Complications in Pregnancy

Pregnancies are not always without complications and women with other medical complications get pregnant. In these instances, extra education, fetal survellance, and antepartum testing is necessary. This module will review some of the common issues that can complicate pregnancy.

Study Worksheets

worksheet PN complications.pdf

Let's Practice

The nurse is reviewing the laboratory test results of a pregnant client. Which one of the following findings would alert the nurse to the development of HELLP syndrome?

Hyperglycemia
Elevated platelet count
Leukocytosis
Elevated liver enzymes

Elevated liver enzymes

A woman hospitalized with severe preeclampsia is being treated with hydralazine to control blood pressure. Which of the following would the lead the nurse to suspect that the client is having an adverse effect associated with this drug?

Gastrointestinal bleeding
Blurred vision
Tachycardia
Sweating

Tachycardia

A woman is receiving magnesium sulfate as part of her treatment for severe preeclampsia. The nurse is monitoring the woman's serum magnesium levels. Which level would the nurse identify as therapeutic?

3.3 mEq/L
6.1 mEq/L
8.8 mEq/L
10.8 mEq/L

6.1 mEq/L

A nurse is assessing a pregnant woman with gestational hypertension. Which of the following would lead the nurse to suspect that the client has developed severe preeclampsia?

Urine protein 300 mg/24 hours
Blood pressure 150/96 mm Hg
Mild facial edema
Hyperreflexia

Hyperreflexia

After reviewing a client's history, which factor would the nurse identify as placing her at risk for gestational hypertension?

Mother had gestational hypertension during a previous pregnancy.
Client has a twin sister.
Sister-in-law had gestational hypertension.
This is the client's second pregnancy.

Mother had gestational hypertension during a previous pregnancy.

A woman with placenta previa is being treated with expectant management. The woman and fetus are stable. The nurse is assessing the woman for possible discharge home. Which statement by the woman would suggest to the nurse that home care might be inappropriate?

"My mother lives next door and can drive me here if necessary."
"I have a toddler and preschooler at home who need my attention."
"I know to call my health care provider right away if I start to bleed again."
"I realize the importance of following the instructions for my care."

"I have a toddler and preschooler at home who need my attention."

A nurse suspects that a pregnant client may be experiencing abruption placenta based on assessment of which of the following? (Select all that apply.)

Dark red vaginal bleeding
Insidious onset
Absence of pain
Rigid uterus
Absent fetal heart tones

Dark red vaginal bleeding
Rigid uterus

Which of the following would the nurse have readily available for a client who is receiving magnesium sulfate to treat severe preeclampsia?

Calcium gluconate
Potassium chloride
Ferrous sulfate
Calcium carbonate

Calcium gluconate

Let's Practice! Case Study

Adelita is a 28yo G2 P 0010 who is 18 weeks 4 days pregnant and presents to triage complaining of vaginal bleeding. Her obstetrician is Dr. Sussey. What other questions would you ask her to determine the cause? (Select all that apply - there are 3 answers)

Are you having pain?
When was your last period?
What color is the bleeding?
When did the bleeding begin?

Are you having pain? - to differentiate between placenta previa and placenta abruption
What color is the bleeding? - to determine if it is actively bleeding or old blood
When did the bleeding begin? - to determine potentially how much bleeding has occurred, identify the timeline of the occurrence.

Adelita stated she had bright red vaginal bleeding that began 2 hours ago. She is not having pain. An ultrasound was performed at the bedside and shows the placenta covers the cervix and this is causing the bleeding.

Placental Abruption
Prolapsed Umbilical Cord
Placenta Previa
Incompetent cervix

Placenta Previa

Fetal Image: <a href="https://www.freepik.com/free-vector/hand-drawn-fetal-development-set_21077206.htm#fromView=search&page=1&position=12&uuid=eed3f8b3-6b2d-4996-a570-e78b1e453eba">Image by freepik</a>

Blood Drop image: <a href="https://www.freepik.com/free-vector/red-blood-drop_136471761.htm#fromView=search&page=1&position=4&uuid=5b324abc-2961-45cd-842c-3a234c03cb65">Image by studiogstock on Freepik</a>

Match the above diagnosis with the correct image

The last image is placenta previa. Other images include:

Cervical cerclage for incompetent cervix
Prolapsed Umbilical Cord
Placental Abruption (aka Abruptio Placenta)

Adelita's pregnancy was sent home with placenta previa and the bleeding has stopped. Her pregnancy has progressed and she is about to do a Gestational Diabetes screening. When during pregnancy is the best time to do a Gestational Diabetes Screening?

Between 10-14 weeks
Between 24-28 weeks
Between 32-34 weeks
Between 35-37 weeks

Between 24-28 weeks

What testing is done to screen for Gestational Diabetes?

Fasting Blood Sugar
Hemoglobin A1C
1 hour glucose screen
3 hour glucose tolerance test (GTT)

1 hour glucose screen
If the 1 hour glucose screen is abnormal, the 3 hour glucose tolerance test (GTT) will be done. If there are 2 abnormal values, the patient will be diagnosed withgestational diabetes

What else is checked at the same time as the Gestational Diabetes Screen?

Group B Strep Culture
CBC for anemia and platelets
Cell Free DNA
Genetic Carrier Testing

CBC for anemia and platelets

Adelita passed her Gestational Diabetes Screen and her Hemoglobin, Hematocrit, and Platelets are all within normal limits.

Dr. Sussey wants to recheck the placenta previa that she had. How is that done and what findings is he looking for?

1. Abdominal Ultrasound

2. Xray

3. MRI

4. Blood sampling

A. Mother's Blood Type

B. That the anatomy of the baby is normal

C. That the placenta has moved away from the cervix

D. That there is good blood flow through the placenta

1. Abdominal Ultrasound

C. That the placenta has moved away from the cervix

When is the last time we check to make sure everything is resolved with the Placenta Previa?

40 weeks
36 weeks
34 weeks
32 weeks

36 weeks - if placenta previa is still present at 36 weeks, a cesarean section will be scheduled

Adelita's ultrasound showed the placenta has moved away from the cervix and she is cleared for a vaginal delivery.

Adelita is now 36 weeks gestation and comes for her normal prenatal visit. What testing is done at this time for all women?

HIV screening
Gonorrhea and Chlamydia
Hemoglobin and Hematocrit
Group B Strep Screening

Group B Strep Screening is done for all women
Some populations who are high risk may be screened again for STIs at 36 weeks
People who have had issues with anemia may be rescreened for their H&H at 36 weeks

At her visit her blood pressure is 150/92. What other assessments would you want to do? (select all that apply)

Headache
Visual Changes
Protein in the urine
Glucose in the urine
Deep Tendon Reflexes
Generalized edema
Pedal edema

Headache
Visual Changes
Protein in the urine
Deep Tendon Reflexes
Generalized edema
Right Upper Quadrant Abdominal Pain would also be assessed

She denies any of the above symptoms. What is likely Adelita's problem?

Gestational Hypertension
Eclampsia
HELLP syndrome
Toxoplasmosis infection

Gestational Hypertension
Gestational Hypertension with severe features would indicate she is having the symptoms of worsening blood pressure. It is also known as Preeclampsia or Pregnancy Induced Hypertension (PIH)
Eclampsia occurs when the features are severe enough to cause seizures
HELLP syndrome occurs when the features are severe enough to cause organ damage
Toxoplasmosis infection is a transplacental infection and not related to blood pressure

Adelita is sent to Labor and Delivery from the office a week later. Her BP here is 158/90, DTR 2+, Urine Protein 3+, Pitting edema in ankles 2+, Headache with a pain scale of 5/10, and she is seeing some spots in her eyes.

Dr. Sussey decided to induce labor due to her Gestational Hypertension with severe features. What medication will Adelita be given for this specific condition? Why is it given?

Penicillin
Magnesium Sulfate
Pitocin
Cytotec

To induce labor
To prevent seizures
To prevent infection
To alleviate the headache

Magnesium Sulfate is given to people with Gestational Hypertension with severe features to help prevent seizure activiry and provides some neuroprotection for the fetus
Penicillin is given for people who are positive for vaginal Group B Strep to prevent infection to the infant
Pitocin is given to stimulate uterine contractions for induction of labor
Cytotec is given to ripen the cervix and stimulate uterine contractions for induction of labor

What medication should you have on hand in the event that Adelita gets too much of this medication and becomes toxic? What is the typical concern/ symptom of toxicity?

1. Calcium Gluconate

2. Vitamin K

3. Narcan

4. Cervidil

A. Full body rash

B. Hypotension

C. Jitteriness

D. Respiratory depression

1. Calcium Gluconate is given for magnesium toxicity - Respiratory depression is the complication from magnesium

2. Vitamin K is given to the newborn to help with blood clotting until they can make it on their own

3. Narcan is given for respiratory depression due to narcotics

4. Cervidil is given to ripen the cervix for induction of labor

Adelita delivered a healthy baby boy!

Congratulations to her and you for completing this Case Study!!

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