Families At Risk
- Hyperemesis
Gravidarium: excessive vomiting, electrolyte imbalance can lead to maternal acidosis, may be d/t increased HCG, may be psychological
or may be d/t H. pylori
- Premature
Rupture of Membranes: defined as before 38 weeks, litmus test will be yellow if it’s urine, will turn blue if alkaline
- Chronic HTN:
does not necessarily lead to PIH, check for proteinuria or edema
- Pregnancy
Induced Hypertension: can happen to any mom at any time, baby aspirin to mom may help, mom’s thick sludgy blood damages
her vessels and decreases profusion to baby; laying mom on side is the only way to increase profusion but bedrest may do more
harm than good.
- women at risk: primiparas, high stress women,
family hx, change in sex partner (ie. 2nd husband...)
- tx: bed rest? LR to increase circulating blood
volume, baby aspirin to decrease clotting, maybe older HTN meds, Na restriction not necessary, increase Ca to help muscle
activity, increase protein to keep fluid in circulating blood volume
- Preeclampsia
is unique to pregnancy, diastolic above 100, maybe not completely reversible but usually resolves w/in 1 month after delivery,
can exacerbate other problems, can harm vital organs, high maternal BP can cause abruption
- warning signs: sudden weight gain, increased
body edema (hands) (lower body edema is normal), increased BP, double vision, visual disturbances
- severe PIH: this mom needs to be in the hospital
- PIH Assessments:
resps will increase, uterine activity might decrease but you don’t want it to!, clonis (spasticity), check neuro status,
check renal function (once the liver is involved mom will have abdominal pain d/t liver enlargement & sclerosis), decrease
in FHR variability w/long term PIH
- Tx: Magnesium Sulfate (most be hospitalized)
CNS depressant, interferes w/acetylcholine at neurotransmitter junction, must monitor hourly for Mg toxicity (BP decreases,
FHR decreases, hyporeflexes, slow speech)
- Tx: Betamethasone may also be given to help
mature fetal lungs
- If mom has a seizure, C/S will be done because
baby is safer outside than in a seizing mom
- HELLP syndrome: can happen before the baby’s
born but is usually after, this happens when delivery of the baby doesn’t cure preeclampsia, mom has low hematocrit
(increases risk for DIC disseminated intravascular coagulopathy (blood can’t clot)
- Premature
Onset of Labor (POL) - between 20-37 wks, often d/t infection/dehydration/overdistention of uterus (as in twins)
- Dx: 22-34 wks Fetal Fibrinectine test: there
shouldn’t be any fetal fibrinectine, if present it indicates a higher risk for premature labor, done by vaginal swab;
estriol level may also be checked w/urine test, 4cm dilation or ROM are irreversible
- Tx: tocolytic agents (turbutaline (may cause
pulmonary edema) or Magnesium sulfate); Oral turbutaline must be around the clock, it is a smooth muscle relaxant that mom
can use at home once contractions stop, can make mom feel crazy like she’s on speed.
- Gestational
Diabetes: checked at 24-28 wks, blood sugar usually has to be greater than 170 to see sugar in urine, babies are often large
(but not necessarily fully developed), babies often have hyperbilirubinemia d/t immature liver, diet is 1st tx
followed by insulin (which does not cross placenta); this mom will have non-stress test after 34 wks to check placental viability
- Postterm
Pregnancy: umbilical cord compression often d/t wharton’s jelly drying up
- Abruptio
Placenta: PAIN with or without bleeding
- Placenta
Previa: Bleeding without pain, can be early or near term, bleeding w/sex or at vaginal exam, total/partial have increased
risk for hemorrhage at delivery, less fetal death than abruptio placenta
- Placental
Problems: often indicate fetal anomalies
- Placenta Accreta: placenta trying to find good
blood supply and grows through myometrium, maybe through entire uterus
- Amniotic Fluid Embolism: placenta detaches
& amniotic fluid enters maternal blood circulation & mom dies
