disease = Hydatidiform Mole = Molar Pregnancy

Pregnancy characterized by abnormal growth of trophoblasts, often without formation of a fetus, and manifests as an edematous grapelike cluster that may be nonmalignant or develop into choriocarcinoma.

Follow-up hCG titer must be done after D&C

After a D&C you must do this

Gestational Trophoblastic Disease = Hydatidiform Mole

Rare condition of pregnancy characterized by abnormal growth of trophoblasts and a snowstorm pattern on US.

Excessive salivation

Ptyalism is

Hyperemesis gravidarum

Persistent vomiting with excessive weight loss, dehydration, and electrolyte imbalances in pregnancy.

Hyperemesis Gravidarum

Defined as pernicious vomiting in pregnancy and intractable N/V during the 1st trimester that causes disturbances in nutrition and fluid and electrolyte balance.

Pregnancy-induced hypertension (PIH)

Characterized by hypertension, edema, and proteinuria and may occur antepartally, intrapartally, or postpartally.

Magnesium sulfate

Medication of choice for PIH

Roll – Over Test

Test that involves measuring BP while the client is on her back and again while on her left side to predict preeclampsia.

Preeclampsia

Client previously experiencing normal progression of pregnancy but who develops PIH with edema, proteinuria, or both (usually after the 20th week of gestation).

S/S of Severe Preeclampsia

Persistent HTN, proteinuria, hyperreflexia, oliguria, persistent HA, and visual disturbances.

Prevent seizures, not to lower blood pressure.

Main reason for administering magnesium sulfate

Calcium gluconate (Kalcinate)

Antidote for magnesium sulfate toxicity

Hydralazine HCl (Apresoline)

Medication used if BP remains dangerously elevated in preeclampsia

Eclampsia

One of most severe complications of pregnancy with tonic-clonic seizures and very high blood pressure.

Gestational diabetes

Client develops diabetes during pregnancy.

Dyspnea, CP, and PE.

During labor, clients with a history of cardiac problems should be assessed for:

Smoking during pregnancy may result in?

Low birth weight, a higher incidence of birth defects, and stillbirths.

Consumption of alcohol during pregnancy

May lead to fetal alcohol syndrome (FAS) and can cause jitteriness, physical abnormalities, congenital anomalies, and growth deficiencies in the newborn.

Rubella

If contracted early in pregnancy, fetal malformation is a strong possibility, AB may be an option, and after pregnancy, the mother is immunized and advised not to become pregnant for at least 3 mos.

Rh Sensitization

Client is Rh negative, but Rh-positive RBCs from the fetus cross the placental barrier and enter the maternal circulation.

Erythroblastosis Fetalis

Newborn born with this condition due to Rh sensitization

Rho (.) immune globulin (RhoGAM)

Administered at 28 weeks’ gestation and again after 72 hr after the birth of an Rh-positive baby, any abortion, or any invasive procedure.

Placenta Previa

Low implantation of the placenta that partially or completely covers the cervical os.

C-Section

Complete placenta previa requires this

Sudden onset painless bright red vaginal bleeding in the last half of pregnancy (primarily the last trimester) and Uterus is soft, relaxed, and nontender.

S/S of Placenta Previa

Placenta previa.

SVE is contraindicated if client is suspected of having or has a known:

Abruptio Placentae

Condition in which the placenta tears abruptly and prematurely from the uterus.

Dark red vaginal bleeding, uterine pain or tenderness or both, uterine rigidity, Signs of fetal distress Signs of maternal shock if bleeding is excessive.

S/S of abruption placentae

Painless, bright red vaginal bleeding

Placenta previa has this kind of bleeding

Polyhydramnios = Hydramnios

Excessive amount of amniotic fluid.

Placenta Accreta = Retained Placenta

An abnormally adherent placenta that fails to separate or be expelled within 20-30 minutes after delivery.

Tocolytics

Medications that produce uterine relaxation and suppress uterine activity to halt UC and prevent preterm births.

Magnesium sulfate

Medication, a CNS depressant, that relaxes smooth muscle, including the uterus, and is used to halt PTL contractions and prevent Sz for preeclamptic clients.

nifedipine – Procardia

Medication, a calcium channel blocker, that relaxes smooth muscles, including the uterus, by blocking calcium entry and is a 1st-line Tx to halt PTL contractions.

Precipitate Labor and Delivery

Labor lasting <3 hours with interventions including Ritgen maneuver.

Copious vaginal bleeding
Boggy uterus (massage first and then report)
Uterus high in the abdomen
Signs of maternal shock

In postpartum hemorrhage report this to the birth attendant:

Nuchal cord

As the fetus moves within the uterus, the umbilical cord may become wrapped around the neck.

Bishop Score

Used to determine maternal readiness for labor and evaluates cervical status and fetal position prior to Induction of Labor.

Maternal Indications for C/S

Maternal: Cephalopelvic Disproportion, Previous C/S. Breech Presentations.
Abnormal conditions of the placenta: Placenta Previa and Abruptio Placentae.