abnormal pregnancy II Flashcards
1
Q
Define placenta previa
A
- placental location close to or over the internal cervical os
2
Q
leading cause of third-trimester bleeding
A
placenta previa
3
Q
list the four degrees of placenta previa
A
- complete: internal os completely covered by placenta
- partial: internal os is partially covered
- marginal: edge of placenta is at margin of internal os
- low-lying
4
Q
define low lying placenta previa
A
- one that is implanted in lower uterine segment but the placental edge does not reach the internal os, but is less than 2 cm away
5
Q
placenta previa usually presents as
A
- mod to severe acute painless vaginal bleeding in late 2nd or 3rd trimester
6
Q
how is placenta previa diagnosed
A
- transabdominal US then confirmed with transvaginal US
- detected in 2nd trimester
7
Q
which types of placenta previa resolve by 32-35 weeks as the uterus grows
A
- partial
- marginal
- low-lying
8
Q
exam on a patient with placenta previa should never include
A
- never do a bimanual/cervix exam on a known placenta previa patient
9
Q
management of placenta previa
A
- corticosteroids if < 34 weeks
- schedule c-section at 37-38 weeks
- immediate C-section when presents with spontaneous labor or hemorrhage
10
Q
complications of placenta previa
A
- increased risk for placenta
- accreta
- increta
- percreta
11
Q
placenta accreta
A
all or part of placenta is growing into uterine muscle
12
Q
placenta increta
A
- placenta invades myometrium
13
Q
placenta percreta
A
- Penetrates through myometrium
14
Q
define abruptio placentae
A
- abnormal premature seperation of an otherwise normally implanted placenta
15
Q
types of abruptio placentae
A
- complete
- partial
- marginal
16
Q
biggest risk factor for abruptio placentae
A
abdominal trauma
17
Q
clinical presentation
- hemorrhage and abdominal pain in 2nd or 3rd trimester
- fetal distress
- rigid abdomen
- DIC
A
abruptio placentae
18
Q
define Vasa Previa
A
- fetal blood vessels running unsupported through the membranes over the cervix and under the presenting fetal part
19
Q
problem with Vasa Previa
A
- when membranes rupture, vessels carrying fetal blood also rupture leading to rapid fetal blood loss -> death
20
Q
risk factors for Vasa Previa
A
- multiple gestation pregnancies
- low lying placenta
21
Q
clinical presentation
- vaginal bleeding that occurs upon rupture of membranes with specific changes in fetal heart rate tracing
A
Vasa Previa
22
Q
how is Vasa Previa diagnosed
A
- US using color doppler
23
Q
define Premature rupture of membranes (PROM)
A
- spontaneous rupture of membranes before onset of labor
24
Q
complications associated with Premature rupture of membranes (PROM)
A
- chorioamnionitis
- placental abruption
- prolapse of cord
25
define preterm Premature rupture of membranes (PROM)
* PROM that occurs before 37 weeks gestation
26
main risk factor for preterm Premature rupture of membranes (PROM)
* smoking
27
tests to confirm rupture of membranes
* Nitrazine paper: tests pH
* FERN test
28
avoid if you suspect rutpure of membranes until confirmation to limit risk of infection
vaginal exams
29
managment of Premature rupture of membranes (PROM) with chorioamnionitis
prompt devliery
30
management of Premature rupture of membranes (PROM) without chorioamnionitis
* hospitalization
* \< 34 weeks: give steroids, abx, magnesium for neuroprotection
* \> 34 induce labor
31
define postterm pregnancy
* pregnancy lasting \> or = 42 weeks gestation
32
problems with postterm pregnancy
* stillbirth
* fetal dysmaturity syndrome: chronic intrauterine malnutrition
* shoulder dystocia
* meconium aspriation
33
number 1 cause of postterm pregnancy
* inaccurate estimation of gestational age
34
key to prevent postterm pregnancy
* accurately dating the pregnancy
* perception of fetal movements "quickening" at 18-20 weeks
* first trimester US most accurate for dating
35
managment of postterm pregnancy
* induction of labor at 41 completed weeks
36
list the three types of breech
* Frank: feet near head
* complete: legs crossed
* incomplete (footling): one or both feet are extended
37
management of breech
* external cephalic version at 36 weeks
* Cesarean delivery
* vaginal: inc risk for umbilical cord compression and prolapse
38
define transverse lie malpresentation
* head on one side, butt on other
* manage with ECV or c-section
39
most common cause of cephalopelvic disproportion
* contraction of mid-pelvis
40
define cord prolapse
* when umbilical cord descends alongside or beyond the fetal presenting part
41
risk of cord prolapse is increased with what condition
malpresentations
42
define overt prolapse
* visualize cord protruding
43
define funic prolapse
* palpation of pulsatile mass
44
define occult prolapse
* fetal heart rate changes
45
treatment of cord prolapse
* trendelenburg
* +/- reduce cord
* immediate cesarean delivery
46
define shoulder dystocia
* inability to deliver the shoulders after the head has delivered
* may cause brachial plexus injury or death
47
McRoberts maneuver is used to
* relieve shulder dystocia
48
define fetal intolerance to labor
* adverse response of fetus to stress of labor contractions reflected in fetal heart rate pattern
49
normal fetal heart rate? are accelerations normal
* 120-160
* accelerations normal if present
50
list causes of early, variable, and later decelerations
* early: head compression
* variable: cord compression
* late: uteroplacental insufficiency
51
highest maternal risk of vaginal birth after cesarean
* uterine rupture (1%)
52
list factors that increase risk of uterine rupture after VBAC (vaginal birth after cesarean)
* vertical incision in uterus
* \> 2 previous cesarean deliveries
* induction of labor
* previous uterine rupture
53
define postpartum hemorrhage diagnosis criteria
* vaginal: \> 500 mL and cesarean: \> 1000 mL (subjective)
* **10% decrease in hematocrit**
* **need for transfusion**
* **Signs and symtpoms of blood loss**
54
most common cause of postpartum hemorrhage
* uterine atony
