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Questions and Answers
When does postpartum preeclampsia typically occur?
What can ultrasound reveal early in pregnancy in some cases?
What does HELLP Syndrome stand for?
What is a potential consequence of polyhydramnios during pregnancy?
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What is a common sign of HELLP Syndrome?
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What does accumulation of amniotic fluid suggest during pregnancy assessment?
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What is the result of the fertilization of two separate ova by two separate spermatozoa?
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What effect can oligohydramnios have on the fetus?
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In a multiple pregnancy with identical twins, how many umbilical cords are typically present?
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In what scenario can intrauterine transfusion be performed?
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What is a common laboratory finding in patients with HELLP Syndrome?
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Study Notes
Postpartum Care
- Postpartum preeclampsia can occur up to 10-14 days after birth, usually within 48 hours.
- HELLP Syndrome is a variation of the gestational hypertensive process characterized by:
- Hemolysis leading to anemia
- Elevated liver enzymes leading to epigastric pain
- Low platelets leading to abnormal bleeding/clotting
- Associated with Antiphospholipid Syndrome (APS) or the presence of antiphospholipid antibodies.
Signs and Symptoms
- Proteinuria, edema
- Increased blood pressure
- Nausea
- Epigastric pain
- General malaise
- Right upper quadrant tenderness from liver inflammation
Laboratory Studies
- Hemolysis of red blood cells
- Thrombocytopenia
- Elevated liver enzyme levels (ALT and AST)
Therapy
- Transfusion of fresh frozen plasma or platelets to improve platelet count
- Intravenous glucose infusion
- Epidural anesthesia
Multiple Pregnancy
- Identical (monozygotic) twins:
- One placenta, one chorion, two amnions, and two umbilical cords
- Always of the same sex
- Fraternal (dizygotic, nonidentical) twins:
- Two placentas, two chorions, two amnions, and two umbilical cords
- May be of the same or a different sex
Assessment
- Uterus increases in size at a rapid rate
- AFP levels are elevated
- Quickening feels like flurries of action in different portions of the abdomen
- Auscultation of the abdomen reveals multiple sets of fetal heart sounds
- Ultrasound can reveal multiple gestation sacs early in pregnancy
- Vanishing twin syndrome occurs in 30% of cases
Therapeutic Management
- Multiple pregnancy complications include gestational hypertension, polyhydramnios, placenta previa, preterm labor, and anemia
- Closer prenatal supervision is necessary
Polyhydramnios
- Occurs when there is excess fluid of more than 2,000 ml or an amniotic fluid index above 24 cm
- Causes fetal malpresentation and premature rupture of the membranes
- Leads to additional risks of infection, prolapsed cord, and preterm birth
Assessment
- Accumulation of amniotic fluid suggests difficulty with the fetus’s ability to swallow or absorb, or excessive urine production
- Rapid enlargement of the uterus
- Auscultating the FHR can be difficult due to the increased amount of fluid surrounding the fetus
- Notice extreme shortness of breath due to the overly distended uterus pushing up against her diaphragm
Therapeutic Management
- Admit to hospital for bed rest and further evaluation or care at home
- Report any sign of ruptured membranes or uterine contractions
- Encourage a high-fiber diet and suggest a stool softener to avoid constipation
- Monitor vital signs and lower extremity edema frequently
Oligohydramnios
- Pregnancy with less than the average amount of amniotic fluid
- Effects on the fetus include:
- Severe growth restriction
- Weak muscles at birth
- Lungs can fail to develop (hypoplastic lungs)
- Distorted features of the face occur (Potter syndrome)
Post-term Pregnancy
- Causes include faulty computation and high doses of salicylates
- Complications include meconium aspiration, macrosomia, calcium deposits, and isoimmunization (Rh incompatibility)
Intrauterine Transfusion
- Restores fetal red blood cells through blood transfusion in utero
Fetal Death
- According to the time of quickening, fetal death can occur before or after the time of quickening
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Description
Learn about nursing interventions for postpartum preeclampsia and HELLP Syndrome, which may manifest within days after birth. Understand the key symptoms and associations with antiphospholipid antibodies.
