Hypertensive Disorders
This condition is diagnosed when hypertension develops before 20 weeks of pregnancy or persists past 12 weeks postpartum.
Chronic hypertension
What is the most common location of an ectopic pregnancy?
The fallopian tubes
What maternal complication is more likely to develop in women with preexisting diabetes?
Preeclampsia
What is one fetal/neonatal effect of maternal smoking?
Prematurity, LBW (low birth weight), neurodevelopmental problems, SIDS, or perinatal mortality
What is the therapeutic serum magnesium level range when using magnesium sulfate?
4.8-8.4 mg/dL
Blood pressure ≥140/90 AFTER 20 weeks of gestation without proteinuria is called this.
Gestational hypertension
Sudden, painless bleeding in the 2nd or 3rd trimester suggests this condition...
Placenta previa (Implantation of the placenta in the lower uterus)
- NO VAGINAL EXAMS FOR UNEXPLAINED BLEEDING!
Name two neonatal complications of maternal diabetes?
hypoglycemia, hypocalcemia, hyperbilirubinemia, or respiratory distress syndrome
What is one therapeutic nursing intervention when supporting parents grieving an infant’s unexpected anomaly?
- Reflect their feelings
- Provide accurate information
- Encourage expression of emotions
- Promote bonding and attachment
What is the first line of management for abruptio placentae?
Emergent delivery
DELIVER THAT BABY!
What is Abruptio Placentae? What is the leading cause?
It is the separation of a normally implanted placenta before the fetus is born. The leading cause is cocaine use.
What is the screening test for gestational diabetes at 24-28 weeks?
The 1-hour glucose challenge test (The mother drinks 50 g of oral glucose solution + a blood test taken 1 hour later)
- If positive/abnormal (greater than/equal to 140 mg/dL), the 3-hour oral glucose tolerance test is taken (OGTT)
Preeclampsia, anemia, hemorrhage, LBW, premature birth, or increased infant mortality
Methotrexate is used for this pregnancy complication.
Ectopic pregnancy
-Methotrexate works by stopping the growth of the rapidly dividing cells of the pregnancy, preventing rupture. The medication allows the pregnancy tissue to be gradually reabsorbed by the body.
What does the "HELLP" acronym stand for, and why is it considered an obstetric emergency?
HELLP stands for: Hemolysis, elevated liver enzymes, & low platelets
It is considered an obstetric emergency because it can turn into DIC (disseminated intravascular coagulation), which can lead to maternal & fetal death!
FYI: With DIC, small blood clots develop throughout the body's blood vessels
"Board-like" abdomen, port-wine amniotic fluid, and signs of hypovolemic shock (tachycardia, tachypnea, hypotension, dizziness, etc.) indicate this emergency.
Placental abruption
What are the maternal manifestations of gestational diabetes?
*Brownie points if you can get the fetal manifestations, as well!
Maternal: Hypoglycemia, ketoacidosis, hyperglycemia, shoulder dystocia, macrosomia, PROM (premature rupture of membranes), the three p's of diabetes (polydipsia, polyphasia, polyuria)
Fetal: Congenital malformation, variation in fetal size (small for gestational age, IUGR (Intrauterine growth restriction)
Terminology recap:
- Shoulder dystocia: a complication that occurs during childbirth when the baby's shoulders become stuck after the head has been delivered (ouch!).
- Macrosomia: a condition where the baby is born significantly larger than average.
What opioid drug can cause neonatal abstinence syndrome, meconium aspiration, fetal/neonatal death, IUGR, & SIDS?
Heroin
This steroid may be given to enhance fetal lung maturity in cases of preterm delivery.
Bethmethasone (It's a corticosteroid!)
What is magnesium sulfate used for in pregnancy, and what are the top three signs of magnesium sulfate toxicity?
Magnesium sulfate is used to prevent seizures in women with preeclampsia + eclampsia.
The top three signs are respiratory depression, absent reflexes, and oliguria! Lethargy, slurred speech, muscle weakness, loss of consciousness, and hypotension are also signs of toxicity.
*Good job, smarty-pants!
If an Rh-negative mother is not treated with Rh immune globulin (Rhogam) after delivery, what condition can develop in her Rh-positive fetus (in future pregnancies) due to maternal antibodies crossing the placenta?
Hemolytic disease of the newborn (erythroblastosis fetalis)
During the 3-hour oral glucose tolerance test (OGTT), gestational diabetes is diagnosed if two or more values are abnormal. What are the cutoff values for fasting, 1-hour, 2-hour, and 3-hour?
- Fasting: <95 mg/dL
- 1 hour: <180 mg/dL
- 2 hour: <155 mg/dL
- 3 hour: < 140 mg/dL
THESE ARE THE NORMAL VALUES!
What are three important nursing approaches when supporting a client giving her baby up for adoption?
Being sensitive, non-judgmental, & withholding personal biases
What are some key nursing responsibilities when administering magnesium sulfate?
Continuous fetal monitoring, hourly I/Os via Foley catheter, hourly reflex/BP checks, hourly focused assessments