Pregnancy Complications

ectopic pregnancy

embryo implants in the fallopian tubes instead of the uterus; confirmed with hCG, ultrasound, and laproscopy

methotrexate

chemo drug given to ectopic pregnancy patients if caught early

salpingectomy

procedure to remove the fallopian tube

gestational trophoblastic disease

AKA molar pregancy; enlarged uterus, prune juice discharge, no FHT/FM, hyperemesis, preeclampsia symptoms; grape-like cysts

cervical insufficiency

cervix shortens and dilates prior to delivery with no contractions; occurs around 14-16 weeks

cervical cerclage

a medical procedure used during pregnancy to sew the cervix closed with strong stitches; must be removed before delivery; will need for all future pregnancies

cervical pessary

a flexible, dish- or ring-shaped medical device placed inside the vagina to support the cervix

placenta previa

placenta is on lower part of uterus and sometimes over cervix; cannot delivery vaginally; PAINLESS BRIGHT RED BLEEDING

abrupto placenta

placenta separates from uterine wall early; PAINFUL DARK RED vaginal bleeding; board-like abdomen; can be caused by trauma, vasospasm, HTN, or drug use

DIC

small clots form throughout the body, and eventually the blood clotting factors are used up, rendering them unavailable to form clots at sites of tissue injury; severe bleeding

DIC

low fibrinogen/platelets, prolonged PT/PTT, positive D-dimer and fibrin

placenta accreta

abnormal attachment deep into the wall of the uterus but does not penetrate uterine muscle; placenta grows too deeply into the uterine wall and fails to detach normally after childbirth

placenta increta

placenta grows too deeply and penetrates the uterine muscle

placenta preceta

placenta grows too deeply and goes all the way through the uterus

hyperemesis gravidarum

abnormal levels of N/V that proceed past the first trimester

reglan

increased gastric emptying; med for hyperemesis gravidarum

chronic hypertension

occurs before 20 weeks gestation

gestational hypertension

occurs after 20 weeks gestation

preeclampsia

occurs after 20 weeks and through post-partum period; has 2 stages; HTN and proteinuria; manage to prevent seizure

vasospasm

stage 1 of preeclampsia; elevation of blood pressure and reduced blood flow to brain, liver, kidneys, placenta, and lungs

hypoperfusion

response to abnormal placentation; proteinuria, headache, N/V, blurred vision, hyperreflexia

eclampsia

seizure occurs

NST and amniotic fluid measure

modified BPP

magnesium sulfate

depresses CNS to prevent seizures; can make patient sleepy/fatigued, low LOC

calcium gluconate

reverse magnesium sulfate toxicity

apresoline

smooth muscle relaxant used to improve perfusion to renal, uterine, and cerebral areas; reduce BP

hemolysis of red blood cells, elevated liver enzymes, low platelet count

HELLP

epigastric pain

HELLP syndrome/preeclampsia symptom caused by liver edema

sensitization

antibodies cross to baby and lyse fetal RBC leading to jaundice and organ enlargement

28 weeks and after birth

when rhogam should be administered to prevent sensitization

indirect coombs

a blood test that detects free-floating antibodies in the liquid part of your blood that could attack red blood cells; maternal test

direct coombs

detects antibodies or complement proteins attached directly to the surface of red blood cells in a blood sample; fetal test

polyhydraminos

too much amniotic fluid; uterine enlargement, fundal height measurement greater than expected

oligohydraminos

decreased amniotic fluid; fluid leaking, variable in NST; may do amioinfusion to prevent cord compression

PROM

rupture of amniotic sac before time of delivery; no vaginal exams, risk for infection, risk for cord prolapse

gestational diabetes

pregnancy hormones interfere with insulin production or sensitivity; has 2 categories

pregestational diabetes

diabetes diagnosed prior to pregnancy; type 1 or type 2

24-28 weeks

when gestational diabetes is diagnosed

HPL

human chorionic somatomammotropin; hormone that causes insulin requirements to rise in 2nd hald of pregnancy

1 hour glucose test

fasting not required; blood measured 2 hours after 75 g oral glucose

>120 mg/dl

abnormal result for 1 hour glucose test

3 hour glucose test

fasting required; levels drawn 4 times; two abnormal values confirm diagnosis

metformin

oral med that cannot be used in pt. with HTN or pre-eclampsia; does not cross the placenta and helps with GDM

insulin

first line therapy for GDM

28-32 weeks

most vulnerable period for complications related to CVD

class 1 and class 2

CVD that can push during delivery; reduce worload by rest, low salt diet, avoid weight gain and infections

class 3 and class 4

CVD that cannot push during delivery - C section or vaccum/forceps when fetus is at low station; strict bedrest and I&Os, O2 therapy

class 3

monthly cardiologist appointments needed throughout pregnancy

class 4

weekly cardiologist visits needed throughout pregnancy

asthma

maintain adequate oxygenation of the fetus by preventing hypoxic episodes in the mother

tuberculosis

treatment is the same as nonpregnant women; do not use streptomycin

streptomycin

should be avoided in pregnancy because it is ototoxic to the fetus; TB treatment

thalassemia

shortened RBC lifespan; anemia that does not respond to iron supplementation

vitamin C

take with iron supplement to increase absorption

milk

avoid when taking iron supplement; will decrease absorption

cytomegalovirus

tranmitted through bodily fluids; severe disabilities assciated with maternal infection during the 1st trimester; herpes family

rubella

AKA german measles; may transmit through placenta to fetus; causes deformities and disabilities

1:8

titer ration to prove immunity to rubella

herpes simplex virus

no cure; decrease viral load with acyclovir; visible leisions at birth means c-section only

group B strep

screening done at 36 weeks; give antibiotic if present; most common cause of sepsis and meningitis in newborns; can also cause pnemonia

penicilin G

antibiotic used to treat group B strep

HIV

chronic infections caused by retrovirus infection of T cells that express CD4 receptors causing immunodeficiency; need antiretroviral therapy