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How much weight gain is required during pregnancy for a normal weight woman
2 to 5 pounds during the first trimester, then a pound each week until the end of pregnancy. (total of 25-35 lbs)
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What are some complications that could occur due to inadequate weight gain
- preterm labor
- LBW infants
- increased risk of infant with IUGR
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A woman of normal weight should gain how much weight during the 1st trimester
1-2.5 kg
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A woman of normal weight should gain how much weight during the 2nd and 3rd trimesters?
.4 kg/week
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A woman of normal weight should gain how much weight throughout her whole pregnancy?
11.5-16 kg
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What is the term for a person with DM that existed before pregnancy
pregestational
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What is any degree of glucose intolerance with its onset or first recognition occuring during pregnancy
Gestational DM
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what is excessive fetal growth; birth weight greater than 4000 to 4500 g
macrosomia
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what is excessive amniotic fluid, greater than 2000 mL
hydramnios
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What is the drug of choice in the prevention and treatment of convulsions caused by preeclampsia or eclampsia
magnesium sulfate
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what is an antihypertensive agent of choice for the treatment of chronic hypertension during pregnancy
methyldopa
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what is the antimetabolite and folic acid antagonist that is used to destory rapidly dividing cells; it is used for the medical management of an unruptured ectopic pregnancy
methotrexate
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what are signs of preeclampsia
- MAP at 108
- U/A indicates protein level of 32 mg/dl
- bicep and patellar reflexs are 2+
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what are signs of gestational HTN
at 24 weeks of gestation rising from prepregnant baseline of 120/70 to 150/92. No other problematic signs including proteinuria
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What are signs of chronic HTN
consistently high BP since before pregnant
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what are signs of eclampsia
HTN, hyperactive DTR with clonus, proteinuria of 4+, convulsion
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What are signs of HELLP syndrome
HTN, U/A protein content of 3+, platelets are 95,000 and elevated AST and ALT levels, N/V, and epigastric pain
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In pregnancy what hormones is insulin resistance caused by
insulinase and cortisol
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Smoking during pregnancy has serious health risks including what
- bleeding complications
- miscarriage
- stillbirth
- prematurity
- placenta previa
- placental abruption
- low birth weight
- SIDS
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Maternal and neonatal risks associated with gestational diabetes mellitus are
Maternal preeclampsia and fetal macrosomia.
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what is the term for a blood pressure elevation detected for the first time after mid pregnancy w/o proteinuria
Gestational HTN (normal again at 6 weeks postpartum)
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What is gestational HTN with no signs of preeclampsia present at the time of birth and HTN resolves by 12 weeks after birth
Transient HTN
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What is a pregnancy-specific syndrome that usually occurs after 20 weeks of gestation and is determined by gestational HTN plus proteinuria
preeclampsia
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what is the occurrence of seizures in a woman with preeclampsia that can't be attributed to other causes
eclampsia
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What is HTN that is present and observable before pregnancy or that is diagnosed before week 20 of gestation
chronic HTN
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How is severe preeclampsia classified
- a systolic BP > 160
- a diastolic BP > 110
- proteinuria
- cerebral disturbances
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What does HELLP stand for
- Hemolysis (rupturing of RBCs)
- Elevated Liver Enzymes
- Low Platelets (platelet count must be less than 1000)
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What are some signs of MgSO4 toxicity
- decreased DTRs
- nausea
- muscle weakness
- slurred speech
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What are associated high risk factors for developing preeclampsia
- primigravidity - new partner
- multifetal pregnancy
- obesity
- before age 20 and after age 40
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If HELLP syndrome develops what are the increased risks?
- Placental abruption
- renal failure
- Pulmonary edema
- ruptured liver hematoma
- DIC
- fetal and maternal death
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How do you treat severe preeclampsia and HELLP
with MgSO4
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What is chronic HTN associated with an increased incidence of
- abruptio placentae
- superimposed preeclampsia
- fetal compromise in labor
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what are postpartum complications of HTN
- pulmonary edema
- renal failure
- HTN encephalopathy
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More than half the neonatal deaths in US are caused by
preterm births
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what is excessive vomiting accompanied by dehydration, electrolyte imbalance, ketosis, and acetonuria causing 5% weight loss
Hyperemesis Gravidarum
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What is most bleeding due to in the first trimester
most bleeding is a result of miscarriage, ectopic pregnancy, and hydatidiform mole
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what is bleeding in the 3rd trimester due to?
placenta previa and abruptio placentae
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what do hemorrhagic disorders cause an increased risk for
increased risk for hypovolemia, anemia, and infection
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What is a pregnancy that ends w/o medical or surgical method before 20 weeks of gestation or 500 g birth weight
miscarriage or spontaneous abortion
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What are some signs and symptoms of severe preeclampsia
- Decreased urinary output
- irritability
- Ankle clonus
- epigastric pain
- Platelet count of less than 100,000/mm3
- visual problems
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What are signs and symptoms of preeclampsia
- +1 proteinuria
- transient headache
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What is a process that diminishes the diameter of blood vessels, which impedes blood flow to all organs and raises BP during pregnancy leading to degenerative aging of the placenta, fetal growth restriction, and placental abruption?
Arteriolar vasospasm
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What is a lab dx for a variant of severe preeclampsia that involves hepatic dysfunction?
HELLP syndrome
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What is a protein concentration of 30 mg/dl or more in at least 2 random urine specimens collected at least 6 hours apart
proteinuria
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What is a miscarriage that occurs before 12 weeks
early miscarriage
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what is passive and painless dilation of the cervical os w/o laobr or contractions of the uterus; occurs in 2nd trimester or early in 3rd trimester; miscarriage or preterm birth may result
Recurrent premature dilatoin of cervix (incompetent cervix)
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What is a disorder that arises from the placental trophoblast, it includes hydatiform mole, invasive mole, and choriocarcinoma
Gestational trophoblastic disease
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what is a disorder that results when an egg w/o an active nucleus has been fertilized
complete mole
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what is a disorder that results when 2 sperm fertilize an apparently normal ovum
Partial mole
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What is an implantation of the placenta in the lower uterine segment near or over the internal cervical os
placenta previa
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what is the implantation of the placenta in the lower uterine segment w/o reaching the os
low lying placenta
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what is detachment of part or all of the placenta from its implantation site
placental abruption
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what is the pathologic form of clotting that is diffuse and consumes large amts of clotting factors, cuasing widespread external or internal bleeding or both. It is an overactivation of the clotting cascade and the fibrinolytic system that results in the depletion of platelets and clotting factors
DIC
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How do you measure the BP of a woman with gestational HTN
- Place woman in lateral position
- allow woman to rest for 5 minutes before taking BP
- use same arm for each BP measurement
- Use proper sized cuff that covers at least 80% of upper arm
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What are the signs of severe preeclampsia
- proteinuria of 2+ or greater
- platelet level of less than 100,000
- DTR 3+, ankle clouns present
- BP of 160/110
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What do you implement when starting MgSO4 for a pt
- prepare a loading dose of 4 to 6g of MgSO4 in 100ml of ater
- prepare the maintenance solution by mising 40g of MgSO4 in 1000 ml of lactated ringer's solution
- monitor mom and fetal signs and UCs every 15-30 min
- expect maintenance dose to be 1-3g/hour
- report respiratory rate of less than 12 breaths
- recognize that urinary output should be at least 30 ml per hour
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EOC with administration of MgSO4 would be met if woman experiences
no seizures
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If a woman is treated at home for mild preeclampsia what should she do
- Weigh herself daily before breakfast, after voiding
- place a dipstick into a clean-catch sample of urine to test for protein
- Fluid intake should be 8-10 glasses
- do gentle exercises such as hand and feet circles and gently tensing and relaxing arm and leg muscles
- aviod excessively salty foods
- modified bed rest with diversional activities
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what is the nursing dx for a woman with a ruptured ectopic pregnancy
deficient fluid volume related to blood loss associated with rupture of the uterine tube
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After receiving methotrexate for an ectopic pregnancy what should the woman do?
avoid alcohol until PCP tells her the treatment is complete
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A pregnant woman at 32 weeks comes to the ER b/c she has begun to experience bright red vaginal bleeding. She has no pain. what is it?
placenta previa
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Immediate focus for care of a woman at 38 weeks diagnosed with marginal placenta previa and just given birth is what?
preventing hemorrhage
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What kind of miscarriage is classified as slight spotting, mild cramping, no passage of tissue or cervical dilation
Threatened
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what kind of miscarriage is classified as moderate bleeding, mild to severe cramping, no passage of tissue with cervical dilation
Inevitable
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what kind of miscarriage is classified as heavy profuse bleeding, severe cramping, passage of tissue and servical dilation with tissue in cervix
incomplete
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what kind of misscarriage is classified as slight bleeding, mild cramping, passage of tissue and no cervical dilation
complete
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What kind of miscarriage is classified as no spotting or bleeding, cramping, passage of tissue or cervical dilation (fetus has died but still in uterus)
missed
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when is cerclage or suturing of the cervix done
For recurrent, spontaneous abortion associated with premature dilation (incompetent) cervix
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when is a dilation and curettage performed
for a inevitable, complete or incomplete abortion
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