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Reproductive System
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Pregnancy Complications

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Reproductive System | Nurse Practitioner (NP) School Study Aid

Pregnancy Complications
24 Picmonics to Learn | 53 mins
Gestational Diabetes
Signs and Symptoms
Usually Asymptomatic
Fetal Macrosomia
Polyhydramnios
Diagnosis
Glucose Intolerance After 24 Weeks Gestation
3-hr 100g Glucose Tolerance Test
Treatment
Diet and Exercise
Close Glucose Monitoring
Insulin
Ultrasound (or Nonstress Test (NST))
Delivery
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2 mins
Gestational Hypertension
New-Onset Hypertension
> 20 Weeks Gestation
Risk Factors
Nulliparity
Obesity
African American Females
> 35 years Old
Multiple Gestations
Family History of Gestational HTN (or Preeclampsia)
Complications
IUGR
Prematurity
Abruptio Placentae
Management
Fetal Monitoring
Alpha-Methyldopa
Beta-Blockers (Labetalol)
Calcium Channel Blockers
Hydralazine
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4 mins
Preeclampsia Assessment
After 20 Weeks of Pregnancy
Mild
Hypertension > 140/90
Proteinuria or End-Organ Dysfunction
Severe
Hypertension > 160/110
Progressive Renal Insufficiency
Vision Changes
HELLP Syndrome
Pulmonary Edema
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2 mins
Preeclampsia Interventions
Side Lying Position and Bedrest
Antihypertensives
Magnesium Sulfate
Labor Induction
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1 min
Severe Preeclampsia
Mechanism of Action
Vasospasm and Decreased Organ Perfusion
Intravascular Coagulation
Increased Permeability and Capillary Leakage
Signs and Symptoms
Hypertension
Proteinuria or End-Organ Dysfunction
HELLP Syndrome
Hepatic Dysfunction and Hemolysis
Elevated Liver Enzymes
Low Platelet Counts
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3 mins
Eclampsia
Mechanism of Action
Increased Central Nervous System Irritability
Signs and Symptoms
Hyperreflexia
Positive Ankle Clonus
Headaches
Visual Disturbances
Epigastric or RUQ Pain
Seizures
Coma
Considerations
Don't Leave Bedside
Magnesium Sulfate
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2 mins
Hyperemesis Gravidarum
Signs and Symptoms
Excessive Vomiting
Significant Weight Loss
Dehydration
Hypotension
Electrolyte Imbalance
Interventions
Antiemetics
Frequent Small Meals
IV Therapy
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2 mins
Chorioamnionitis
Fever
Maternal or fetal tachycardia
Leukocytosis
Foul Odor to Amniotic Fluid
Treatment: Antibiotics
Monitor uterine tenderness, contractions and fetal activity
Monitor maternal vital signs & FHR
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2 mins
Spontaneous Abortion Overview
Assessment
Bleeding < 20 weeks Gestation
Interventions
Identify Type
Bed Rest
Monitor for Hemorrhage
Save Pads and Linens
RhoGAM
Dilation and Curettage (DandC)
Cerclage
Emotional Support
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2 mins
Spontaneous Abortion Types
Missed Abortion
No Fetal Heartbeat, No Cervical Dilation, No Bleeding
Threatened Abortion
No Cervical Dilation and Minimal Bleeding
Inevitable Abortion
Bleeding and Cervical Dilation with No Loss of Products of Conception
Incomplete Abortion
Bleeding and Cervical Dilation with Loss of Some Products of Conception
Complete Abortion
Bleeding with No Cervical Dilation, with Loss of All Products of Conception
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2 mins
Fetal Macrosomia
Pathophysiology
Increased Birth Weight
> 4500 g
Causes
Maternal Obesity
Gestational Diabetes
Diagnosis
Weigh Newborn at Birth
Ultrasound
Hadlock's Formula
Complications
Birth Canal Trauma
Neonatal Hypoglycemia
Shoulder Dystocia
Treatment
Planned Cesarean Section
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2 mins
Polyhydramnios
Pathophysiology
Increased Amniotic Fluid
Causes
Duodenal Atresia (or Gastrointestinal Atresias)
Maternal Diabetes
Multiple Gestations
Anencephaly
Hydrops Fetalis
Diagnosis
Ultrasound
Amniotic Fluid Index (AFI) > 25 cm
Treatment
Weekly Nonstress Test (NST) and Biophysical Profile (BPP)
Amnioreduction
Indomethacin
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3 mins
Oligohydramnios
Decreased Amniotic Fluid
Etiologies
Renal Agenesis (Fetal Urinary Tract Abnormalities)
Uteroplacental Insufficiency
Premature Rupture of Membranes (PROM)
Diagnosis
Ultrasound
Amniotic Fluid Index (AFI) < 5 cm
Complications
Spontaneous Abortion
Pulmonary Hypoplasia
Musculoskeletal Abnormalities
Intrauterine Growth Restriction (IUGR)
Treatment
Treat Underlying Cause
Delivery (When Viable)
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2 mins
Intrauterine Growth Restriction (IUGR)
Pathophysiology
Slowed Fetal Growth
Symmetric Type
Factors Early in Pregnancy
Genetic (Chromosomal) Abnormalities
Congenital Infections
Asymmetric Type
Preserved Head Circumference
Factors Late in Pregnancy (2nd / 3rd trimester)
Placental Insufficiency
Diagnosis
Ultrasound
< 10th Percentile (for SGA)
Decreased Fundal Height
Complications
Increased Perinatal (Fetal) Morbidity and Mortality
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2 mins
Premature Rupture of Membranes (PROM)
Pathophysiology
Rupture > 1 Hour Before Labor
Risk Factors
Infection
PROM History
Incompetent Cervix
Diagnosis
Fern Test
Nitrazine Paper Test
Ultrasound
Treatment
Consider Tocolytics
Consider Antibiotics
< 34 Weeks Gestation
Corticosteroids
> 34 Weeks Gestation
Induction of Labor
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2 mins
Cesarean Section - Indications
Maternal Indications
Active Genital Herpes Infection
Cervical Cancer
Eclampsia (Preeclampsia)
History of Uterine Surgery
History of C-section (Vertical)
Fetal Indications
Malpresentation
Fetal Distress
Cord Compression/Prolapse
Other Indications
Failed Vaginal Delivery
Cephalopelvic Disproportion
Abruptio Placentae or Placenta Previa
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2 mins
Uterine Atony
Pathophysiology
Most Common Cause of Postpartum Hemorrhage
Uterine Overdistention
Exhausted Myometrium
Uterine Infection
Presentation
"Boggy" Uterus
Treatment
Resuscitation with IV Fluids and Transfusions
Bimanual Uterine Massage
Oxytocin
Methergine
Prostaglandins
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2 mins
Incompetent Cervix
Mechanism
Premature Cervical Dilation
Assessment
Recurring Miscarriage
Short Cervix
Considerations
Cervical Cerclage
Rest
Labor
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1 min
Prolapsed Umbilical Cord
Mechanism
Cord Prolapses
Signs and Symptoms
Visualization of Cord
Prolonged or Variable Decelerations
Considerations
Hips Elevated
Insert 2 fingers in Vagina
Saline Towel on Cord
Oxygen
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2 mins
Sheehan's Syndrome
Postpartum Pituitary Gland Necrosis
Agalactorrhea
Amenorrhea
Secondary Hypothyroidism with Cold Intolerance
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1 min
Hydatidiform Mole (Molar Pregnancy)
Cause/Mechanism
Abnormal Fertilization
Assessment
Symptoms of Pregnancy
Elevated hCG
Vaginal Bleeding
Inappropriate Uterine Growth
No Fetal Heart Rate (FHR)
Interventions
Dilation and Curettage (D&C)
Emotional Support
Considerations
No Pregnancy 1 Year
Hysterectomy
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3 mins
RhoGam [Rho(D) Immune Globulin]
Indications
Antepartum Prevention at 28 weeks
Suppress Antibody Production
Mechanism of Action
Lysis of Fetal RBC in Maternal Bloodstream
Side Effects
Myalgia and Lethargy
Considerations
Negative Coombs Test
Standard Dose 300 mcg
Microdose 50 mcg
Blood Product
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2 mins
Teratogens
Medications
ACE-Inhibitors: Kidney Damage
Aminoglycosides: Ototoxicity
Lithium: Ebstein Anomaly
Folate Antagonists: Neural Tube Defects
Substance Abuse
Cocaine: Low Birth Weight
Cocaine: Placental Abruption
Other
Vitamin A Excess: Spontaneous Abortion
Vitamin A Excess: Cleft Palate
X-Rays: Intellectual Disability
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4 mins
Potter Sequence
PATHOGENESIS
Oligohydramnios
clinical findings
Limb Deformities
Facial Anomalies
Pulmonary Hypoplasia (Most Common Cause of Death)
Etiologies
Autosomal Recessive Polycystic Kidney Disease (ARPKD)
Posterior Urethral Valves
Chronic Placental Insufficiency
Bilateral Renal Agenesis
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3 mins

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