Obstetrics and Gynecology Quiz

High-Risk Pregnancy: Social and Physiological Factors

• Adolescent pregnancy poses increased risk for eclampsia, puerperal endometritis, and systemic infections.
• Maternal mortality is higher in adolescents.
• Perinatal complications are the leading cause of death for 15-19-year-old girls globally.
• Early pregnancy or marriage contributes to 5-33% of girls (aged 15-24) leaving school.

Age Considerations: Advanced Maternal Age

• Pregnancy after 35 carries increased risks, including maternal death (higher over 40).
• Miscarriage, stillbirth, preterm birth, low birth weight, and Down syndrome are more prevalent.
• Despite these risks, overall risks are relatively low for healthy women without pre-existing conditions.

Women with Disabilities

• Women with disabilities face higher risks of social, economic, and physical problems.
• Care providers and families may hold stigmas or assumptions.
• Social service involvement is more frequent.
• Pre-planning and social support are needed.
• CHN's (Community Health Nurses) should consider biases and assumptions in their assessments and support.

Intimate Partner Violence (IPV) and Pregnancy

• Abuse during pregnancy increases risk of injury to the uterus, miscarriage, stillbirth, or premature birth, as well as bleeding during the first and second trimesters.
• Pre-pregnancy abuse, women under 25, substance use by the woman or partner, single or lone parents, recently separated or ending a relationship, Indigenous women, women with disabilities and women belonging to low SES groups are at higher risk of IPV.
• Associated with preterm labor, prematurity, low birth weight, neonatal and infant/maternal mortality, and maternal depression/substance use.

Substance Use During Pregnancy

• Alcohol and other drugs easily pass from the mother to the baby through the placenta.
• Cocaine, heroin, meth, and alcohol pose serious health risks.
• Miscarriage, stillbirth, prematurity, low birth weight, and congenital anomalies are common complications.
• Substance-use treatment programs may not address the unique needs of pregnant women and long waiting lists and lack of women-only recovery spaces are further barriers.

Nursing Care for Substance Use During Pregnancy

• Assessing for a history of violence, abuse, and mental health issues to provide support and ensure confidentiality.
• Promoting a non-judgmental, trauma-informed approach.
• Supporting the patient's desire to stop using substances while providing harm reduction strategies.
• Encouraging prenatal care, counselling, and treatment.
• Educating women about the effects of cannabis.
• Providing discharge planning, postpartum follow-up, and monitoring.

Application (Specific Scenarios)

• Application questions and the best approaches to address specific issues such as a client who continues to smoke.
• Application questions and the best approaches to address specific issues such as a client and partner who insist on being present during prenatal checkups.

Early Pregnancy Bleeding

• Miscarriage (spontaneous abortion) is the loss of a pregnancy before 20 weeks gestation (less than 500 g fetal weight).
• 80% of miscarriages occur before 12 weeks.
• Majority related to chromosomal abnormalities, teratogenic drugs, faulty implantation, maternal abnormalities.
• There are other issues, like maternal illness, endocrine imbalances, and maternal infections.
• Late loss encompasses week 12-20, commonly caused by advanced maternal age and premature dilation.

Discharge Teaching After Pregnancy Loss

• Advise to report any heavy, profuse, or bright red bleeding (and other significant changes).
• Avoid vaginal items until bleeding stops completely.
• Take medications as prescribed.
• Report foul-smelling discharge or elevated temperature.
• Advise to eat iron- and protein-rich foods.
• Important to acknowledge the loss and encourage family and friend support.

Ectopic Pregnancy

• Fertilized ovum implants outside the uterine cavity (most often fallopian tube; 95%).
• Clinical manifestations include abdominal pain, abnormal vaginal bleeding (spotting), missed menstrual period, referred shoulder pain (diaphragmatic irritation).
• Diagnosis includes ultrasonography, serum progesterone, and β-hCG levels.
• Medical management may involve methotrexate and possible surgery.

Teaching for Patients Receiving Methotrexate Therapy

• Advise patients to avoid foods and vitamins containing folic acid, "gas-forming" foods, sun exposure, and sexual intercourse until β-hCG is undetectable.
• Advise to keep scheduled appointments and report severe abdominal pain.

Premature Dilation of the Cervix

• Cervical insufficiency involves passive and painless dilation of the cervix without contractions.
• Structural weakness of the cervix is often due to collagen disorder or uterine anomalies and can be caused by cervical trauma (birth or mechanical dilation).
• Nursing care includes cervical cerclage (placed at 12-14 weeks) and continuous close observation and supervision.
• Early signs such as preterm labor, rupture of membranes, and infection should be reported.

Late Pregnancy Bleeding: Placenta

• Placenta previa: implantation of the placenta in the lower uterine segment, covering the internal cervical os completely (as opposed to partially or low-lying).
• Placenta previa is often associated with bright-red bleeding that is painless and can present during labor.
• Risk factors include: smoking, multiple pregnancies, previous uterine surgeries, advancing maternal age, low-socioeconomic status, short interpregnancy intervals, and infertility treatment.
• Placental abruption is the premature separation of the placenta.
• It's usually associated with painful bleeding and frequently is a significant medical emergency requiring immediate intervention

Nursing and Interprofessional Care for Late Pregnancy Bleeding

• Expectant management.
• Reduced activity and close observation, especially essential for a patient less than 36 weeks pregnant.
• In cases where labor has not yet started, the patient may be admitted to give time to stabilize, with no internal examinations performed.
• Appropriate surveillance tools include checking and weighing pads, NST, and BPPs.
• Antepartum steroids may be ordered; active management may lead to a cesarean birth, especially if high-risk.

Hypertensive Disorders in Pregnancy

• Hypertensive disorders in pregnancy are a leading cause of maternal mortality.
• Severe hypertension is defined as systolic BP greater than 160 mm Hg and diastolic BP greater than 110 mm Hg.
• Pre-eclampsia/eclampsia is gestational hypertension with proteinuria.

Pre-eclampsia & HELLP Syndrome

• Key components of pre-eclampsia include gestational or chronic hypertension and new-onset proteinuria (greater than 0.3 g/L per 24 hours).
• Additional organ dysfunction, such as acute kidney or liver dysfunction, seizures, blindness, stroke, severe headaches, thromobocytopenia, and DIC, may also be present.
• HELLP refers to an associated syndrome characterized by hemolysis, elevated liver enzymes, and low platelets, and is considered a severe form of pre-eclampsia.
• These conditions require aggressive medical management and hospitalization.

Nursing Care for Pre-eclampsia & HELLP Syndrome

• Blood pressure assessment is crucial to assess any change and the use of deep tendon reflexes to detect any presence of ankle clonus.
• Patient must be aware of complications, especially concerning fetal well-being. Fetal assessments are crucial.
• Assess and monitor for any increase in blood pressure, protein in urine, or decreased fetal movement.
• Urine dipstick test and activity monitoring will determine appropriate interventions.

Eclampsia

• Eclampsia is the occurrence of seizures in a pregnant woman.
• Proper nursing care includes ensuring a patent airway, administering magnesium sulfate, observing for signs of toxicity, assessing fetal status, providing postpartum care, and following up with appropriate healthcare professionals.

Contraction Stress Test (CST)

• Use to measure the fetus's response to contractions to determine if the fetus can handle contractions and get the required oxygen.
• Two procedures exist, nipple or oxytocin stimulation, with interpretation similar to the NST.
• Positive- late decelerations of the fetal heart rate, typically seen during uterine contractions.
• Negative- no late decelerations.

Biophysical Profile (BPP)

• BPP is a non-invasive test that assesses fetal well-being.
• It evaluates fetal breathing movements, fetal movements, fetal tone, and amniotic fluid volume.
• The absence/presence of these factors indicate fetal status and potential risk factors for fetal compromise.
• Each factor is scored; a total score of 8-10 signifies normal, 6 is equivocal, and <6 is abnormal.

Nursing Care for Patients with High-Risk Pregnancies

• Proper nursing care strategies should be implemented which focus on providing psychosocial support for those diagnosed.
• Patients should be given access to appropriate resources from healthcare professionals to ensure that they have clear support for their well-being and concerns.

Hyperemesis Gravidarum

• Hyperemesis gravidarum is persistent vomiting that causes severe dehydration, weight loss, and electrolyte imbalances.
• Usually starts between 4 and 8 weeks of pregnancy, often resolving by the 20th week.

Nursing Care for Hyperemesis Gravidarum

• Assessment of vital signs and hydration status is crucial to provide accurate nursing interventions to the patient.
• Management of dehydration and nutritional deficiencies using interventions for controlling symptoms, particularly nausea and vomiting.
• Careful administration of medications, especially when needed for alleviating symptoms, should be carried out in accordance with protocols and best practices for patient safety.

Other Relevant Topics (From Additional Pages)

• Rh incompatibility: Rh incompatibility occurs when the mother is Rh-negative and the fetus is Rh-positive.
• Gestational Diabetes Mellitus (GDM): Elevated glucose levels occurring during pregnancy.
• Clotting Disorders in Pregnancy (DIC): A rare disorder where the proteins controlling blood clotting become overactive and use up clotting factors, leading to widespread bleeding.