MATERNITY EXAM NOTES
DOWNLOAD TO SCORE A
Asthma
- Asthma complicates 3-5% of pregnancies.
- Some women experience worsening of their symptoms while others see improvements.
- Complications from asthma include:
o Antepartum and postpartum hemorrhage
o Pulmonary embolism
o Miscarriage
- Treatment goals in pregnancy are to optimize control and limit exacerbations.
- Nurses should encourage women to take their asthma medications, stop smoking, and
evaluate asthma exacerbations with continuous pulse oximetry.
- While dyspnea is common in pregnancy, an asthma exacerbation may be recognized by
dyspnea with wheezing or cough.
Question #1
- A pregnant woman with an asthma exacerbation tells the nurse she stopped taking her
medication because she didn’t want it to affect her baby. What is the best response by
the nurse?
o A. “You are right to stop taking any medications while you are pregnant.”
o B. “You should still take your asthma medication while you are pregnant to
help control your asthma.”
o C. “You should only take your asthma medications when you have
an exacerbation.”
o D. “You probably won’t need your medication because asthma always
improves with pregnancy.”
- B- Asthma treatment goals during pregnancy are to optimize control and limit
exacerbations. Asthma improves during pregnancy in some woman and gets worse with
others. The patient should continue taking medications as ordered during her pregnancy,
, MATERNITY EXAM NOTES
DOWNLOAD TO SCORE A
regardless if she experiences an exacerbation.
Epilepsy
- About 1% to 2% of people have epilepsy
- Children of mothers with epilepsy are at increased risk for developing a seizure disorder.
- While most pregnancies are uneventful, complications due to epilepsy include
preeclampsia, preterm labor, and fetal death.
- Increased risk of congenital anomalies in women who take antiseizure medications
during their pregnancy.
- Nurses should teach patients to take antiseizure medications despite risks to fetus and to
avoid individual seizure triggers.
- Women on antiseizure medications should 4 mg folic acid daily, beginning 3
months before conception.
- Infants of mothers who take antiseizure medications are at increased risk for bleeding.
, MATERNITY EXAM NOTES
DOWNLOAD TO SCORE A
Thyroid Conditions
- Hypothyroidism (0.3% to 0.5 of pregnancies) can cause preeclampsia, postpartum
hemorrhage, and early pregnancy loss.
- Treatment includes levothyroxine (a T4 replacement) adjusted based on TSH levels
every 4 weeks to 3 months.
- Medication dose adjustments are typically required more frequently in ealy pregnancy
than later pregnancy.
- Women should be taught to take levothyroxine first thing in the morning and on an
empty stomach with no further oral intake for one hour.
- Hyperthyroidism (0.1% to 0.4% of pregnancies) may cause pregnancy loss, low
birth weight, and maternal heart failure.
- Treatment involves the suppression of thyroid hormone synthesis with a class of
medications called thioamides.
o Thioamides cross the placenta, suppress fetal thyroid hormone synthesis, and
have been associated with fetal anomalies.
o Goal is to control hyperthyroidism and hypothyroidism
- The nurse should encourage consistent medication use.
Pregestational Diabetes
- Ideally women with pregestational diabetes should receive preconception care and
achieve excellent glycemic control prior to attempting pregnancy
- Pregestational diabetes risks include
o Preeclampsia
o Perinatal death
o Macrosomic fetus
o Congenital anomalies
o Polyhydramnios
o Fetal loss
, MATERNITY EXAM NOTES
DOWNLOAD TO SCORE A
o Preterm birth
- First trimester assessments:
o Hemoglobin A1c
o Women with diabetes will have an evaluation of baseline kindey function with a
24-hour urine collection
o She may also have a screening of her thyroid, heart, and eyes during the first
trimester
- Second and third trimester assessments:
o Vasculopathy may be evidenced by fetal growth restriction
o Antepartum testing for fetal well-being usually begins between 32- and 34-
weeks’ gestation and may include:
▪ Nonstress test
▪ Biophysical profiles
▪ Contraction stress tests
DOWNLOAD TO SCORE A
Asthma
- Asthma complicates 3-5% of pregnancies.
- Some women experience worsening of their symptoms while others see improvements.
- Complications from asthma include:
o Antepartum and postpartum hemorrhage
o Pulmonary embolism
o Miscarriage
- Treatment goals in pregnancy are to optimize control and limit exacerbations.
- Nurses should encourage women to take their asthma medications, stop smoking, and
evaluate asthma exacerbations with continuous pulse oximetry.
- While dyspnea is common in pregnancy, an asthma exacerbation may be recognized by
dyspnea with wheezing or cough.
Question #1
- A pregnant woman with an asthma exacerbation tells the nurse she stopped taking her
medication because she didn’t want it to affect her baby. What is the best response by
the nurse?
o A. “You are right to stop taking any medications while you are pregnant.”
o B. “You should still take your asthma medication while you are pregnant to
help control your asthma.”
o C. “You should only take your asthma medications when you have
an exacerbation.”
o D. “You probably won’t need your medication because asthma always
improves with pregnancy.”
- B- Asthma treatment goals during pregnancy are to optimize control and limit
exacerbations. Asthma improves during pregnancy in some woman and gets worse with
others. The patient should continue taking medications as ordered during her pregnancy,
, MATERNITY EXAM NOTES
DOWNLOAD TO SCORE A
regardless if she experiences an exacerbation.
Epilepsy
- About 1% to 2% of people have epilepsy
- Children of mothers with epilepsy are at increased risk for developing a seizure disorder.
- While most pregnancies are uneventful, complications due to epilepsy include
preeclampsia, preterm labor, and fetal death.
- Increased risk of congenital anomalies in women who take antiseizure medications
during their pregnancy.
- Nurses should teach patients to take antiseizure medications despite risks to fetus and to
avoid individual seizure triggers.
- Women on antiseizure medications should 4 mg folic acid daily, beginning 3
months before conception.
- Infants of mothers who take antiseizure medications are at increased risk for bleeding.
, MATERNITY EXAM NOTES
DOWNLOAD TO SCORE A
Thyroid Conditions
- Hypothyroidism (0.3% to 0.5 of pregnancies) can cause preeclampsia, postpartum
hemorrhage, and early pregnancy loss.
- Treatment includes levothyroxine (a T4 replacement) adjusted based on TSH levels
every 4 weeks to 3 months.
- Medication dose adjustments are typically required more frequently in ealy pregnancy
than later pregnancy.
- Women should be taught to take levothyroxine first thing in the morning and on an
empty stomach with no further oral intake for one hour.
- Hyperthyroidism (0.1% to 0.4% of pregnancies) may cause pregnancy loss, low
birth weight, and maternal heart failure.
- Treatment involves the suppression of thyroid hormone synthesis with a class of
medications called thioamides.
o Thioamides cross the placenta, suppress fetal thyroid hormone synthesis, and
have been associated with fetal anomalies.
o Goal is to control hyperthyroidism and hypothyroidism
- The nurse should encourage consistent medication use.
Pregestational Diabetes
- Ideally women with pregestational diabetes should receive preconception care and
achieve excellent glycemic control prior to attempting pregnancy
- Pregestational diabetes risks include
o Preeclampsia
o Perinatal death
o Macrosomic fetus
o Congenital anomalies
o Polyhydramnios
o Fetal loss
, MATERNITY EXAM NOTES
DOWNLOAD TO SCORE A
o Preterm birth
- First trimester assessments:
o Hemoglobin A1c
o Women with diabetes will have an evaluation of baseline kindey function with a
24-hour urine collection
o She may also have a screening of her thyroid, heart, and eyes during the first
trimester
- Second and third trimester assessments:
o Vasculopathy may be evidenced by fetal growth restriction
o Antepartum testing for fetal well-being usually begins between 32- and 34-
weeks’ gestation and may include:
▪ Nonstress test
▪ Biophysical profiles
▪ Contraction stress tests
