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Questions and Answers
What is the main goal of anticoagulant therapy in pregnant women with cardiac disease?
What is the main goal of anticoagulant therapy in pregnant women with cardiac disease?
Why is Coumadin contraindicated in pregnancy for pregnant women with cardiac disease?
Why is Coumadin contraindicated in pregnancy for pregnant women with cardiac disease?
Which medication is primarily used to control congestive heart failure manifestations in pregnant women with cardiac disease?
Which medication is primarily used to control congestive heart failure manifestations in pregnant women with cardiac disease?
What is the key goal of antidysrhythmia therapy for pregnant women with cardiac disease?
What is the key goal of antidysrhythmia therapy for pregnant women with cardiac disease?
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Why are anticoagulants used in pregnant women with cardiac disease?
Why are anticoagulants used in pregnant women with cardiac disease?
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What is the main characteristic of gestational hypertension?
What is the main characteristic of gestational hypertension?
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What is the goal of anticonvulsant therapy in the context of preeclampsia and eclampsia?
What is the goal of anticonvulsant therapy in the context of preeclampsia and eclampsia?
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Which medication is considered the antihypertensive of choice postpartum for patients with eclampsia?
Which medication is considered the antihypertensive of choice postpartum for patients with eclampsia?
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What is the purpose of using magnesium sulfate in hypertensive disorders during pregnancy?
What is the purpose of using magnesium sulfate in hypertensive disorders during pregnancy?
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What side effect is NOT typically associated with magnesium sulfate use in hypertensive disorders during pregnancy?
What side effect is NOT typically associated with magnesium sulfate use in hypertensive disorders during pregnancy?
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What is the goal of tocolytic therapy in preterm labor?
What is the goal of tocolytic therapy in preterm labor?
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Which drug is considered the tocolytic drug of choice for stopping preterm labor?
Which drug is considered the tocolytic drug of choice for stopping preterm labor?
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What is the mechanism of action of Indomethacin, the drug of choice for stopping preterm labor?
What is the mechanism of action of Indomethacin, the drug of choice for stopping preterm labor?
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Which side effect is associated with Calcium Channel Blockers used in preterm labor?
Which side effect is associated with Calcium Channel Blockers used in preterm labor?
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What is the primary purpose of Beta-Adrenergics like Terbutaline in preterm labor?
What is the primary purpose of Beta-Adrenergics like Terbutaline in preterm labor?
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What is the main purpose of Betamethasone in the management of preterm labor?
What is the main purpose of Betamethasone in the management of preterm labor?
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Which side effect is commonly associated with Beta-Adrenergics used in preterm labor?
Which side effect is commonly associated with Beta-Adrenergics used in preterm labor?
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What should be monitored in patients receiving Beta-Adrenergics for preterm labor?
What should be monitored in patients receiving Beta-Adrenergics for preterm labor?
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What is the drug of choice to accelerate surfactant production in preterm labor?
What is the drug of choice to accelerate surfactant production in preterm labor?
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Which symptom should a patient on Corticosteroids for preterm labor report to their healthcare provider?
Which symptom should a patient on Corticosteroids for preterm labor report to their healthcare provider?
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Study Notes
Induction of Labor
- The goal of induction of labor is to initiate labor before it begins naturally.
- Oxytocin (Pitocin) is used to induce labor, with a goal of achieving effective contractions every 2-3 minutes, lasting 40-90 seconds, and with an intensity of 50-80 mmHg.
- Oxytocin stimulates smooth muscle contraction, triggers contractions in uterine smooth muscle, and promotes milk letdown in lactating women.
Oxytocin Side Effects
- Hypotension
- Hypertension
- Dysrhythmias
- Headache
- Anorexia
- Nausea and Vomiting
Oxytocin Nursing Implications
- Oxytocin is administered via secondary IV with a TWO nurse check required.
- Determine fetal maturity, presentation, and pelvic adequacy prior to administration.
- Assess frequency, duration, intimacy, and resting tone of contractions.
- Continuous EFM is required, and oxytocin should be stopped in the event of fetal distress or hyperstimulation.
Preterm Labor
- Regular contractions that result in cervical dilation after 20 weeks gestation but prior to 37 weeks gestation.
- Goal of tocolytic therapy is to decrease or stop uterine contractions and allow the fetus to mature.
- Corticosteroids are used to increase fetal lung maturity.
Tocolytics
- Magnesium sulfate
- Calcium Channel Blockers (Nifedipine)
- Prostaglandin Synthesis Inhibitors (Indomethacin)
- Beta-Adrenergics (Terbutaline)
Magnesium Sulfate
- Used to stop preterm labor via tocolysis.
- Mechanism of action: inhibits synthesis of prostaglandins that stimulate smooth muscle contraction.
- Side effects: maternal nausea, vomiting, heartburn, prolonged bleeding time, fetal constriction of PDA, and oligohydramnios.
Calcium Channel Blockers (Nifedipine)
- Used to stop preterm labor via tocolysis.
- Mechanism of action: blocks Ca entry into smooth muscle cells, decreasing rate and force of contractions.
- Side effects: orthostatic hypotension, headache, dizziness, flushing, and fluid retention.
Prostaglandin Synthesis Inhibitors (Indomethacin)
- Used to stop preterm labor via tocolysis.
- Mechanism of action: inhibits synthesis of prostaglandins that stimulate smooth muscle contraction.
- Side effects: maternal nausea, vomiting, heartburn, prolonged bleeding time, fetal constriction of PDA, and oligohydramnios.
Beta-Adrenergics (Terbutaline)
- Used to stop preterm labor via tocolysis.
- Mechanism of action: smooth muscle relaxant, producing bronchodilation and uterine relaxation.
- Side effects: tachycardia, cardiac dysrhythmias, chest pain, dyspnea, hyperglycemia.
Cardiac Disease in Pregnancy
- Goal of anticoagulant therapy: prevent undesired clotting.
- Goal of diuretic therapy: control CHF manifestations.
- Goal of antidysrhythmic therapy: control cardiac dysrhythmias.
Anticoagulants
- Prevent undesired clotting.
- Heparin is used to prevent stroke, MI, and death.
Heparin
- Used to prevent undesired clotting.
- Mechanism of action: prevents clot extension and formation.
- Contraindicated in pregnancy due to teratogenic effects on fetus!
Hypertensive Disorders in Pregnancy
- Chronic hypertension: diagnosed prior to 20 weeks gestation or after 12 weeks postpartum.
- Gestational hypertension: blood pressure that exceeds 140/90 mmHg diagnosed after 20 weeks gestation.
- Preeclampsia: blood pressure that exceeds 140/90 mmHg accompanied by proteinuria or other organ involvement.
- Eclampsia: progression of preeclampsia into generalized seizures.
Antihypertensives
- Vasodilators (Hydralazine): increase cardiac output and blood flow to placenta.
- Beta Blockers (Labetalol): reduce heart rate and vasoconstriction.
- Calcium Channel Blockers (Nifedipine): smooth muscle relaxation.
Magnesium Sulfate
- Used to decrease incidence and severity of seizures associated with eclampsia.
- Mechanism of action: decreases acetylcholine released by motor nerve impulses, blocks neuromuscular transmission, and depresses CNS.
- Side effects: depressed CNS, depressed deep tendon reflexes, depressed respirations.
Diabetes Mellitus in Pregnancy
- Pre-gestational diabetes: patient education focuses on insulin needs, diet, exercise, and medication regimen.
- Insulin needs decrease in the first trimester due to anti-insulin placental hormones and fetal consumption of glucose.
- Insulin needs increase in the second and third trimesters due to maternal insulin resistance.
- Euglycemia is key during labor and delivery to prevent neonatal hypoglycemia.
Patient Education
- Review signs of hypoglycemia and hyperglycemia.
- Review treatment of hypoglycemic episodes.
- Review correct procedure for glucose monitoring.
- Encourage appropriate diet, exercise, and medication regimen.
- Review proper insulin administration.
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Description
Test your knowledge on hypertensive disorders in pregnancy including chronic hypertension, gestational hypertension, preeclampsia, and eclampsia. Learn about the goals of antihypertensive therapy in pregnancy.
