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.
 ○ 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 risks-
lacerations, 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?
 ○ 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 effect-
pulmonary 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..