1M ANTENATAL Flashcards
1
Q
is a method of terminating a pregnancy
A
Abortion
2
Q
embryo or fetus, as well as the placenta, are removed from the uterus using medicine or surgery
A
Abortion
3
Q
Common Risk Factors of Abortion (MASSCIS)
A
- Maternal age
- Alcohol consumption
- Smoking
- Substance abuse
- Chronic diseases (diabetes, autoimmune
conditions) - Infections
- Structural uterine abnormalities
4
Q
T/F: About 50% cases of early pregnancy loss is believed to be due to fetal chromosomal abnormalities.
A
TRUE
5
Q
Options for Abortion: 1st Trimester
A
- Medical Abortion
- Vacuum Aspiration
6
Q
Requires the woman to take mifepristone and misoprostol
A
Medical Abortion
7
Q
Inhibits the development of pregnancy
A
Mifepristone
8
Q
Causes the uterus to empty, occurs 1-4hrs after the pill is taken
A
Misoprostol
9
Q
Risks/Side effects of Medical Abortion
A
- Nausea
- Heavy Vaginal Bleeding
- Dizziness
- Diarrhea
- Fatigue
- Mild Fever
10
Q
Advantages of Medical Abortion
A
- Doesn’t involve surgery
- Available for the first trimester
- Doesn’t require anesthetic
11
Q
Disadvantages of Medical Abortion
A
- Not available for the second trimester
- Only part of the treatment takes place in a clinic
- May cause painful cramping
12
Q
Type of surgical abortion in which a pregnancy is terminated by using gentle suction.
A
Vacuum Aspiration
13
Q
A speculum is first inserted into the woman’s vagina to start the procedure. Then, before placing a tube into the uterus, the medical personnel will use thin rods called dilators to open the cervix. After that, the uterus is evacuated using a mechanical or manual suction equipment.
A
Vacuum Aspiration
14
Q
Recovery for Vacuum Aspiration
A
- Rest for an hour after treatment
- Take antibiotics to prevent infection
- Avoid sex for 1 week
15
Q
Risks/Side effects of Vacuum Aspiration (B&C)
A
Bleeding and Cramping
16
Q
Advantages of Vacuum Aspiration
A
- Available in the first 12 weeks of pregnancy
- Quick procedure (5-10mins)
- Pain-free
- Does not require a general anesthesia
17
Q
Disadvantages of Vacuum Aspiration
A
Not available in the second trimester
18
Q
Options for Abortion: 2nd Trimester
A
- Dilatation and Evacuation
- Labor Induction Abortion
- Incomplete Release of Pregnancy Tissue
19
Q
A type of surgical abortion that is commonly used by doctors. Usually recommended between 14 and 24 weeks.
A
Dilatation and Evacuation
20
Q
A general anesthesia may be given as this type of anesthetic ensures that a person does not feel anything during the procedure.
A
Dilatation and Evacuation
21
Q
The doctor begins by inserting a speculum into the woman’s vagina. Then, they use dilators to open the cervix. Next, they remove the pregnancy tissue with small forceps. Lastly, they use suction to remove any remaining tissue. This procedure takes about 10-20
minutes.
A
Dilatation and Evacuation
22
Q
Recovery for Dilatation and Evacuation
A
A few hours of rest is advised
23
Q
Risks of Dilatation and Evacuation (IHI)
A
- Infection
- Heavy Bleeding
- Injury to the Uterus
24
Q
Advantages of Dilatation and Evacuation
A
It is safe and effective
25
Disadvantages of Dilatation and Evacuation
Requires a general anesthesia
26
A late-term method of ending a pregnancy in the second or third trimester
Labor Induction Abortion
27
A procedure reserved for when there is a medical complication/s detected to the fetus or the mother that may pose a threat to their life.
Labor Induction Abortion
28
Involves using medications to start labor, which causes the uterus to empty over a period of around 12–24 hours.
Labor Induction Abortion
29
A woman can take these medications by mouth or the
doctor may place them into the vagina or inject them into the uterus.
Labor Induction Abortion
30
Recovery of Labor Induction Abortion
Remain in the clinic or hospital for a few hours to 1-2 days
31
Risks of Labor Induction Abortion
- Nausea and vomiting
- Fever
- Diarrhea
- Hemorrhage
- Cervical injury
- Infection
- Rupture of the uterus
32
Commonly performed for pregnancies with birth defects or pregnancy complications.
Incomplete Release of Pregnancy Tissue
33
The process often begins with an
injection to stop the fetal heartbeat.
Incomplete Release of Pregnancy Tissue
34
The skin on the abdomen is numbed with a painkiller, and then a needle is used to inject a medication (digoxin or potassium chloride) through the abdomen into the fluid around the fetus or the fetus to stop the heartbeat.
Incomplete Release of Pregnancy Tissue
35
Medication is then given to start contractions and to cause the cervix to dilate. One medication (Misoprostol) can be taken by mouth or put in the vagina. Another medication (Pitocin) which is administered through IV.
Incomplete Release of Pregnancy Tissue
36
Recovery of Incomplete Release of Pregnancy Tissue
Depend on the client's health. Some women stay for a few hours and other women stay for 1-2 days.
37
Risks of Incomplete Release of Pregnancy Tissue
- Infection
- Heavy bleeding
- Hole or tear in the wall of the uterus
- Injury to the cervix
- Fail induction
38
Signs and Symptoms of Abortion (VSSCFD)
- Vaginal spotting
- Scant and bright red vaginal bleeding
- Slight cramping
- Cervical dilatation
- Fever
- Depression
39
- if vaginal spotting is present, pregnant woman should immediately notify healthcare provider
- Be aware of the guidelines in assessing bleeding during pregnancy
- ask pregnant woman’s action before spotting or bleeding occurred and identify the measures she did when first noticed the bleeding
- Inquire of the duration and intensity of the bleeding or pain felt.
- identify the client’s blood type for cases of Rh incompatibility.
Nursing Management of Abortion
40
- Medical interventions should also be incorporated in the patient’s care plan to reinforce his treatment.
- physicians would also have to order a series of therapeutic management for the pregnant woman.
- Administration of intravenous fluids. Such as Lactated Ringer’s, IV therapy should be anticipated by the nurse as well as administration of oxygen regulated at 610L/minute by a face mask to replace intravascular fluid loss and provide adequate fetal oxygenation.
- physician would also avoid further vaginal examinations to avoid disturbing the products of conception or triggering cervical dilatation.
- physician might also order an ultrasound examination to glean more information about the fetal and also maternal well-being.
Medical Management of Abortion
41
- Oral mifepristone (Mifeprex) and oral misoprostol (Cytotec). These medications are usually taken within seven weeks of the first day of your last period. Mifepristone blocks the hormone progesterone, causing the lining of the uterus to thin and preventing the embryo from staying implanted and growing. Misoprostol causes the uterus to contract and expel the embryo through the vagina.
- Oral mifepristone and vaginal, buccal or sublingual misoprostol. The vaginal, buccal or sublingual approach lessens side effects and may be more effective. taken within nine weeks of the first day of your last period.
- Methotrexate and vaginal misoprostol. Methotrexate (Otrexup, Rasuvo, others) is rarely used for elective, unwanted pregnancies, although it's still used for pregnancies outside of the uterus (ectopic pregnancies). take up to a month for methotrexate to complete the abortion. Methotrexate is given as a shot or vaginally and the misoprostol is later used at home.
- Vaginal misoprostol alone can be effective when used before nine weeks of gestation of the embryo. But vaginal misoprostol alone is less effective than other types of medical abortion.
Pharmacologic Management of Abortion
42
- Dilatation and evacuation. physician must be sure that no fetal heart sounds could be heard anymore and the ultrasound must show an empty uterus.
- Dilation and curettage. performed for incomplete abortions to remove the remainder of the products of conception from the uterus.
Surgical Management of Abortion
43
Occurs during the middle or early third trimester, depending on the severity of the insufficiency
Etiology/Cause of Incompetent Cervix
44
Also called cervical insufficiency, occurs when weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy. May be congenital or acquired
Incompetent Cervix
45
Cervix opens too quickly which may force them to deliver their child early
Incompetent Cervix
46
Defect in the embryological development of Mullerian ducts
Most common congenital cause of Incompetent Cervix
47
Cervical lacerations during childbirth, cervical conization, or forced cervical dilatation during the uterine evacuation in the first or second trimester
Most common acquired cause of Incompetent Cervix
48
Conditions that cause incompetent cervix (APSDE)
- Abnormally formed uterus or cervix
- Previous cervix surgery
- Short cervix
- Damaged uterus from previous miscarriage or childbirth
- Exposure to diethylstilbestrol (DES), a synthetic (human-made) hormone given to some women in the past to help them have successful pregnancies.
49
Signs and Symptoms of Incompetent Cervix (SMAL)
Signs and Symptoms start between 14th-20th week such as spotting and discomfort
- Sensation of pelvic pressure, a new backache
- Mild abdominal cramps
- A change in vaginal discharge
- Light vaginal bleeding
50
- Conduct an interview to ask the patient, who is experiencing painless bleeding, if she is having an intense pressure on her pelvis.
- Determine if the woman is experiencing true contractions to prepare for the birth of the fetus.
- Inspect and save pads used by the woman during bleeding to determine any clots or tissues that already passed out.
Nursing Management of Incompetent Cervix
51
- Determine certain factors that can further contribute to the anxiety of the patient so that it can be avoided.
- Monitor vital signs in order to determine any physical responses of the patient that could affect her current condition.
- Show empathy and establish a therapeutic nurse-client relationship so that the patient will be able to express her feelings freely.
- Provide simple and accurate information about the situation to aid the patient in addressing her concerns.
Nursing Interventions for Incompetent Cervix
52
The physician will not include medications that could prevent the dilation of a woman’s cervix.
Medical Management of Incompetent Cervix
53
Having a history of premature birth, the physician could suggest the patient to take weekly shots of the hormone progesterone in a form called hydroxyprogesterone caproate (Makena) during the second and third trimester.
Pharmacologic Management of Incompetent Cervix
54
Surgical Management of Incompetent Cervix
- McDonald’s Cervical Cerclage
- Shirodkar Cervical Cerclage
55
Nylon sutures are placed horizontally and vertically across the cervix. They are pulled back together until the cervical canal is only a few millimeters in diameter.
McDonald’s Cervical Cerclage
56
Sterile tape is used for this technique, where it is threaded in a purse-string manner under the submucous layer of the cervix. Then, it is sutured in place so it would close the cervix.
Shirodkar Cervical Cerclage
57
The sutures used in this management are removed on the 37th/38th week of pregnancy for the fetus to be born vaginally.
Surgical Management of Incompetent Cervix
58
This is not appropriate for everyone at risk of premature birth and the procedure is not recommended for women carrying twins or more.
Cervical Cerclage (Surgical Management of Incompetent Cervix)
59
Occurs when a fertilized egg implants and grows outside the main cavity of the uterus. Occurs in a fallopian tube in most cases.
Ectopic Pregnancy
60
This is a lifethreatening condition as the pregnancy cannot be carried to term and can be dangerous for the mother if not immediately treated.
Ectopic Pregnancy
61
Happens when a fertilized egg gets stuck on its way to the uterus because of an obstruction.
Etiology/Cause of Ectopic Pregnancy
62
Etiology/Cause of Ectopic Pregnancy (ACSUHEA)
- Adhesion of the fallopian tube from a previous infection (chronic salpingitis or pelvic inflammatory disease)
- Congenital malformations
- Scars from tubal surgery
- Uterine tumor pressing on proximal end of tube
- Hormonal imbalances
- Endometriosis
- Abnormal development of the fertilized egg
63
Types of Ectopic Pregnancy (THICCACOI)
- Tubal Ectopic Pregnancy
- Heterotopic Pregnancy
- Interstitial Pregnancy
- Cesarean Scar Pregnancy
- Cervical Pregnancy
- Abdominal Pregnancy
- Cornual Pregnancy
- Ovarian Pregnancy
- Intramural Pregnancy
64
This type is the most common and makes up 95% of ectopic pregnancies It occurs in the Fallopian tube.
Tubal Ectopic Pregnancy
65
3% of ectopic pregnancies are this type. It occurs in the part of the Fallopian tube that crosses into the uterus.
Interstitial Pregnancy
66
A rare case and occur when the fertilized egg implants into the gap in the muscle of the uterus caused by a previous Cesarean section. The pregnancy may then grow out of the uterus or onto the cervix and cause torrential internal or vaginal bleeding.
Cesarean Scar Pregnancy
67
Cervical pregnancies occur on the cervix and are one of the rarest forms of ectopic pregnancy. This type is thought to be of special concern because of the risk of life-threatening vaginal hemorrhage.
Cervical Pregnancy
68
This is another rare type of ectopic that only occurs in a uterus that has not formed as expected. It is also known as Rudimentary Horn pregnancy
Cornual Pregnancy
69
This rare type of ectopic pregnancy occurs on the ovary. These are difficult to diagnose as they look very similar to a tubal ectopic pregnancy that is stuck to the ovary or a ‘corpus luteum’ which is the place that the egg was released from. Often not diagnosed until surgery
Ovarian Pregnancy
70
A pregnancy that implants outside the cavity of the uterus, but within its muscular wall. These pregnancies are thought to occur when the uterus has been scarred by previous surgery or a condition called adenomyosis.
Intramural Pregnancy
71
Are thought to have begun in the Fallopian tube and then separated from the wall of the fallopian tube, floating into the abdominal cavity to then reattach to one of the structures in the abdomen.
Abdominal Pregnancy
72
Is when there is the coexistence of an intrauterine pregnancy with an ectopic pregnancy. Although it is rare, it is possible to have a twin pregnancy with one embryo to implant in the uterus and another elsewhere.
Heterotopic Pregnancy
73
Signs and Symptoms of Ectopic Pregnancy (MPVPSDPS)
- Missed or late period
- Positive hCG pregnancy test
- Vaginal bleeding
- Pain in lower abdomen, pelvis, lower back - dizziness or weakness
- Shoulder tip pain
- Diarrhea
- Pain while urinating or defecating
- Shooting/sharp vaginal pain
74
- May show signs of shock when she arrives at the hospital, such as a rapid, thread pulse, rapid respirations, and low blood pressure.
- Once a rupture has occurred, the woman will likely experience sharp, stabbing pain in the lower region, followed by scant vaginal bleeding.
Nursing Management of Ectopic Pregnancy
75
- Upon arrival of the patient, place the woman in a supine position on a bed
- Assess the vital signs to establish baseline data and determine if the patient is under shock.
- Maintain accurate intake and output to establish the patient’s renal function.
Nursing Interventions of Ectopic Pregnancy
76
- Blood sampling or withdrawal of blood is ordered wherein a large amount of blood would be lost, blood typing and crossmatching must be done in anticipation of a blood transfusion.
- The pregnant woman's hemoglobin levels would also be determined using the blood sample.
Medical Management of Ectopic Pregnancy
77
- A woman who is diagnosed early of ectopic pregnancy without unstable bleeding is often treated with a medication of methotrexate.
- This stops rapidly growing cells such as trophoblasts and the zygote.
Pharmacologic Management of Ectopic Pregnancy
78
Surgical Management Procedures for Ectopic Management
- Laparoscopy
- Salpingectomy
79
- The bleeding blood vessels will be ligated, and the injured fallopian tube will be repaired or removed.
Laparoscopy
80
- If the fallopian tube is fully destroyed, this procedure would be performed. The damaged tube would be removed, and the remaining portion would be sutured appropriately.
Salpingectomy
81
Extreme, persistent nausea and vomiting during pregnancy. It can lead to dehydration, weight loss, and electrolyte imbalances. Morning sickness is mild nausea and vomiting that occurs in early pregnancy.
Hyperemesis Gravidarum
82
It can cause a weight loss of more than 5% of body weight. The condition can happen in any pregnancy, but is a little more likely if you are pregnant with twins (or more babies), or if you have a hydatidiform mole.
Etiology/Cause of Hyperemesis Gravidarum
83
Types of Hyperemesis Gravidarum
- Mild
- Moderate
- Severe
84
A woman can function somewhat but is still feeling miserable
- usually ends by mid-pregnancy
- 5% weight loss
- requires medications and sometimes IV fluids
- mother can continue some daily activities
- recovery may take a few months or more
Mild Hyperemesis Gravidarum
85
A woman struggles to function and is very miserable
- may continue beyond mid-pregnancy but severity lessens
- 5-10% weight loss (less with early treatment)
- requires medications sometimes fluids and/or nutrition therapy
- mother is extremely fatigued and only able to do a few tasks
- recovery may take several months
- signs of trauma and changes in family planning occur
Moderate Hyperemesis Gravidarum
86
A woman is unable to function and constantly sick
- symptoms are often difficult to control with medications
- 10% or more weight loss (less with early treatment)
- requires fluids, medications, and sometimes nutrition support for months
- mother is exhausted, malnourished, and unable to care for herself
- recovery can take 1-2 months for every month sick
- signs of trauma and changes in family planning are common
- delivery my be complicated due to debility
- without treatment, the life of the mother and baby are at risk
Severe Hyperemesis Gravidarum
87
Signs and Symptoms of Hyperemesis Gravidarum (NLVDD5)
- Nausea
- Loss of appetite
- Vomiting
- Dehydration
- Dizziness
- 5% weight loss
