Nursing 209

N209: Reproductive Health Study Guide

Gestational hypertension o One in fourteen women affected o Develops after 20 th week of pregnancy o Gestational: Hypertension without signs and symptoms of preeclampsia o Increased incidence in teens, women over 40, and those in their first pregnancy • Preeclampsia o New onset BP over 140/90, edema, and proteinuria o Signs and symptoms: Sudden weight gain, proteinuria, edema, severe headaches, visual disturbances, and decreased urine output o Increased risk for placental abruption, eclampsia, renal and kidney problems, PTD, and HELLP syndrome o Workup includes CBC, UA, platelets, liver function studies, electrolytes, BUN, creatinine, uric acid, 24 hour urine collection for protein, creatinine, and creatinine clearance, and an NST and BPP to evaluate fetus • RH Sensitization o RH negative mother with RH positive fetus (impregnated by RH positive male) o Occurs if fetal RBCs cross into maternal circulation causing antibody production against the RH antigens o Normally, fetal RBCs cross placenta into maternal circulation throughout the pregnancy, but movement of large volumes can stimulate the antibody production o Can occur after trauma, abortion, after delivery, or inadvertent infusion with RH positive blood o No problems with first pregnancy; complications occur in subsequent pregnancies o Causes lysis of fetal RBCs resulting in anemia, hypoalbuminemia, heart failure, or death o Hemolysis can increase indirect bilirubin levels in neonate  Prevention: Administration of Rho(D) immunoglobulin (Rhogam 300 mcg IM) at 28 weeks, within 72 hours of pregnancy termination or miscarriage, ectopic pregnancy, episode of vaginal bleeding during pregnancy, post-amniocentesis, or chorionic villus sampling  Can cause Erythroblastosis Fetalis in newborn; treatment is transfusion as indicated in newborn with delivery after fetal lung maturity is established • Hyperemesis Gravidarum o Severe, persistent nausea and vomiting in pregnancy o Can result in dehydration, weight loss, and electrolyte imbalance o Treatment includes IV fluid administration, including MVIs daily • Preterm labor o Defined by ACOG as “regular contractions of the uterus resulting in changes in the cervix that start before 37 weeks of pregnancy”

3.6 Gestational Problems •

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