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32 Cards in this Set
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- Back
Risk factors during pregnancy |
maternal age under fifteen (going through own growth cycle, more likely for early labor, STDs, high blood pressure or anemia during pregnancy) or over 35 (C-sections or prlonged labor, genetic disorder) maternal parity (5 or more pregnancies) maternal ob/gyn history (2 or more spontaneous abortions, still birth, pelvic shape disorders, infection, NO PRENATAL CARE) medical history (preeclampsia, multiple gestations, gestational diabetes, high blood pressure, diabetes, cardiac disease, lupus, multiple sclerosis, obesity, HIV, ) lifestyle (alcohol, drugs, smoking, poor nutrition, vegetarian diet) genetics (defective genes inherited by the baby, chromosomal abnormalities resulting in spontaneous abortions, ABO incompatability) |
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substance abuse in pregnancy |
below poverty level, exposed to violence, depression, low education, unmarryed, unemployed, involved in criminal justice system, highest in first trimester smoking in white women are most common smoking is going down, but alcohol and drug use in pregnancy are going up most frequently missed diagnosis typically do not seek prenatal care till later in pregnancy 15 states consider it child abuse |
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heroin treatment |
methadone, behavioral, buprenorphine (linked to better treatment adherence with fewer side effects and overdoses than methadone), naltrexone (antagonist) |
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pathophysiology of diabetes |
hyperglycemia results in decrease in insulin production or action, results in hypoosmolarity resulting in blood being more viscous drawing more intracellular fluid being drawn in, cellular dehydration, kidneys have to secrete more urine (polyuria), lead to excessive thirst (polydypsia), burn proteins and fats to compensate resulting in ketonuria and fat breakdown, starvation results making patient eat a lot (polyphasia), results in vascular changes resulting in heart, eye, and nerve ddamage |
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four cardinal signs of diabetes |
polyuria, polydipsia, weight loss, polyphagia (from tissue breakdown) |
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types of diabetes |
type I (10% of population, absolute insulin deficiency, autoimmune) type II (most prevalent, 90% of population, insulin resistance, insufficient) gestational diabetes (any degree of glucose intolerance recognized during pregnancy) white's classification- age at diagnosis, duration of illness, end organ involvement, assesses maternal and fetal risk (a-c are okay, d- t have poor pregnancy outcome due to already having vascular damage) |
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physiological changes during pregnancy related to diabetes |
pancreas needs to produce more insulin because cells use more glucose, increase in glycogen storage nausea and vomiting put them at risk for hypoglycemia, 2/3 trimester- glucose needs ot get to fetus, HPL and somatotropin cause insulin resistance to cause more blood to be available to cross over placenta glucose levels in fetus are proportional to maternal blood stream, but does not cross placenta |
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maternal risks with diabetes |
hydraminios, preeclampsia-eclampsia, hyperglycemia, ketoacidosis, cesarean delivery, increased susceptibility to infections, worsening retinopathy |
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affects of diabetes to neonate |
congenital anomalies, cardiovascular, CNS, and skeletal system affected, increased size of fetus, macrosomia (resulting in birth injury), IntraUterine Growth Retardation (very small baby, diabetes with vascular involvement (decreased perfusion to placenta)), respiratory distress syndrome |
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risk factors |
over 40, family history, prior macrosomic, malformed, or stillborn, obesity, PCOS, hypertension, glycosuria |
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hemoglobin A1C |
level should be less than or equal to 6% higher levels are highly correlated to fetal anomalies shows how blood has been doing over 3 months period and more accurate than one that's from only a few hours |
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Rh Alloimmunization |
occurs when a woman's immune system is sensitized to foreign erythrocyte surface antigens, stimulating the production of IgG antibodies, when the protein is not htere, then they are Rh-. hemolytic anemic babies can occur if mom is Rh- and baby is Rh+ |
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indirect coombs test |
tests mother to see if she has been sensitized to Rh. antibody screen. Identifies antibodies that could be problematic for baby or mother if a transfusion is needed. if father is positive and mother is negative, than you need to do testing |
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ABO incompatibility |
mild hemolytic from mothers with O blood type andd baby has A or B blood type. mother has anti A and anti B antibodies in serum no prophylactic treatment done. monitored for hyperbillirubinemia and anemia check baby for positive coombs test in which case you check for jaundice |
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Group beta strep |
around 35-37 week gestation, need to be screened for colonization of this. GBS positive means they are given antibiotics after labor or ROM. decreases bacterial count that fetus is exposed to. need to monitor for sepsis of the newborn |
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preeclampsia types of hypertension |
leading cause of maternal mortality. 4 hypertensive classificiation chronic (preexisting before preg.) chronic with superimposed preeclampsia (preexisting and then develop preeclampsia) preeclampsia-eclampsia gestational hypertension (hypertension in pregnancy without preeclampsia symptoms) |
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preeclampsia |
proteinuria, hypertension, if after 20 weeks they develop proteinuria and hypertension it was believed they had preeclampsia no longer requires proteinuria occurs in about 5-10% |
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pathophysiology preeclampsia |
only cure is delivery of the placenta which it is thought to be related to. vasospasm and decreased perfusion to organs, increased cardiac output wihtout lowered vascular resistance leading to hypertension, decreased perfusion, endothelial dysfunction. imbalance in hormones in placenta (vasodilator and vasoconstrictor: increase in prostacyclin and decrease in thromboxane) leads to vasoconstriction. |
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vasospasm and decreased organ perfusion results in |
decreased perfusion to liver, kidney, placenta, and brain resulting in failure, seizures, retinal issues/ detachment, hemolysis of red blood cells, low platelet count (DIC) |
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mild preeclampsia |
women with hypertension of 140/90 after 20 weeks. with proteinurea. mild is being discouraged because it is not really mild instead called preeclampsia without severe features |
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severe preeclampsia |
womenwith progressing symptoms. BP 160/110 or higher. proteinurea higher (3+) multi organ failure, kidney and liver failure. increased liver enzyme secretions. CNS irritability |
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risk factors for preeclampsia |
nulliparity, teensand older adults, african american, hispanic, lower socioeconomic status, family history, chronic hypertension, diabetes, lupus erythematosus, mulltigestation, trophoblastic disease, fetal hydrops |
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symptoms that mean preeclampsia is getting worse |
increasing edema, scotomata, blurred vision, decreasing urinary output, epigastric pain, vomiting, bleeding gums, persistent or severe headache, neurologic hyperactivity, pulmonary edema, cyanosis |
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eclampsia |
occurrence of seizure activity!! can be different types of seizures |
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magnesium sulfate |
used for CNS depressant to prevent seizures need to check for alertness. can stop them from breathing. need to have antagonist available. too much can cause depressant. baby can have CNS depression too need to check clonus and CNS freuently |
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HELLP syndrome |
occurrs from breakdown of red blood cells Hemolysis Elevated Liver Enzymes Low Platelet Count Associated with severe preeclampsia epigastric pain is primary symptom- from elevated liver enzymes |
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ectopic pregnancy |
implants outside uterine cavity occurs in 2% of pregnancy- 95% of them are in fallopian tubes (called tubal pregnancy) |
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number one s/s of ectopic pregnancy |
unilateral pain in abdomen |
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risk factors for ectopic pregnanc |
STIs or pelvic inflammatory disease, use of an IUD, IVF, endometriosis |
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treatment of ectopic pregnancy |
salpingostomy (removal of tube), methotrexate (chemotherapy agent, targets rapidly dividing cells, monitor for blood loss, possible loss of fallopian tube and fetus |
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molar pregnancy |
abnormal placenta from fertilization cysts form instead of placenta low protein intake, asian women, more than 35 years old. complete molar is an empty egg fertilized by a sperm - avascular vessicles grow. 20% become malignant. incomplete molar- normal ovum fertilized with polar spermy, lower incidence of malignancy |
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s/s of molar pregnancy |
rapidly growing uterus, vaginal bleeding, nausea/ vomiting, hypertension, high levels of hCG, no fetal heart beat |