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What is Hyperemesis gravidum?
1. Prolonged, uncontrolled nausea and vomiting that interferes with quality of life (mild form), persists beyond 20th week, weight loss usually exceeds 5% of body mass
Usually prevalance in molar pregnancies and multiple gestations
Severe form:dehydration, electrolyte imbalance, hospitalization
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What are happens during hyperemisis gravidum?
- dcreased placental blood flow
- decreased maternal blood flow
- acidosis
- Dehydration can cause preterm labor
Likely cause: elevated HcG, estrogen, vit b, stress
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Tx for Hyperemesis Gravidum
- NPO 24-36 hours to allow GI rest
- antiemetics IV, PR
- TPN/ fluid replacement
- comfort measures
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Define gestional hypertension
- 1. hypertension BP 140/90 on two or more occasions at least 6 hours apart during pregnancy
- 2. no protein in urine after 20 weeks of gestation,
- 3. BP returns to normal postpartum within 12 weeks of postpartum
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Define Preeclampsia
1, New onset, sudden increase in BP greater than 140/90, hypertension with proteinuria (>300 or +1)
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what is the difference between mild preeclampsia and severe
- Mild is >140/90
- mild facial or hand edema
- weight gain
- Protein >300mg or +1
- Severe is BP >160/110
- >500 mg or +3
- Hyperreflexia
- oliguria
- blurred visions
- scotomata (blind spots)
- pulmonary edema
- thrombocytopenia
- cerebral disturbances
- epigastric/RUQ pain
- HELLP
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What are the risks of preeclampsia
- PROM
- IUGR (intrauterine growth restriction)
- abruptio placentae
- fetal hypoxia and acidosis
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Tx/ monitor for mild Preeclampsia
- bed rest (lateral recumant preferred postion)
- CBC
- Clotting studies
- liver enzymes
- increased platelet levels
- monitor BP 4-6 hour
- proteinuria
- daily weights
- sodium restriction
- 6-8oz of water daily
- catheter for accurate output readings
- monitor DTR
- neuro status
- Increased ICP
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What is the medications used for ecclampsia/preeclampsia
- mag sulfate
- antihypertensives
calcum gluconate (antidote to toxic mag)
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How do you cure preeclampsia?
Birth of the fetus
-use bethamethasone to enhance lung maturity before delivery
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Why is mag sulfate and oxytocin used in preeclampsia?
seizures and to increase contractions
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What should you monitor the baby for post labor of a preeclampsia mother?
- respiratory depression
- hypocalcemia
- hypotonia
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What S&S are seen with eclamptic seizure?
- facial twitching
- muscle ridgidity
- respirations cease for duration of seizure, resulting from muscle spasms compramising fetal oxygenation
- coma usually follows seizure activity with respirations resuming
eclamptic seizures are life-threatening emergencies and require immediate tx to decrease maternal morbidity and mortality
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What interventions should you be prepared for with seizure
- -airway
- turn to side
- protect head
- suction equipment at bedside
- iv fluids to replace urine output
- monitor FHR
- Give Mag sulfate to prevent further seizures
- antihypertensives
- c-section or induction
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What is HELLP?
- Hemolysis,
- elevated liver enzymes
- low platelets
- -develops in severe preeclampsia
- -usually between 22-36 weeks
-increased ris for developing liver hematoma, rupture, stroke, cardiac arrest, pulmonary edema, DIC, subendocardial hemmorrhage, ARDS, renal damage, hypoxic encephalopathy, maternal or fetal death
-red blood cells become fragmented as they pass through small damaged blood vessels, elevated liver enzymes result as reduced blood flow to liver secondary to obstruction from fibrin depposits. hyperbilirubinemia nad jaundice result from liver impairment, low platelets reusult from vasuclar damage, result of vasospasm, platelets aggregate at sites of damage, resulting in thrombocytopenia in multiple sites
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What is the difference between PROM and PPROM?
PROM spontaneous rupture after 37 weeks and is not in labor
PPROM spontaneous ruputure less than 37 weeks
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How is PPROM and PROM tx differently
- PROM can have vaginal exams
- PPROM has speculum exams, takes methods to inhibit labor
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