Chapter 28

Topics: Obstetrics, Blood, Pregnancy Pages: 22 (5882 words) Published: December 4, 2013
Chapter 28: Care of the High-Risk Mother, Newborn, and Family with Special Needs High-risk pregnancy
One in which the life or health of the mother or the infant is jeopardized by a d/o that is associated with or exists at the same Morbidity
State of being diseased
Mortality
Quality or state of being subject to death
Classifications of high-risk factors of pregnancy
Biophysical, Psychosocial, Sociodemographic, Environmental
Biophysical
Genetic considerations, nutritional status, medical and obstetric d/o Psychosocial
Smoking, caffeine, alcohol, drugs, psychological status
Sociodemographic
Low income, Lack of prenatal care, Age, Parity, Marital status, Residence, Ethnicity Environmental
Infections, radiation, chemicals such as pesticides, therapeutic drugs, illicit drugs, industrial pollutants, and cigarrette smoke Hyperemesis gravidarum
AKA pernicious vomiting
When a woman vomits so much during pregnancy that it causes electrolyte, metabolic, and nutritional imbalances Although morning sickness is common, this is a serious problem Multifetal pregancy
Pregnancy involving twins occurs in approximately 1 of 85 births in the US Triplets occur in approximately 1 in 8100 births
Pregnancies involving more than three fetuses are even rarer Women carrying three or more embryos often took fertility drugs Twins are classified as monozygotic and dizygotic
Monozygotic twins
Begin with one fertilized ovum; the embryonic disc divides, causing identical twins Because the genetic message is identical, the twins are of the same sex and carry an identical genetic code They sometimes share a placenta, but each has a separate umbilical cord Dizygotic twins

The result of two separate ova being fertilized at the same time These twins almost always have separate placentas
The sexes can be different, and the genetic makeup varies; they are no more closely related than siblings born at different times This type of twins may be hereditary in some families, presumably because the woman inherited a tendency to release more than one ovum per cycle An incomplete separation of the embryonic disk can result in conjoined (Siamese) twins Many twin pregnancies and almost all with more than two fetuses require a cesarean delivery Hydatidiform Mole

AKA molar pregnancy
A gestational trophoblastic disease
Come in two distinct types: complete (or classic) mole and partial mole Complete (classic) mole
Results from fertilization of an egg whose nucleus has been lost or inactivated The nucleus of a sperm (23X) duplicates itself resulting in the diploid number 46X because the ovum has no genetic material or the material is inactive The mole resembles a bunch of white grapes

The fluid filled vesicles grow rapidly, causing the uterus to be larger than expected for the duration of pregnancy Any symptoms of GH before 20 weeks of gestation may suggest a hydatidiform mole Ectopic Pregnancy

Implantation occurs somewhere other than within the uterus, most commonly in the fallopian tube Incidences are higher in woman who are non-white and older, particularly those over 35 The rapid increase is attributed to the growing number of women of childbearing age who have fallopian tubes scarred by pelvic infection, inflammation, surgery, STIs Vaginal bleeding occurs in 95% of cases

The vaginal discharge is dark brown (resembling prune juice) or bright red and either scant or profuse It may continue for a few days or off and on for a few weeks Anemia from blood loss, excessive n/v, and abdominal cramps caused by uterine distention are relatively common findings Saplingectomy

Removal of the fallopian tube
Salpingostomy
Repair of the fallopian tube
Methotrexate
This has been effective in treating unruptured ectopic pregnancy It is a folic acid antagonist that has been used for years to treat actively proliferating trophoblastic disease It destroys the rapidly dividing cells

Complete Hydatidiform Mole
The patient may have slight vaginal bleeding and...
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