SAB and Cervical Insufficiency
How is cervical insufficiency treated?
Cerclage placement, bedrest, avoid heavy lifting, progesterone administration
Ricci, Kyle, & Carman (2021) p. 670
Discuss how pre-eclampsia without severe features can be monitored at home.
Daily BP monitoring, bed rest, monitor kick counts, report worsening signs of pre-eclampsia, frequent lab monitoring (CBC, clotting studies, liver enzymes)
Ricci, Kyle, & Carman (2021) p.684
How does the abdomen upon assessment with previas and abruptions?
In previas, the abdomen is soft and nontender.
In abruptions, the abdomen is rigid and often painful
Ricci, Kyle, & Carman (2021) p.675
When would you administer rhogam? (Situations and indications)
Mother Rh negative, baby Rh positive
Prenatal hemorrhage, maternal trauma, amniocentesis, SAB/IAB, fetal surgery
Ricci, Kyle, & Carman (2021) p.693
What are a few causes of SAB?
Fetal genetic abnormalities, cervical insufficiency, polycystic ovary syndrome, infections (cytomegalovirus, rubella).
Ricci, Kyle, & Carman (2021) p.666
What are severe and concerning signs of pre-eclampsia?
Blurred vision, persistent headache, RUQ pain, sudden increase in swelling, hyperreflexia in DTRs, oliguria.
Ricci, Kyle, & Carman (2021) p.685
Are you dressing up for Halloween? If not, why not?
:P
If you could explore deep sea or deep space, which would you chose and why?
0_o
Share your favorite OB clinical experience!
:D
What are common medications used with pre-eclampsia?
Magnesium sulfate, hydralazine, labetalol, Procardia, and Lasix.
Ricci, Kyle, & Carman (2021) p.688
Explain why the fetus is at risk for hypoxia with both of these conditions?
Blood flow to the placenta is compromised, resulting in decreased blood flow to fetus.
Ricci, Kyle, & Carman (2021) p.678
What are nursing interventions for hyperemesis
Gut rest, NPO, IV rehydration, administration of anti-emetics, oral care, restart food gradually once vomiting subsides.
Ricci, Kyle, & Carman (2021) p.681
What are some risk factors for cervical insufficiency?
Short interval pregnancy, previous cervical trauma, fetal loss in second trimester, preterm labor.
Ricci, Kyle, & Carman (2021) p.670
Have you seen any of these complications during your clinical and what did you think about them?
:)
What are nursing interventions for a placental abruption?
Establish 2 large bore IVs, have blood cross matched, place patient on left side, monitor for signs of DIC, vitals q15 minimum, continuous fetal monitoring, provide emotional support, prepare for OR.
What are interventions and follow-up protocols for a molar pregnancy that developed into choriocarinoma?
Surgically remove all moles.
Chest x-ray with regular follow-ups
Routine pelvic exams
Avoid pregnancy for one year
Routinely follow-up for indications of liver, brain, lung, or vaginal metastasis.
Ricci, Kyle, & Carman (2021) p.668
How do you support your patient after a spontaneous abortion?
Assess if this was a desired pregnancy, offer chaplain services, allow time for grieving, encourage patient and family to express emotion, address infant by its name.
Ricci, Kyle, & Carman (2021) p.662
Explain how pre-eclampsia effects the: liver, brain, and kidneys
Liver--fibrin deposits in veins, blocking blood flow to liver, resulting in elevated liver enzymes.
Placenta--decreased perfusion to placenta results in decreased blood flow to the fetus.
Kidneys--decreased perfusion leads to decreased glomerular filtration rate. Increased Na, uric acid, creatinine. Increased capillary permeability allows for albumin and other protein to escape.
Ricci, Kyle, & Carman (2021) p.683
Explain how a placenta previa or placental abruption can lead to DIC.
During an acute hemorrhage, the coagulation cascade is triggered, creating multiple small clots in the blood stream. When the clotting factors are depleted, the patient is unable to form clots at the site of injury, resulting in further hemorrhage.
Ricci, Kyle, & Carman (2021) p.676
Explain how the mother develops anti-D antibodies and how RH isoimmunization protects a fetus.
A Rh negative mother gets exposed to the Rh positive baby's blood. As a response, she develops anti-D antibodies. RhoGAM binds with the mother's RBC that express the D-antigen
Ricci, Kyle, & Carman (2021) p.693