Category 1
What are the increased risks of a mother who is AMA (Advanced Maternal Age)?
Gestational diabetes mellitus, HTN, LBW, Cesarean birth and instrumental vaginal deliveries, placenta previa, preterm labor, postpartum hemorrhage, austism
When is gestational diabetes diagnosed?
If patient has 2 or more of the following: Fasting >95 mg/dL, 1 hr >180, 2 hr >155, 3 hr >140
When are microdoses of RhoGAM given?
within 72 hours of chorionic villus sampling and termination of pregnancy less than 13 weeks' gestation
Intra and Postpartum Nursing Care for Substance Abuse
Preventinginjury, effective communication, pain control, preventing withdrawal
Maternal Effects of Cocaine Use
Hyperarousal state, generalized vasoconstriction, HTN, increased incidence of spontaneous abortion, abruptio placentae, PTL, cardiovascular complication, seizures, increased STDs
Fetal/Neonatal Effects of Heroin, Methadone, Morphine and Other Opioids
IUGR, meconium aspiration, hypoxia, intellectual impairment, withdrawal s/sx, neonatal infections, fetal or neonatal death (SIDS, child abuse, neglect)
Increased maternal risks with gestational diabetes:
Hypoglycemia, PIH, Preeclampsia, UTI, Labor dystocia, C-sectioin, birth injury, PROM, ketoacidosis
Do not give RhoGAM to:
What effect does Nicotine have on mothers and their babies?
Nicotine decreases placental circulation and decreases the oxygen carrying capacity of blood (transient intrauterine hypoxemia). Maternal: decreases placental perfusion, anemia, PROM, preterm labor, spontaneous abortion
Fetal: Prematurity, SGA, fetal demise, developmental/intellectual delays, hyperactivity, increased incidence of SIDS.
Fetal effects of Cocaine Use During Pregnancy
Tachycardia, stillbirth, prematurity, LBW, tremor, IUGR, irritability, decreased ability to interact with environmental stimuli, poor feeding, n/v, diarrhea, decreased intellectual development
TORCH Infections
Toxoplasmosis
Other (group B strep)
Rubella
Cytomegalovirus
Herpes
Increased fetal risks for gestational diabetes:
Congenital anomalies, macrosomia, IUGR, Birth injury, Hypoglycemia, polycythemia, hyperbilirubinemia, RDS, prematurity
Describe ABO Incompatibility
ABO Incompatibility is unrelated to the Rh antigen, and it occurs when the mother is type O and the baby is type A, B, or AB. The first child may be affected.
Outcomes of early exposure to alcohol in pregnancy:
Outcomes of later exposure to alcohol in pregnancy:
facial anomalies, IUGR
lower IQ, IUGR
s/sx of recent cocaine use
Diaphoresis, high BP, irregular respirations, dilated pupils, increased body temperature, sudden onset of severely painful contractions, fetal tachycardia, excessive fetal activity, angry, caustic, abusive reactions and paranoia
What can occur as a result of Hemolytic Disease of the Newborn?
Fetal anemia with generalized edema (Hydrops Fetalis) can develop and lead to pleural and pericardial effusions, heart failure, and death. Hyperbilirubinemia
Red Flags and Behaviors Associated with Substance Abuse:
Seeking prenatal care late in pregnancy, failure to keep appointments, poor grooming and inadequate weight gain, needle punctures, cellulitis, thrombosed veins, defensive or hostile reactions, anger or apathy regarding pregnancy, partner is substance abuser, involvement with DCS, and lack of family involvement
Acute and Long Term Maternal Effects of Marijuana:
Long-Term: Impaired learning, memory, loss of IQ, increased risk of other drug or alcohol use
Fetal effects of Methamphetamine use:
LBW, SGA, Lethargy, heart and brain abnormalities, neurobehavioral problems such as: decreased arousal and increased stress, attention impairments
What are the components of the Bishop score?
Dilation, Effacement, Station, Consistency, Position
What is the difference between a direct and indirect Coomb's?
Indirect Coomb's is done on the mom @ 28 weeks to determine if antibodies developed. Direct Coomb's is perfored on cord blood at time of birth
Antepartum Nursing Care for Substance Abuse
Examine own attitudes, communicating with women, and helping women identify strengths
Fetal effects of Marijuana
Causes tremors, hyper-irritability, sensitivity to light, high pitched scream, withdrawal s/sx, hyperactivity disorders, neurological development problems, memory issues, issues with problem solving skills
Maternal effects of heroin, methadone, morphine and other opioids: