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)
(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)
