Week 5 power point notes, Lecture notes of Obstetrics

Download Week 5 power point notes and more Lecture notes Obstetrics in PDF only on Docsity!

Complications

in Pregnancy

Review

Preterm Labor

PTL = multi-factorial and not fully understood

4 major contributors:

• (^) Excessive uterine stretch/distention
• (^) Decidual hemorrhage/activation
• (^) Infection & inflammation
• (^) Maternal/fetal stress (HPA axis)

Preterm Labor

Medical Management

• Old “treatments” (bedrest, no sex, hydration) not recommended
• Goal: delay birth 48–72 hours if beneficial to fetus
• Use tocolytics short term (24–34 weeks)
• Give antenatal corticosteroids
• Consider magnesium sulfate for neuroprotection (<32 weeks)
• Avoid tocolysis when contraindicated

Preterm Labor

Common tocolytics:

Calcium channel blocker : Nifedipine

Maternal: hypotension, dizziness, headache

NSAID : Indomethacin

Fetal: premature ductus arteriosus closure, oligohydramnios

Beta-agonist : Terbutaline

Maternal: tachycardia, arrhythmias, pulmonary edema

Magnesium sulfate

Primarily for neuroprotection , not long-term tocolysis

Preterm Labor

A 29-week woman in preterm labor receives her first dose of

betamethasone at 8 AM Monday.

At 8 PM Monday, contractions stop and the provider plans to

discharge her Tuesday morning.

The patient asks, “Should I still get the second shot if I’m not contracting anymore?”

What is the nurse’s best response?

A. “No, since the labor stopped, we’ll cancel the next dose.”

B. “Yes, the second dose helps your baby’s lungs mature even if

labor has stopped.”

C. “You’ll only need another course if contractions restart next

week.”

D. “The second dose is given only if your membranes have

ruptured.”

PPROM

• PROM / Prelabor ROM: Rupture of membranes before

labor begins

• PPROM: ROM before 37 weeks’ gestation
• Prolonged ROM: >24 hours between ROM and birth
• Latency: Time from membrane rupture to delivery
• Infection : major factor in early PPROM
• Other contributing factors:
• Repeated uterine strain/stretch
• Hormonal (relaxin) & micronutrient (vitamin C) imbalances
• Tissue remodeling & collagen weakening

PPROM

Medical Management

• Balance risks: infection vs. prematurity
• Delivery indicated for:
• Infection (chorioamnionitis)
• Fetal compromise
• Significant placental abruption
• Otherwise → expectant management when safe
• Approach depends on gestational age
• Corticosteroids
• Magnesium
• GBS Screening
• Treat infection → Delivery

PPROM

Nursing Actions

• Continuous FHR & UC monitoring
• Assess for infection :
• Fever ≥100.4°F
• Maternal/fetal tachycardia
• Uterine tenderness
• Malodorous fluid
• Monitor for labor or abruption
• Perform NST/BPP as ordered
• Avoid repeated vaginal exams

PPROM

A 33-week patient with PPROM is being managed expectantly. The

nurse is reviewing the care plan.

Which nursing actions are appropriate? (Select all that apply.)

A. Obtain vaginal cultures and begin prophylactic antibiotics

B. Perform sterile speculum exam if increased leakage reported

C. Encourage daily NSTs and BPPs as ordered

D. Use tocolytics to prevent contractions for the next 10 days

E. Administer a single course of antenatal corticosteroids

Cervical Insufficiency

Definition:

• (^) Inability of cervix to retain pregnancy without contractions or labor —

typically 2nd trimester loss

• (^) May be congenital (collagen or structural defect) or acquired (trauma: LEEP,

conization, dilation)

Assessment & Diagnosis:

• (^) Often painless cervical dilation , ± pelvic pressure, spotting, backache
• (^) Short cervical length (<25 mm) ↑ risk but not diagnostic
• (^) Ultrasound monitoring 16–24 weeks for high-risk patients

Management:

• (^) Cerclage = gold standard
• Prophylactic: 12–16 wks for history of painless 2nd trimester loss
• Rescue: up to ~24 wks if cervix dilating, no labor
• (^) Not effective: bedrest, activity restriction, pelvic rest

Nursing Focus:

• (^) Monitor for UCs, ROM, bleeding, infection, fever
• (^) Teach signs of labor or infection
• (^) Remove cerclage at 36–37 wks or sooner if labor/infection occurs

Multiple Gestation

Management Highlights

• (^) Frequent ultrasound & surveillance (growth, fluid, NST/BPP)
• (^) Corticosteroids before 34 wks → ↓ neonatal morbidity

Delivery timing:

• (^) Di/Di: 38 wks Mono/Di: 34–37 wks Mono/Mono: 32–34 wks Triplets

≤34 wks

Multidisciplinary prep : perinatology, NICU, blood products ready

Nursing Focus

• (^) Monitor for PTL, PIH, bleeding
• (^) Reinforce nutrition, rest, hydration
• (^) Provide emotional & educational support for high-risk pregnancy

and parenting multiples

Hyperemesis Gravidarum

Definition & Key Features

• (^) Persistent, uncontrolled vomiting → dehydration , electrolyte imbalance , ketosis , >5% weight loss
• (^) Peak: ~9 weeks Improves by: ~20 weeks
• (^) ↑ risk with: multiple gestation , migraine hx , family hx , previous episode Assessment Findings
• (^) Severe/prolonged vomiting, acetonuria/ketonuria
• (^) Dehydration: dry mucosa, poor turgor, dizziness, tachycardia, hypotension
• (^) Weight loss, malaise, electrolyte imbalances Medical Management
• (^) IV hydration , electrolyte & vitamin replacement (esp. thiamine )
• (^) Vitamin B6 ± doxylamine = 1st-line
• (^) Antiemetics: antihistamines, phenothiazines, benzamides if refractory
• (^) Enteral feeding > parenteral if unable to tolerate PO Nursing Focus 💡
• (^) Assess triggers & contributing factors; minimize odors, stuffy rooms
• (^) Monitor I&O, daily weights, labs
• (^) Maintain NPO until vomiting controlled → gradual diet advance
• (^) Encourage emotional support , rest , and complementary therapies (e.g., ginger )
• (^) Provide hydration, oral care, nutrition consult

Diabetes in Pregnancy

• Two main groups:
• Overt (Pregestational) Diabetes
  • Type 1 or Type 2 before pregnancy
• Gestational Diabetes (GDM)
  • First recognized during pregnancy
• Pregnancy = insulin-resistant state
• Placenta makes insulin antagonists
  • Human placental lactogen
  • Progesterone, estrogen
  • Cortisol, growth hormone
• Goals are the same for both:
• Keep blood sugar in target range ( euglycemia )
• Prevent complications in mom and baby
• Avoid prematurity when possible

Diabetes in Pregnancy (GDM)

• (^) Glucose intolerance first recognized in pregnancy
• (^) Usually diagnosed 24–28 weeks with: - (^) 1-hour 50 g screening test → if high → - (^) 3-hour OGTT for diagnosis
• (^) Types:
  • (^) GDM A1: diet + exercise controlled
  • (^) GDM A2: needs insulin Key Differences vs Overt Diabetes:
• (^) NO ↑ risk of congenital anomalies - (^) Because GDM typically appears after organ formation
• (^) Similar pregnancy complications : - - (^) Long-term risk: up to 70% will develop Type 2 later in life Management Focus (student level): - (^) Cornerstone = glycemic control - (^) Fasting < 95 mg/dL - (^) 1-hr postprandial < 140 mg/dL - (^) 2-hr postprandial < 120 mg/dL - (^) Start with diet + exercise ; add insulin if needed - (^) Teach: - (^) SMBG (fasting + post- meals) - (^) Kick counts + prenatal follow-up -