Hypertensive Disorders of Pregnancy and Placental Abruption Quiz

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Questions and Answers

What are the criteria for defining HDP (Hypertensive disorder of Pregnancy)?

SBP ≥ 140mmHg and/or DBP ≥ 90 mmHg, based on a single measurement

SBP ≥ 150mmHg and/or DBP ≥ 100 mmHg, based on a single measurement

SBP ≥ 130mmHg and/or DBP ≥ 80 mmHg, based on average of at least 3 measurements taken at least 10 minutes apart using any arm

SBP ≥ 140mmHg and/or DBP ≥ 90 mmHg, based on average of at least 2 measurements taken at least 15 minutes apart using the same arm (correct)

What is the incidence of HDP in all pregnancies in Canada?

7% (correct)

10%

15%

Which demographic characteristics can influence the risk markers for HDP?

Genetic considerations, physical environment, culture, employment & working hazards, substance use

Biology & genetic factors, demographic characteristics, personal health practices & coping skills

Availability of health care, physical environment, income & social status, education, social support networks (correct)

Immigrants, indigenous population, education, social support networks, employment & working hazards

What are the maternal complications from significant HTN (140/90)?

Maternal death, acute renal failure, pulmonary edema, HELLP syndrome Signup and view all the answers

What are the risks for the fetus of a pre-eclamptic woman?

Abruptio placentae, preterm birth, intrauterine growth restriction, oligohydramnios, acute hypoxia, stillbirth Signup and view all the answers

What are the high-risk factors for developing CV risk factors after pregnancy?

Nulliparity, family history of pre-eclampsia, multiple gestation, obesity, chronic medical disorders Signup and view all the answers

Which SDOH (Social Determinants of Health) can influence the risk markers for HDP?

Income & social status, education, culture, employment & working hazards, physical environment, social support networks Signup and view all the answers

What are the maternal deaths associated with severe HTN (160/110) primarily due to?

Complications of hepatic rupture, abruptio placentae, and eclampsia Signup and view all the answers

What demographic group has the highest rates of pregnancy-related HTN?

Women at extremes of age (< 20 or > 40) Signup and view all the answers

What plays a crucial role in identifying risk markers for hypertensive disorders of pregnancy (HDP)?

Primary health and preventative medicine Signup and view all the answers

How is the severity of hypertensive disorders of pregnancy (HDP) determined?

By target organ involvement and blood pressure levels Signup and view all the answers

What are complications of hypertensive disorders of pregnancy (HDP)?

Fetal preterm birth Signup and view all the answers

What does the management of hypertensive disorders of pregnancy (HDP) involve?

Emotional support for the patient Signup and view all the answers

What is a cause of placental abruption?

Substance use Signup and view all the answers

What are clinical manifestations of placental abruption?

Sudden uterine pain Signup and view all the answers

What is involved in home care for hypertensive disorders of pregnancy (HDP)?

Close supervision by family or friends Signup and view all the answers

How is the diagnosis of hypertensive disorders of pregnancy (HDP) made?

Ultrasound examinations Signup and view all the answers

What is a complication of placental abruption?

Hypovolemic shock Signup and view all the answers

What is involved in the management of placental abruption?

Continuous electronic monitoring Signup and view all the answers

What can contribute to fetal alcohol spectrum disorders and teratogenic effects?

Alcohol consumption Signup and view all the answers

What is a role of ultrasound examinations in the diagnosis of placental abruption?

Detecting abnormal placental attachment Signup and view all the answers

What is the significance of HTN during pregnancy?

It is the most common medical problem encountered during pregnancy Signup and view all the answers

What are the maternal complications from significant HTN (140/90)?

Maternal death, acute renal failure, pulmonary edema, HELLP syndrome Signup and view all the answers

What are the risks for the fetus of a pre-eclamptic woman?

Abruptio placentae, preterm birth, intrauterine growth restriction, oligohydramnios Signup and view all the answers

What are some risk markers for hypertensive disorders of pregnancy (HDP)?

Nulliparity, Fam Hx of pre-eclampsia, multiple gestation, obesity Signup and view all the answers

What are the potential post-pregnancy risks for developing CV risk factors?

Hypertension, Type 2 diabetes, obesity Signup and view all the answers

What are the SDOH (Social Determinants of Health) that can influence the risk markers for HDP?

Income & social status, education, culture, employment & working hazards Signup and view all the answers

How is HDP (Hypertensive disorder of Pregnancy) defined?

SBP ≥ 140mmHg and/or DBP ≥ 90 mmHg, based on average of at least 2 measurements Signup and view all the answers

What plays a crucial role in identifying risk markers for hypertensive disorders of pregnancy (HDP)?

Primary health and preventative medicine Signup and view all the answers

What is involved in the management of hypertensive disorders of pregnancy (HDP)?

Reduced activity, continuous electronic monitoring, and emotional support for the patient Signup and view all the answers

What is a cause of placental abruption?

Maternal hypertension Signup and view all the answers

How is the severity of hypertensive disorders of pregnancy (HDP) determined?

By target organ involvement and blood pressure levels Signup and view all the answers

What are complications of hypertensive disorders of pregnancy (HDP)?

Maternal hemorrhage, abnormal placental attachment, and fetal preterm birth Signup and view all the answers

What is a complication of placental abruption?

Maternal hemorrhage, hypovolemic shock, and fetal IUGR Signup and view all the answers

What are clinical manifestations of placental abruption?

Sudden uterine pain, vaginal bleeding, and fetal distress Signup and view all the answers

What can contribute to fetal alcohol spectrum disorders and teratogenic effects?

Alcohol consumption and medication Signup and view all the answers

What is a role of ultrasound examinations in the diagnosis of placental abruption?

Involves ultrasound examinations and careful monitoring of fetal heart rate Signup and view all the answers

What is involved in home care for hypertensive disorders of pregnancy (HDP)?

Close supervision by family or friends, teaching the patient to assess fetal and uterine activity, and avoiding certain activities Signup and view all the answers

What are the potential complications of HDP?

Maternal hemorrhage, abnormal placental attachment, and fetal preterm birth Signup and view all the answers

What is a potential cause of placental abruption?

Substance use Signup and view all the answers

What is the recommended A1C level for preconception in diabetes management?

A1C ≤ 7.0% Signup and view all the answers

What is the recommended daily dose of folic acid for pre and post conception in diabetes management?

1.0 mg daily Signup and view all the answers

Which medication should be discontinued due to its fetotoxic effects during pregnancy in diabetes management?

ACE-I Signup and view all the answers

What is the primary goal for mothers with pregestational diabetes during pregnancy?

Achieve euglycemia Signup and view all the answers

What are the characteristics of a baby with macrosomia?

Round face, chubby body, and flushed complexion Signup and view all the answers

What is the primary cause of hypoglycemia in newborns?

Pancreatic hyperplasia and hyperinsulinemia Signup and view all the answers

What are the potential signs of hypoglycemia in newborns?

Jitteriness, lethargy, poor feeding, seizures Signup and view all the answers

What is the recommended initial management for asymptomatic hypoglycemia in newborns?

Glucose gel and breastfeeding or formula feeding Signup and view all the answers

What is the recommended initial management for symptomatic hypoglycemia in newborns?

Glucose gel and breastfeeding or formula feeding Signup and view all the answers

What is the risk for shoulder dystocia in babies with macrosomia?

High due to head being smaller than large shoulders Signup and view all the answers

What are the potential complications for babies with macrosomia?

Hypoglycemia, hypocalcemia, and hyperbilirubinemia Signup and view all the answers

What is the nursing management for babies at risk of hypoglycemia?

Immediate assessment for symptoms and glucose check if present Signup and view all the answers

What is an important aspect of intrapartum management for women with pregestational diabetes?

Continuous insulin pump Signup and view all the answers

What is a key factor in the pathophysiology of gestational diabetes?

Increased fetal nutrient demands Signup and view all the answers

What is a recommended postpartum care measure for women with gestational diabetes?

Encouraging breastfeeding Signup and view all the answers

What is a potential risk for infants of diabetic mothers?

Respiratory distress syndrome Signup and view all the answers

What is a key factor in the collaborative management of gestational diabetes?

Dietary and exercise modifications Signup and view all the answers

What is a crucial aspect of postpartum management for women with pregestational diabetes?

Reducing insulin dose immediately after delivery Signup and view all the answers

What is involved in the screening process for gestational diabetes?

Glucose challenge test and oral glucose tolerance test Signup and view all the answers

What is a potential complication for infants of diabetic mothers?

Polycythemia Signup and view all the answers

What is a key aspect of the intrapartum management of gestational diabetes?

Close monitoring of maternal blood glucose levels Signup and view all the answers

What is a potential consequence of gestational diabetes for women?

50% chance of developing diabetes within 5-10 years Signup and view all the answers

What is an important aspect of postpartum care for women with gestational diabetes?

Encouraging breastfeeding Signup and view all the answers

What is the recommended threshold for investigation of blood glucose levels in at-risk infants after the transitional period?

2.8 mmol/L Signup and view all the answers

When should blood glucose screening of asymptomatic, at-risk infants be performed?

At 2 hours of age Signup and view all the answers

When can testing for blood glucose be discontinued in large-for-gestational-age (LGA) infants and infants of diabetic mothers (IDMs)?

After 12 hours Signup and view all the answers

What is the recommended frequency for blood glucose screening of asymptomatic, at-risk infants after the initial test at 2 hours of age?

Every 3 to 6 hours Signup and view all the answers

What is the recommended therapeutic target for blood glucose levels in at-risk infants after the transitional period?

3.3 mmol/L Signup and view all the answers

When is immediate glucose testing recommended for symptomatic and unwell infants?

Immediately Signup and view all the answers

What blood glucose measurement range should be implemented in all birthing and newborn care centers?

1 mmol/L to 3 mmol/L Signup and view all the answers

What is the recommended frequency of blood glucose screening for asymptomatic, at-risk infants after the initial 2-hour test and before discontinuation?

Every 3 to 6 hours Signup and view all the answers

Which condition is a pre-existing medical risk factor for hypertensive disorders of pregnancy?

Pre-existing hypertension Signup and view all the answers

Which factor is a risk marker for preeclampsia?

Obesity (BMI > 35 kg/m²) Signup and view all the answers

Which interval between pregnancies is a risk factor for hypertensive disorders of pregnancy (HDP)?

Inter-pregnancy interval < 2 years Signup and view all the answers

Which maternal characteristic is a potential risk marker for hypertensive disorders of pregnancy (HDP)?

Excessive weight gain in pregnancy Signup and view all the answers

Which blood pressure measurement at booking is considered a risk factor for HDP?

Booking sBP > 130 mmHg Signup and view all the answers

Which demographic group is a risk marker for hypertensive disorders of pregnancy?

Black ethnicity Signup and view all the answers

Which factor is a potential cause of heritable thrombophilia?

Family history of early-onset cardiovascular disease Signup and view all the answers

Which substance use is associated with increased risk during pregnancy?

Cocaine use Signup and view all the answers

Which of the following markers is associated with hypertensive disorders of pregnancy in the second or third trimester?

Elevated BP Signup and view all the answers

Which investigational laboratory marker is potentially indicative of hypertensive disorders of pregnancy?

Elevated uric acid Signup and view all the answers

What is a marker for hypertensive disorders of pregnancy that involves abnormal uterine artery Doppler velocimetry?

Elevated BP Signup and view all the answers

What cells of the placenta can modify arteries in the uterus to accommodate increased blood flow?

Syncytiotrophoblasts Signup and view all the answers

During pregnancy, which vessels do trophoblast cells primarily modify to accommodate increased blood flow?

Arteries Signup and view all the answers

Which of the following is the primary function of trophoblast cells in the placenta?

Modifying uterine arteries for increased blood flow Signup and view all the answers

What is the recommended method for taking blood pressure in home care for mild pre-eclampsia?

Using the same arm in sitting position with arm supported on table at heart level Signup and view all the answers

How often should fetal activity be assessed in home care for mild pre-eclampsia?

Once a day Signup and view all the answers

When should daily weights be taken in home care for mild pre-eclampsia?

At the same time of day before breakfast after voiding Signup and view all the answers

What should the nurse be alert for during second-stage labour when attempting delivery of a macrosomic infant?

Shoulder dystocia Signup and view all the answers

What should the nurse be prepared to assist with if shoulder dystocia occurs during delivery of a macrosomic infant?

Manoeuvres to free the fetal shoulder Signup and view all the answers

In which stage of labour should the nurse be alert for the possibility of shoulder dystocia when delivering a macrosomic infant?

Second stage Signup and view all the answers

Which of the following is a potential fetal complication of pregestational diabetes?

Still birth due to fetal acidosis Signup and view all the answers

What is a potential maternal complication of pregestational diabetes during pregnancy?

Hypertension/pre-eclampsia Signup and view all the answers

What is a potential neonatal morbidity associated with macrosomia in pregestational diabetes?

Shoulder dystocia Signup and view all the answers

What is a potential congenital malformation associated with hyperglycemia in the first trimester of pregestational diabetes?

Anencephaly Signup and view all the answers

What is a recommended measure for preconception care for women with diabetes?

Evaluating the woman's health status and planning the optimal time for pregnancy Signup and view all the answers

What is a risk factor for gestational diabetes?

Obesity Signup and view all the answers

What should be done to prevent diabetes in pregnancy?

Preconception counseling and achieving optimal glycemic control Signup and view all the answers

What is the primary method for screening for gestational diabetes?

50g glucose challenge test Signup and view all the answers

What is a key aspect of intrapartum management for women with diabetes?

Close monitoring of maternal blood glucose levels and fetal heart rate Signup and view all the answers

What is a recommended postpartum management measure for women with diabetes?

Adjusting insulin doses and monitoring for hypoglycemia Signup and view all the answers

What percentage of women diagnosed with gestational diabetes may develop diabetes within 5-10 years?

Around 50% Signup and view all the answers

What increases as a result of hormones during pregnancy, leading to gestational diabetes?

Maternal insulin resistance Signup and view all the answers

What should be included in the management during pregnancy for women with diabetes?

Achieving euglycemia, close fetal monitoring, and maternal glucose monitoring Signup and view all the answers

What should be included in intrapartum management for women with diabetes?

Close monitoring of maternal blood glucose levels and fetal heart rate Signup and view all the answers

What is a measure to prevent diabetes in pregnancy?

Preconception counseling, achieving optimal glycemic control, and switching from oral hypoglycemic agents to insulin Signup and view all the answers

What is a recommended measure for preconception care for women with diabetes?

Evaluating the woman's health status and planning the optimal time for pregnancy Signup and view all the answers

What is the first line pharmacological therapy for gestational diabetes mellitus (GDM) if non-pharmacological management does not achieve blood glucose (BG) targets?

Insulin basal-bolus Signup and view all the answers

What is the recommended frequency for fetal surveillance once 40 weeks gestation is reached in poorly controlled GDM with maternal comorbidities?

Twice a week Signup and view all the answers

What is the recommended blood glucose range to be maintained in the mother during labor and delivery to reduce the risk of neonatal hypoglycemia?

4.0-7.0 mmol/L Signup and view all the answers

What is the recommended action if the fetus presents with macrosomia during labor and delivery in the context of GDM?

Prepare for C-section Signup and view all the answers

What is the recommended duration for breastfeeding to prevent childhood obesity and reduce the risk of maternal hyperglycemia and neonatal hypoglycemia?

3-4 months Signup and view all the answers

What are the signs of hypoglycemia that should be observed in newborns?

Jitteriness and seizures Signup and view all the answers

What are the risk factors for the development of hypoglycemia in newborns?

Small for gestational age (SGA) Signup and view all the answers

What is the recommended action if asymptomatic hypoglycemia is detected in a newborn with glucose levels of 1.8-2.5 mmol/L?

Administer glucose gel and breastfeed Signup and view all the answers

When should glucose testing be performed for at-risk infants who are ≥ 35 weeks gestation at birth?

2 hours after birth, after the first feed Signup and view all the answers

What is the recommended management for symptomatic hypoglycemia in newborns with glucose levels of 1.8-2.5 mmol/L?

Administer glucose gel and breastfeed Signup and view all the answers

What are the signs of hypoglycemia that should be observed in newborns?

Jitteriness, lethargy, poor feeding Signup and view all the answers

What is a risk factor for the development of hypoglycemia in newborns?

Being born at less than 37 weeks gestation Signup and view all the answers

What is the recommended initial management for asymptomatic hypoglycemia in newborns?

Give glucose gel and breastfeed or provide formula Signup and view all the answers

What should be done if a newborn has symptomatic hypoglycemia?

Check glucose levels and provide appropriate intervention Signup and view all the answers

What is the nursing management for babies at risk for hypoglycemia who are 35 weeks gestation or older?

Facilitate skin to skin care with mom and breastfeed or provide formula Signup and view all the answers

Study Notes

Hypertensive Disorders of Pregnancy and Placental Abruption Overview

Alcohol consumption and medication can contribute to fetal alcohol spectrum disorders and teratogenic effects.
Primary health and preventative medicine play a crucial role in identifying risk markers for hypertensive disorders of pregnancy (HDP).
Severity of HDP is determined by target organ involvement and blood pressure levels.
Complications of HDP include maternal hemorrhage, abnormal placental attachment, and fetal preterm birth.
Diagnosis of HDP involves ultrasound examinations and coagulation profile assessments.
Management of HDP includes reduced activity, continuous electronic monitoring, and emotional support for the patient.
Home care for HDP involves close supervision by family or friends, teaching the patient to assess fetal and uterine activity, and avoiding certain activities.
Placental abruption is a serious complication that accounts for significant maternal and fetal morbidity and mortality.
Placental abruption can be caused by maternal hypertension, substance use, trauma, and multiple gestations.
Clinical manifestations of placental abruption include sudden uterine pain, vaginal bleeding, and fetal distress.
Complications of placental abruption include maternal hemorrhage, hypovolemic shock, and fetal IUGR.
Diagnosis of placental abruption involves ultrasound examinations and careful monitoring of fetal heart rate.

Hypertensive Disorders of Pregnancy and Placental Abruption Overview

Alcohol consumption and medication can contribute to fetal alcohol spectrum disorders and teratogenic effects.
Primary health and preventative medicine play a crucial role in identifying risk markers for hypertensive disorders of pregnancy (HDP).
Severity of HDP is determined by target organ involvement and blood pressure levels.
Complications of HDP include maternal hemorrhage, abnormal placental attachment, and fetal preterm birth.
Diagnosis of HDP involves ultrasound examinations and coagulation profile assessments.
Management of HDP includes reduced activity, continuous electronic monitoring, and emotional support for the patient.
Home care for HDP involves close supervision by family or friends, teaching the patient to assess fetal and uterine activity, and avoiding certain activities.
Placental abruption is a serious complication that accounts for significant maternal and fetal morbidity and mortality.
Placental abruption can be caused by maternal hypertension, substance use, trauma, and multiple gestations.
Clinical manifestations of placental abruption include sudden uterine pain, vaginal bleeding, and fetal distress.
Complications of placental abruption include maternal hemorrhage, hypovolemic shock, and fetal IUGR.
Diagnosis of placental abruption involves ultrasound examinations and careful monitoring of fetal heart rate.

Diabetes Management in Pregnancy

Women with pregestational diabetes need education on diet, insulin therapy, exercise, and blood glucose monitoring to avoid complications during pregnancy.
Pregestational diabetes requires close fetal monitoring and carrying insulin, glucometer, and hypoglycemia kit at all times to manage the risk of hypoglycemia, especially in the first trimester.
Intrapartum management of pregestational diabetes involves monitoring maternal blood glucose levels and maintaining them at 4.0-7.0mmol/L, continuous insulin pump, and close monitoring for dehydration, hypoglycemia, and hyperglycemia.
Postpartum management includes reducing insulin dose immediately after delivery, monitoring blood glucose for hypoglycemia, and promoting early neonatal feeding, especially for women with T1DM.
Women diagnosed with gestational diabetes have a 50% chance of developing diabetes within 5-10 years, and several risk factors increase the likelihood of developing gestational diabetes.
The pathophysiology of gestational diabetes involves increased fetal nutrient demands and maternal insulin resistance during the second and third trimesters.
Screening for gestational diabetes involves a glucose challenge test and an oral glucose tolerance test, with a focus on healthy diet and weight gain follow-up.
The collaborative management of gestational diabetes includes dietary and exercise modifications, insulin therapy, and fetal surveillance, with a shift to pharmacological therapy if blood glucose targets are not achieved.
Intrapartum management of gestational diabetes requires close monitoring of maternal blood glucose levels, routine assessment of fetal heart rate and uterine activity, and preparedness for a C-section if the fetus presents with macrosomia.
Postpartum care for women with gestational diabetes includes encouraging breastfeeding to prevent neonatal hypoglycemia and screening for prediabetes and diabetes with an oral glucose tolerance test.
Infants of diabetic mothers are at risk for a range of complications including hypocalcemia, hypomagnesemia, congenital abnormalities, hyperbilirubinemia, polycythemia, respiratory distress syndrome, birth trauma, and cardiomyopathy.
The degree of risk for infants of diabetic mothers is influenced by the severity and duration of maternal disease, and careful monitoring and management are required to mitigate these risks.

Diabetes Management in Pregnancy

Preconception counseling and care is recommended for all women of reproductive age with diabetes to improve pregnancy outcomes
Preconception care includes evaluating the woman's health status, planning the optimal time for pregnancy, and stabilizing any vascular complications of diabetes
It decreases the risk of congenital anomalies and spontaneous abortion
The woman's partner should be included to improve support and understanding of potential complications
Steps to prevent diabetes include preconception counseling, achieving optimal glycemic control, and switching from oral hypoglycemic agents to insulin
Management during pregnancy includes achieving euglycemia, close fetal monitoring, and maternal glucose monitoring
Intrapartum management involves close monitoring of maternal blood glucose levels, fetal heart rate, and preparation for potential complications
Postpartum management includes adjusting insulin doses, monitoring for hypoglycemia, and promoting early neonatal feeding
Around 50% of women diagnosed with gestational diabetes will develop diabetes within 5-10 years
Risk factors for gestational diabetes include age, obesity, high-risk population, family history of T2DM, and history of infant weighing over 4000g
Maternal insulin resistance increases as a result of hormones during pregnancy, leading to GDM
Screening for GDM should be done at 24-28 weeks gestation using the 50g glucose challenge test and the 75g oral glucose tolerance test if necessary

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Description

Test your knowledge of hypertensive disorders of pregnancy (HDP) and placental abruption with this informative quiz. Review key concepts such as risk markers, complications, diagnosis, and management of these serious pregnancy conditions.