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Lowdermilk: Maternity Nursing, 8th Edition

Chapter 21: Pregnancy at Risk: Gestational Conditions


Key Points Print
The four most common types of hypertensive disorders during pregnancy are
gestational hypertension, preeclampsia, chronic hypertension, and preeclampsia
superimposed on chronic hypertension.
Gestational hypertension is hypertension without proteinuria that develops after week 20
of gestation.
Preeclampsia is a condition in which hypertension and proteinuria develop after 20 weeks
of gestation in a previously normotensive woman. Preeclampsia complicates 3% to 7% of
all pregnancies.
Chronic hypertension is hypertension that begins before pregnancy or is diagnosed
before 20 weeks of gestation.
Preeclampsia superimposed on chronic hypertension increases morbidity for the
mother and fetus.
HELLP syndrome, a variant of severe preeclampsia, involves hepatic dysfunction
characterized by hemolysis (H), elevated liver enzymes (EL), and low platelets (LP).
With frequent maternal and fetal evaluation, a woman who has mild gestational
hypertension or mild preeclampsia may be managed at home.
Women diagnosed with severe gestational hypertension or severe preeclampsia should
be hospitalized for a 24-hour observation period.
Magnesium sulfate is the drug of choice for preventing and treating convulsions caused
by preeclampsia.
After a woman experiences preeclampsia the first time, the chances that she will
experience it in a future pregnancy increase sevenfold.
The pregnant woman with hyperemesis gravidarum may experience weight loss,
dehydration, electrolyte imbalances, nutritional deficiencies, and ketonuria.
Common bleeding disorders of early pregnancy include miscarriage (spontaneous
abortion), premature dilation of the cervix, ectopic pregnancy, and hydatidiform mole.
The signs and symptoms of miscarriage depend on the duration of pregnancy.
Medical management of recurrent premature dilation of the cervix includes bed rest,
pessaries, antibiotics, antiinflammatory drugs, and progesterone supplementation. Surgical
management consists of placing a cervical cerclage.
The three classic symptoms of ectopic (or tubal) pregnancy are abdominal pain, delayed
menses, and abnormal vaginal bleeding (spotting) 6 to 8 weeks after the last normal
menstrual period.
Hydatidiform mole, a benign proliferative growth of the placental trophoblast, occurs in 1
of every 1,000 pregnancies in the United States.
Mosby items and derived items 2010 by Mosby, Inc., an affiliate of Elsevier Inc.

Key Points Print

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The major causes of bleeding in late pregnancy are placenta previa and premature
separation of the placenta.
Severe preeclampsia, HELLP syndrome, and gram-negative sepsis can trigger
disseminated intravascular coagulation.
The most common medical complication of pregnancy is urinary tract infection.
A pregnant woman diagnosed with pyelonephritis should be admitted to the hospital
immediately and treated with IV antibiotics.
During pregnancy, the most common nongynecologic abdominal conditions requiring
surgery are appendicitis and symptomatic cholelithiasis.
Major trauma complicates about 8% of pregnancies, and trauma is the leading cause of
nonobstetric maternal death.
Motor-vehicle accidents account for most cases of blunt-force abdominal trauma during
pregnancy.
After a pregnant woman sustains trauma, the first priorities are to resuscitate her and
stabilize her condition. Fetal survival depends on maternal survival.
A pregnant woman may require cardiopulmonary resuscitation if she sustains
trauma or has an airway obstruction caused by choking.

Mosby items and derived items 2010 by Mosby, Inc., an affiliate of Elsevier Inc.