Test Review

Test Review 10?s On Breat Feeding • If the baby has galactosemia or PKU- no BF. Breast milk has high phenylalanine. Need to wait 24 hours before you go testing the babe, need to see if he/she can convert or not. • IgG- helps protects GI tract, mucus membranes, bacterial protection, passes on down from mama to baby… (can cross the placenta) • IgA-in breast milk, rich in colostrum • Breast milk has ore fat, more amino acids, more cholesterol. • Mom produces specific antibodies for that baby- different for each baby. 30? On High Risk Pregnancy • Around 4?s on diabetes • Around 4 ?s on PIH • Around 4?s on Rh • The rest will be on….previa, bleeding, molar, GBS, Abs, cardiac, etc.. • Ya gotta be Rh- or we don’t care. Therefore, eliminate if Mama is Rh +. ○ If baby is also Rh-… the problem is …nada. Rh- mom with Rh- babe… things are good. ○ If ya got a Rh- mama AND Rh + baby… look at the Coombs (antibodies on babys RBC) ○ Direct Coombs is the test on cord blood- on the baby ○ Around 28 weeks a indirect Coombs is done, we ae really wondering whats going on with baby, but can’t get to baby so we do the next best thing and check antibodies in mama’s blood ○ Rh- development of antibodies is bad, try to do everything you can to prevent that. Antibodies….bad. bad bad bad. ○ Passive immunity- RhoGam (theres a new generic name)…Rhogam gives her the antibodies so she doesn’t develop them herself… RhoGam will last for about 13 weeks, that’s why we give at 28 weeks. Gonna last until we know what baby is (RhoGam won’t hurt it, just helps it) ○ If baby is positive we give RhoGam again so she isn’t sensitized.

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○ Give any time there might be exchange of blood, external version, trauma, abruption, SAb, ectopic (need to screen for blood time), amnio. ○ If antibodies cross the placenta and attack babe this is called erythoblastosis fetalis….from here baby can have jaundice, anemia, hydrops fetalis, can cross blood brain barrier and have problems. ○ If she has been sensitized, RhoGam does her no good. Won’t give it if she has been sensitized….zero good. She would have a positive Indirect Coombs, previous baby… you can usually find out if she is sensitized. ○ Not sensitized? Give RhoGam within 72 hours- given IM, blood product so people who won’t take blood may refuse it. Forceps assisted birth…. there are indications- AND riskslacerations, bleeding, brusing on baby (which can lead to jaundice 1 ? on psychological disorders No substance abuse questions 1 ? on GBS Placenta Previa- painless, safety for previa no vag exam with vaginal bleeding. Low lying placenta. May have previous c-section scars Abruption. What can cause it? Trauma, cocaine, increased BP….Big abruption? Big Trouble- get her a c-section- get VS, FHT- late decels ( indicates baby too is in big trouble) HELLP PP hemorrhage is not tolerated well by anemic or PIH HEELP, Abruption, Fetal Demise, Missed abortion DIC. Abortion- loss of pregnancy before 20 weeks or under 500 g ○ Threatened- bleeding ( Ask her….How much? Recently have intercourse? How long?) If it seems significant- save everything that she has passed to look for products of conception. Just spotting? Lay down, rest… ○ Inevitable/imminent – cervix dilating, ROM, fetal demise ○ Missed- IUFD that was not passed—this can cause DIC. ○ Complete/Incomplete  Incomplete POC’s haven’t passed Ectopic- one sided pain, referred to shoulder, sometimes blue around navel?

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○ You are worried about rupture. Major sign wouldn’t be vaginal bleeding , although it can happen- but its internal bleeding that you are worried about. ○ Methotrexate if less than 3.5 cm… baby will abort. ○ Risk factors- PID, STI, infections…. Anything that will narrow the tube. Will get postive preg. test, however hormone levels may not be as high. GBS- organism found in women- asymptomatic. Usu will cause no problems to woman at all , problems comes with infection in baby as he comes through birth canal. Test her at 35 weeks, that way you will know results at labor. If she is positive, she will be placed on IV antiobiotics- need four hours on board to kill GBS in vagina. Malpresentation- breech (prob c-section) 1 ? on version ( try to get transverse to turn) MgS04 Pit PTL medication ○ Terbutaline- contraindications- her pulse will go up and needs to be stopped if over 120, adverse effectpulmonary edema Diabetes ○ GDM- 1 hour glucose screening (50g, cut off level 130) if over level 3 hour GTT (Do you need to fast? will you have an IV? – look in notes. Will get consult with diabetic specialist if needed) ○ Meal pattern? 3 regular meal, 3 snacks- constant source of glucose to fetus. ○ Insulin resistance- she still makes it, but isn’t getting into her cells. Insulin doesn’t cross placenta (neither does heparin)- baby is still gonna produce insulin though, and that’s how baby becomes hyperinsulinism. ○ Risks to babemacrosomia, and hypoglycemia after birth, shoulder dystocia ○ Pre-exisiting diabetic the risks are genetic anomalies (hyperglycemia in first few weeks), macrosomic, microsomic. Uterine atonymassage If you can fix the problem- fix it. When do you stop mag? ○ RR less than 12, absent DTRs, decreased UOP below 30- first thing to go are reflexes. ○ Antecdote- calcium gluconate.

○ Stop Mag- don’t be too quick to jump to giving cal.gluconate unless her RR are like 4. • Drugs? Wise to know expected effect, side effect, reverse effect. ○ Example : Terbutaline- side effect increase HR, reverse effect would be pulmonary edema, used for PTL • PTL- watching for infection- chorioamniotis. Mama would have fever, tenderness, change in blood work, do vitals often! • If mom has PROM, don’t always rush off to go to deliver, if that baby isn’t term ya want to keep that baby in. 5?s On infertility • Sperm analysis, hormone levels, patent tubes 5? On module- 5 different questions • You can still BF with a cleft palate ( who knew… totally thought that they would aspirate)

***Tips when studying pregnancy complications: what it is, what is the cause, risk, how it presents, treatment, nursing care. ComplicationsGBS, Abs, PTL, PROM, Cardiac, Sickle Cell, Diabetes, PIH….that’s not all of them though..