Category: Maternal Neonatal Nursing Appendicitis is the most common surgical emergency in pregnant patients. The incidence of appendicitis in pregnant patients is the same as that in nonpregnant patients, but delays in diagnosis contribute to an increased rate of perforation.
Category: Maternal Neonatal Nursing Amniotic fluid embolus should be suspected during the second or third trimester of pregnancy, particularly in the setting of uterine manipulation or contraction, when a patient experiences sudden hypotension, hypoxia and coagulopathy.
Category: Maternal Neonatal Nursing Amniotic fluid embolus is the release of amniotic fluid into the maternal circulation during intense uterine contractions or uterine manipulation at areas of placental separation from the uterine decidua basalis (abruptio placentae).
Category: Maternal Neonatal Nursing In treating eclampsia, magnesium administration should be accompanied by clinical observation for loss of reflexes or respiratory depression. The infusion should be stopped if signs of hypermagnesemia are seen.
Category: Maternal Neonatal Nursing Eclamptic seizures are controlled in patients with doses of magnesium sulfate. Magnesium has little antihypertensive effect but is an effective anticonvulsant, preventing recurrent seizures while maintaining uterine and fetal blood flow.
Category: Maternal Neonatal Nursing Seizures and coma are the hallmarks of eclampsia, the ultimate consequence of preeclampsia. As in all seizure patients, hypoglycemia, drug overdose and other causes of seizures should be excluded with appropriate tests.
Category: Maternal Neonatal Nursing The patient who has severe preeclampsia should have an IV line and fetal monitoring initiated. Blood testing should include complete blood cell count, renal function studies, liver function tests, platelet count and coagulation profile.
Category: Maternal Neonatal Nursing The most dangerous complication is of preeclampsia is eclampsia - which is the occurrence of seizures or coma in the setting of preeclampsia. Warning signs for the development of eclampsia include headache, vomiting and visual disturbances.
Category: Maternal Neonatal Nursing The HELLP syndrome, a particularly severe form of preeclampsia, is characterized by hemolysis, elevated liver enzyme levels (alanine transaminase [ALT] and aspartate transaminase [AST]) and low platelet count.
Category: Maternal Neonatal Nursing Gestational hypertension or preeclampsia is a vasospastic disease of unknown cause unique to pregnant women. Vasospasm, ischemia and thrombosis are associated with preeclampsia and can cause injury.
Category: Maternal Neonatal Nursing Patients who have significant abruptio placentae may require early delivery - vaginal or surgical, depending on fetal status. If placenta previa is diagnosed or if abruptio placentae is considered mild, the patient is admitted for close monitoring.
Category: Maternal Neonatal Nursing Fetomaternal hemorrhage can occur with abruption. If the Rh-negative patient has not yet received her routine Rh immune globulin prophylaxis at 28 weeks, 300 µg of Rh immune globulin should be administered within 72 hours.
Category: Maternal Neonatal Nursing Blood loss requiring transfusion can occur in patients with placenta previa or abruptio placentae. Fresh-frozen plasma or fresh whole blood may be needed because of the coagulopathy associated with significant abruptio placentae.
Category: Maternal Neonatal Nursing Ultrasonography is the diagnostic procedure of choice for localization of the placenta and diagnosis of placenta previa. Accuracy is excellent, but visualization of the placenta and of the internal cervical os is required.
Category: Maternal Neonatal Nursing Most cases of placenta previa identified during the midtrimester resolve by the time of delivery as the lower uterine segment elongates and the placenta no longer overlaps the cervical os.
