Podcast
Questions and Answers
What is the recommended interval for monitoring hCG levels in a patient with gestational trophoblastic disease until titers are negative for 3 consecutive weeks?
What is the recommended interval for monitoring hCG levels in a patient with gestational trophoblastic disease until titers are negative for 3 consecutive weeks?
Which method is recommended to prevent another pregnancy until hCG titers and X-ray findings are all negative?
Which method is recommended to prevent another pregnancy until hCG titers and X-ray findings are all negative?
What is the prophylactic chemotherapy indicated after evacuation of the uterus in gestational trophoblastic disease?
What is the prophylactic chemotherapy indicated after evacuation of the uterus in gestational trophoblastic disease?
Which treatment approach is used for metastatic choriocarcinoma in gestational trophoblastic disease?
Which treatment approach is used for metastatic choriocarcinoma in gestational trophoblastic disease?
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How often should chest X-rays be performed to check for lung metastasis in patients with gestational trophoblastic disease once hCG titers are negative?
How often should chest X-rays be performed to check for lung metastasis in patients with gestational trophoblastic disease once hCG titers are negative?
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In which scenario is cesarean delivery commonly indicated?
In which scenario is cesarean delivery commonly indicated?
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What is the purpose of administering betamethasone during pregnancy?
What is the purpose of administering betamethasone during pregnancy?
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What should be assessed preoperatively in a patient with gestational trophoblastic disease to watch for complications?
What should be assessed preoperatively in a patient with gestational trophoblastic disease to watch for complications?
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Which action is essential when monitoring a patient with gestational trophoblastic disease postoperatively?
Which action is essential when monitoring a patient with gestational trophoblastic disease postoperatively?
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What is a key recommendation for medical management in cases of hydatidiform mole?
What is a key recommendation for medical management in cases of hydatidiform mole?
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Study Notes
Placenta Previa
- Vaginal delivery is considered when bleeding is minimal and the placenta previa is marginal or when labor is rapid.
Placenta Previa Medical Management
- A pediatric team should be on hand during delivery to immediately assess and treat neonatal shock, blood loss, and hypoxia.
- Continuously monitor the patient's blood pressure, pulse rate, respirations, central venous pressure, intake and output, and amount of vaginal bleeding.
- Anticipate the need for electronic fetal monitoring and assist with application as indicated.
Placenta Previa Nursing Management
- Have oxygen readily available in case fetal distress occurs.
- Administer Rhogam after every bleeding episode if the patient is Rh-negative.
- Prepare the patient and her family for a possible cesarean delivery and the birth of a preterm neonate.
- Complete bed rest is necessary.
- If the fetus isn’t mature, expect to administer an initial dose of betamethasone (Celestone) IM.
- Provide emotional support during labor.
Complications
- Possible complications include stillbirth of the neonate, seizures, coma, premature labor, renal failure, and hepatic damage in the mother.
Preeclampsia
- Blood pressure exceeding 140/90 mmHg or increase above baseline of 30 mm Hg in systolic pressure or 15 mmHg in diastolic pressure on two readings taken 4-6 hours apart.
- Generalized edema in the face, hands, and ankles.
- Weight gain of about 1.5 kg (3.3 lb.) per month in the second trimester or more than 1.3 to 2.3 kg (3 to 5 lb.) per week in the third trimester.
- Proteinuria 1+ to 2+, or 300 mg/dL, in a 24-hour sample.
Assessment Findings for Mild Preeclampsia
- Blood pressure exceeding 160/110 mm Hg noted on two readings taken 6 hours apart with the client on bed rest.
- Proteinuria exceeding 5 g/24 hours.
- Oliguria (less than 400 mL/24 hours).
- Headache.
- Blurred vision, spots before eyes, and retinal edema.
- Pitting edema of the sacrum, face, and upper extremities.
- Dyspnea.
- Epigastric pain.
- Nausea and vomiting.
- Hyperreflexia.
Assessment Findings for Severe Preeclampsia
- Rapid rise in blood pressure.
- Rapid weight gain.
- Generalized edema.
- Increased proteinuria.
- Epigastric pain, marked hyperreflexia, and severe headache, which usually precede convulsions in eclampsia.
- Visual disturbances.
- Oliguria.
Gestational Trophoblastic Disease/Hydatidiform Mole
- Medical management includes monitoring hCG levels once weekly until titers are negative for 3 consecutive weeks, then once monthly for 6 months, then every 2 months for 6 months.
- Contraceptive methods prevent another pregnancy until at least 1 year after all titers and X-ray findings are negative.
- Prophylactic chemotherapy methotrexate or actinomycin-D (Cosmegen) after evacuation of the uterus.
- Chemotherapy and radiation are used for metastatic choriocarcinoma.
- Monitoring for malignancy includes chest X-rays to check for lung metastasis once monthly until hCG titers are negative, then once every 2 months for 1 year.
- Assess the patient’s vital signs.
- Preoperatively, observe for signs of complications, such as hemorrhage and uterine infection, and vaginal passage of vesicles.
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Description
Test your knowledge on the medical management of placenta previa, including when vaginal delivery is considered, and the necessary precautions to take in case of active bleeding during delivery. Make sure you are familiar with protocols for fetal blood loss, neonatal shock, and monitoring the patient's vital signs.
