HELLP syndrome
What is HELLP syndrome mean?
Hemolysis, elevated liver enzymes, low platelet count
associated with severe preeclampsia
why is a pregnant woman placed on her left side
to decrease pressure on the vena cava, thereby increasing venous return, circulatory volume and placental and renal perfusion
which two antihypertensives are first line for severe preeclampsia?
labetalol and hydralazine
if water breaks what is the first thing that should be done?
check FHR than check color of fluid
DX of preterm labor
uterine contractions, 4-20 mins documented cervical change of effacement
1) baby position
2) cervical diltation
3) cerival effacement
4) contraction duration
what causes hemolysis?
hemolysis that occurs is termed microangiopathic hemolytic anemia. RBC are fragmented during passage through small damaged vessels
Mild prepreclampsia care
Bed rest on left side
Assessments
Daily weight-edema more than 3 lbs in 24 hrs or 4 in 3 day period
Diet
Fetal movement record
NST
US
BPP
Amniocentesis( fetal lung maturity)
when does DIC occur and how is it dx
when normal clotting is overactivated
when thrombocytopenia, low fibrinogen levels and elevated fibrin split products are found in the lab findings.
platelet/fibrin labs done
supportive measures reversing causative factors
medical emergency
Prom management
vaginal speculum
pooling of amniotic fluid
nitrazine paper
ferning test
Fetal well being- FHR, biophysical profile
protein found in fetal membranes, test cervical fluid, indication can go into preterm labor
what causes elevated liver
occur from blood flow that is obstructed by fibrin deposits. hyperbilirubinema and jaundice may be see, liver distention causes epigastric pain
Diet for mild preeclampsia
well balanced
moderate to high in protein ( 80-100 g a day)
sodium intake should be moderate not to exceed 6/g day
excessively salty food should be avoid
What is spontaneous rupture of membranes before 37 weeks gestation?
Premature rupture of membranes
for prom which corticosteriod is amin to promote fetal lung maturity
bethamethosone
Risk factors of preterm labor
physical stress, placenta previa, BP, prolong standing, multiple gestations
what causes low platelet count
thrombocytopenia ( platelet count less than 100,000) it occurs when platelets aggregate at the sites of vascular damage associated with vasospasms.
symptoms may include nausea, vomiting, flulike symptoms, epigastric pain
severe preeclampsia
birth is the tx of choice, bedrest, diet, anticovulsants, fluid and electrolyte replacement, corticosteriods, antyhypertensives, in hospital IV bolus of mag sulfate
Causes of PROM
associated with infection, previous hx of PROM, hydramnios, multiple pregnancy, UTI, trauma
goal of prom-
absence of infection and prevention of delivery before 37 weeks
Preterm labor management
maintain good uterine blood flow-mother is asked to lie on her side, uterine contractions are monitored, iv infusion is started for hydration, labs- CBC, C-reactive protein, vaginal culturesm fetal fibronectin, and urine cultures, US, tocolysis= use of medications to attempt to stop labor
goals for management
- prompt dx of disease
-prevention of cerebral hemorrhage seizures, hematologic complications and renal and hepatic disease
- birth of an uncompromised newborn as close to term as possible
-reduction of BP
fetus assessed using NST, biophysical profile
Which medication should be avoided in women with asthma and heart failure
Labetalol
Maternal and fetal risk of PROM
maternal risk is infection
fetal- RDS, fetal sepsis, prolapse of umbilical cord, premature birth
other tests for prom
when s&s of infection antibiotics are started
bedrest, CBC, vaginal cultures, UA, US, Vaginal exams are avoided, maternal BP, P, Temp every 4 hours
two things magnesium sulfate is used for?
preeclampsia and preterm labor