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COMPLETE STUDY GUIDE FOR FIRST OBSTETRICS EXAM (VERIFIED) $11.99   Add to cart

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COMPLETE STUDY GUIDE FOR FIRST OBSTETRICS EXAM (VERIFIED)

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COMPLETE STUDY GUIDE FOR FIRST OBSTETRICS EXAM (VERIFIED)

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  • October 10, 2024
  • 39
  • 2024/2025
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COMPLETE STUDY GUIDE FOR FIRST OBSTETRICS EXAM
(VERIFIED)


Hypertensive Disorders of Pregnancy
Care of the Woman with Hypertensive Disorder
• Classifications

– Gestational Hypertension (>20 weeks) elevated BP that was not there prior to 20 weeks

– Chronic hypertension present before 20 weeks or when they were not pregnant

– Chronic hypertension with superimposed preeclampsia elevated BP prior to 20 weeks with
proteinuria

How is preeclampsia diagnosed? Elevated BP and proteinuria (24hr urine collection), unrelenting HA

– Pre-eclampsia (>20 weeks) without seizure

– Eclampsia patient has seizure, decreased oxygen during seizure for pt and baby

If pre-eclampsia worsens, how is it cured? Giving birth, at risk up to 2 weeks after

Hypertensive Disorders: Maternal Risks
• Maternal risks:

– Stroke- anti-hypertensive meds should be given to lower BP about 15% to prevent stroke, needs to be
checked within 15 min, decreases chance by 90% by giving meds

– Pulmonary edema

– Death

1. What patient complaint might be a “Red Flag” for preeclampsia? headache

2. Worsening pre-eclampsia will cause a marked increase of deep tendon reflexes. Why? check every hr
DTR; CNS is becoming more irritated causing increased DTR

Hypertensive Disorders: Fetal Risks
• Fetal-neonatal risks:

– Small for gestational age: SGA spiral artery not getting good blood flow

– Intra Uterine Growth Restriction: IUGR

– Placental abruption due to maternal hypertension

– Prematurity

– Over sedation due to maternal medications – magnesium sulfate

,– Intra Uterine Fetal Demise: IUFD

Preeclampsia: symptoms and nursing care
Clinical Manifestations and Diagnosis
Most common cause of maternal & fetal death

• Mild preeclampsia

– After 20 weeks, BP 140 mm Hg systolic or 90 mm Hg diastolic

– Proteinuria (3 g/24 hours)

• Severe preeclampsia (life-threatening)

– BP 160 mm Hg systolic or 100 mm Hg diastolic

– Proteinuria (5 g/24 hours)

– Elevated creatinine (>1.1 mg/dL)

• Underlying Cause: Vasospasms causing poor tissue perfusion

Hospital Care of Pre-eclampsia
• Mild preeclampsia

– Low activity, diet (well-balanced, high protein)

– Frequent monitoring for fetal and maternal well-being

• Severe preeclampsia

– Immediate hospitalization for treatment

– Possible early childbirth, foley catheter in

Hospital Care of Preeclampsia (cont’d)

• Rapid initiation of medication to lower BP

• Therapeutic goal – diastolic BP between 90-100 mm Hg

• Medications

– Labetalol (Trandate) IV

– Hydralazine (Apresoline) IV

– Nifedipine (Procardia) PO

– Magnesium Sulfate IV (4-7 mg/dl is therapeutic level) – prevent seizure, lowers BP short term; given for
at least 24hrs

-Antidote: Calcium Gluconate IV

,Eclampsia
• Occurrence of seizure or coma

• Treatment

– Magnesium sulfate

– Antihypertensive agents

• Observe fetal reaction to seizure

• Fetus should recover when mother stabilizes

• Give supplemental oxygen following seizure

Lab Diagnosis: HELLP Syndrome
• Hemolysis

• Elevated Liver enzymes

• Low Platelet count

Associated with severe preeclampsia

• Symptoms

– Nausea, vomiting, malaise, epigastric pain (liver), RUQ pain

– Results in anemia, thrombocytopenia, jaundice

– HELLP should be delivered regardless of gestational age!


Nageles’ Rule
Nägele’s Rule important to know

• Most common method of determining EDB

• First day of LMP, – 3 months, + 7 days, and (add 1 year if needed) = EDB

Nägele’s Rule Examples

A. Last Menstrual Period: Dec 18, 2013 = Sept 25, 2014
B. Last Menstrual Period: Jan 15, 2013 = Oct 22, 2013


Know How Determine Gravida and Para: TPAL
Pregnancy and Birth History

• Gravida – number of pregnancies including current pregnancy twins = 1 Gravida

, • Para– Birth after 20 weeks’ gestation, regardless of whether the infant is born alive or dead how many
births

– full Term – number of pregnancies delivered at 38.0 weeks or later

– Preterm – number of pregnancies delivered from 20 to 37.6 weeks

– Abortion – number of pregnancies ending in spontaneous or therapeutic abortion prior to 20.0

weeks

– Living Children– number of currently living children

(Consideration for more than 1 fetus)

Acronym “Florida Power And Light”

GTPAL Examples

A. May is 6 weeks pregnant. Her previous two pregnancies ended in live births at 41 weeks

G3 T2 P0 A0 L2

B. Sue is experiencing her fourth pregnancy. Her first pregnancy ended in a spontaneous abortion
at 8 weeks, the second resulted in the live birth of a son at 38 weeks, and the third resulted in
the live birth of a daughter at 34 weeks.

G4 T1 P1 A1 L2



Goodell’s, Chadwick’s, Hegar’s, and McDonalds Signs
More Objective (Probable Signs) Changes
• Hegar’s Sign: softening of the lower uterine segment

• Goodell’s Sign: Softening of the cervix

• Chadwick’s Sign: Blue-ish discoloring of the cervix, vagina, and labia due to increased blood flow


Know how to assess the fundal height and correlation with gestational age
Uterine Assessment

• Physical assessment

• Fundal height fetus grows about 1 cm each week- measure from top of pubic symphysis to top of
uterine fundus

Most accurate btwn 22-36 weeks; +/- 2cm is considered normal

– McDonald’s method (18-38 weeks gestation is accurate)

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