Obstetrics and Gynecology Quiz

Nursing Management of Pregnancy at Risk

• The presentation covers various high-risk pregnancies, including hyperemesis gravidarum, bleeding complications (miscarriage, ectopic pregnancy, cervical insufficiency, hydatidiform mole, placenta previa, placental abruption), gestational hypertension, preeclampsia, chronic hypertension, and diabetes in pregnancy.
• Specific learning objectives include understanding management of care for hyperemesis gravidarum, differentiating causes of pregnancy bleeding, various pregnancy complications and their management, and management of pregestational and gestational diabetes, among other conditions.

Hyperemesis Gravidarum

• Hyperemesis gravidarum is excessive nausea and vomiting lasting beyond 16 weeks of pregnancy.
• Risk factors include maternal age under 30, personal or family history of hyperemesis, multiple pregnancies, hyperthyroidism, diabetes, and molar pregnancy.
• Assessment involves monitoring for excessive vomiting, dehydration/electrolyte imbalance, weight loss, increased heart rate, decreased blood pressure, poor skin turgor, dry mucous membranes, elevated specific gravity in urine, and ketonuria.
• Management includes IV Lactated Ringers, medications like pyridoxine (B6), doxylamine (Unisom), promethazine (Phenergan), ondansetron (Zofran), and metoclopramide, and, in severe cases, enteral tube feedings or parenteral nutrition.
• Recommended dietary practices include advancing to clear liquids and bland foods gradually, frequent, small meals, and eating what is palatable.

Diabetes in Pregnancy

• Classification: Type 1 (absolute insulin deficiency requiring insulin injections), Type 2 (relative insulin deficiency or resistance), Gestational Diabetes (developed during pregnancy), Pregestational Diabetes (pre-existing type 1 or 2).
• Pregestational Diabetes (1st Half): Reduced insulin requirement, increased risk of hypoglycemia due to reduced placental function.
• Pregestational Diabetes (2nd Half): Increased insulin requirement due to placental changes and hormonal shifts; increased risk of hyperglycemia.
• Gestational Diabetes: Screening typically occurs at 24-28 weeks. Diagnosis utilizes a 1-hour oral glucose screen followed by a 3-hour oral glucose tolerance test (OGTT) if indicated.
• Nursing Assessment: Includes classic symptoms (3Ps - polyuria, polydipsia, polyphagia), infections (UTIs, yeast infections), polyhydramnios (extra fluid in uterus), and routine urine screening; glucose tolerance tests.
• Nursing Care and Management: Patient education, blood sugar monitoring, and possible dietary modifications or insulin administration, as needed.

Cervical Insufficiency

• Cervical insufficiency is premature dilation of the cervix during pregnancy, resulting in premature labor or pregnancy loss, typically occurring in the second or early third trimester.
• Risk factors include history of cervical trauma or surgery, history of preterm delivery, and a short cervix.
• Interventions include bed rest, pelvic rest, avoidance of heavy lifting, progesterone supplementation, or cervical cerclage to maintain pregnancy until term.

Bleeding and Loss of Pregnancy

• Early Pregnancy Bleeding (Miscarriage): A pregnancy loss due to natural causes before fetal viability (20 weeks or 500 grams).
• Assessment involves assessing pregnancy history, vital signs, pain levels, amount and type of bleeding, and related lab values (e.g., HCG, CBC, clotting factors).
• Potential interventions include monitoring for hemorrhage, infection, and psychological support, as well as possible necessary procedures like IVF, blood products, or D&C.
• Follow-up care includes rest, avoiding strenuous activities, monitoring for bleeding, foul-smelling discharge or signs of infection, and receiving prescribed antibiotics.

Ectopic Pregnancy

• An ectopic pregnancy occurs when a fertilized egg implants outside the uterus (most commonly in the fallopian tubes).
• Risk factors include sexually transmitted infections (STIs), intrauterine devices (IUDs), previous tubal surgeries, and scar tissue.
• Clinical manifestations comprise unilateral lower quadrant pain (sharp stabbing, shooting), delayed menses, abnormal vaginal bleeding, palpable unilateral mass, low hCG levels, and/or rigid and tender abdomen.
• Management includes determining hCG and progesterone levels, transvaginal ultrasound, and possibly methotrexate treatment in early stages, or surgical intervention (salpingostomy or salpingectomy).

Placenta Previa

• The placenta is implanted near or over the cervix.
• Risk factors include previous C-sections, uterine scarring, prior placenta previa, advanced maternal age, multiparity, and smoking.
• Clinical presentation often involves painless, bright red vaginal bleeding, especially during the second and third trimesters.
• Outcomes may include delivery via C-section (if full term or excessive bleeding in active labor).

Placental Abruption

• The premature separation of the placenta from the uterine wall.
• Risk factors include maternal hypertension, preeclampsia, cocaine use, smoking, blunt trauma, and history of placental abruption.
• Symptoms include localized uterine pain, uterine rigidity, dark red vaginal bleeding (concealed or apparent), and rapid onset of maternal shock and fetal distress.
• Management focuses on immediate delivery (usually C-section), supportive care for maternal hemodynamic stability (blood replacement), lab work, and monitoring for DIC.

Hypertension Disorders

• Hypertension disorders in pregnancy include Chronic Hypertension, Gestational Hypertension and Preeclampsia.
• Preeclampsia includes new onset hypertension and proteinuria after 20 weeks gestation

HELLP Syndrome

• HELLP Syndrome is a variant of preeclampsia characterized by Hemolysis, Elevated Liver enzymes (ALT, AST), and Low Platelets (thrombocytopenia).
• This potentially serious complication presents similarly to preeclampsia but requires immediate medical intervention because of the greater risk of complications (possibly requiring immediate birth, possibly requiring blood transfusions, among other actions).

Eclampsia

• Eclampsia is the development of seizure activity or coma in a woman with severe preeclampsia.
• Assessment involves frequent blood pressure monitoring, dipstick urinalysis for protein, monitoring for edema in hands, face, arms and/or legs.
• Interventions focus on immediate care(checking airway, and calling for help).

Magnesium Sulfate

• Magnesium Sulfate is used to prevent or treat seizures associated with preeclampsia/eclampsia.
• It involves administration via IV for prevention and treatment.