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Womens health final > abnormal pregnancy II > Flashcards

abnormal pregnancy II Flashcards

1
Q

Define placenta previa

A
  • placental location close to or over the internal cervical os
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2
Q

leading cause of third-trimester bleeding

A

placenta previa

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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
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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
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5
Q

placenta previa usually presents as

A
  • mod to severe acute painless vaginal bleeding in late 2nd or 3rd trimester
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6
Q

how is placenta previa diagnosed

A
  • transabdominal US then confirmed with transvaginal US
    • detected in 2nd trimester
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7
Q

which types of placenta previa resolve by 32-35 weeks as the uterus grows

A
  • partial
  • marginal
  • low-lying
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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
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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
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10
Q

complications of placenta previa

A
  • increased risk for placenta
    • accreta
    • increta
    • percreta
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11
Q

placenta accreta

A

all or part of placenta is growing into uterine muscle

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12
Q

placenta increta

A
  • placenta invades myometrium
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13
Q

placenta percreta

A
  • Penetrates through myometrium
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14
Q

define abruptio placentae

A
  • abnormal premature seperation of an otherwise normally implanted placenta
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15
Q

types of abruptio placentae

A
  • complete
  • partial
  • marginal
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16
Q

biggest risk factor for abruptio placentae

A

abdominal trauma

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17
Q

clinical presentation

  • hemorrhage and abdominal pain in 2nd or 3rd trimester
  • fetal distress
  • rigid abdomen
  • DIC
A

abruptio placentae

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18
Q

define Vasa Previa

A
  • fetal blood vessels running unsupported through the membranes over the cervix and under the presenting fetal part
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19
Q

problem with Vasa Previa

A
  • when membranes rupture, vessels carrying fetal blood also rupture leading to rapid fetal blood loss -> death
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20
Q

risk factors for Vasa Previa

A
  • multiple gestation pregnancies
  • low lying placenta
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21
Q

clinical presentation

  • vaginal bleeding that occurs upon rupture of membranes with specific changes in fetal heart rate tracing
A

Vasa Previa

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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
Q

define preterm Premature rupture of membranes (PROM)

A
  • PROM that occurs before 37 weeks gestation
26
Q

main risk factor for preterm Premature rupture of membranes (PROM)

A
  • smoking
27
Q

tests to confirm rupture of membranes

A
  • Nitrazine paper: tests pH
  • FERN test
28
Q

avoid if you suspect rutpure of membranes until confirmation to limit risk of infection

A

vaginal exams

29
Q

managment of Premature rupture of membranes (PROM) with chorioamnionitis

A

prompt devliery

30
Q

management of Premature rupture of membranes (PROM) without chorioamnionitis

A
  • hospitalization
  • < 34 weeks: give steroids, abx, magnesium for neuroprotection
  • > 34 induce labor
31
Q

define postterm pregnancy

A
  • pregnancy lasting > or = 42 weeks gestation
32
Q

problems with postterm pregnancy

A
  • stillbirth
  • fetal dysmaturity syndrome: chronic intrauterine malnutrition
  • shoulder dystocia
  • meconium aspriation
33
Q

number 1 cause of postterm pregnancy

A
  • inaccurate estimation of gestational age
34
Q

key to prevent postterm pregnancy

A
  • accurately dating the pregnancy
    • perception of fetal movements “quickening” at 18-20 weeks
    • first trimester US most accurate for dating
35
Q

managment of postterm pregnancy

A
  • induction of labor at 41 completed weeks
36
Q

list the three types of breech

A
  • Frank: feet near head
  • complete: legs crossed
  • incomplete (footling): one or both feet are extended
37
Q

management of breech

A
  • external cephalic version at 36 weeks
  • Cesarean delivery
  • vaginal: inc risk for umbilical cord compression and prolapse
38
Q

define transverse lie malpresentation

A
  • head on one side, butt on other
    • manage with ECV or c-section
39
Q

most common cause of cephalopelvic disproportion

A
  • contraction of mid-pelvis
40
Q

define cord prolapse

A
  • when umbilical cord descends alongside or beyond the fetal presenting part
41
Q

risk of cord prolapse is increased with what condition

A

malpresentations

42
Q

define overt prolapse

A
  • visualize cord protruding
43
Q

define funic prolapse

A
  • palpation of pulsatile mass
44
Q

define occult prolapse

A
  • fetal heart rate changes
45
Q

treatment of cord prolapse

A
  • trendelenburg
  • +/- reduce cord
  • immediate cesarean delivery
46
Q

define shoulder dystocia

A
  • inability to deliver the shoulders after the head has delivered
    • may cause brachial plexus injury or death
47
Q

McRoberts maneuver is used to

A
  • relieve shulder dystocia
48
Q

define fetal intolerance to labor

A
  • adverse response of fetus to stress of labor contractions reflected in fetal heart rate pattern
49
Q

normal fetal heart rate? are accelerations normal

A
  • 120-160
  • accelerations normal if present
50
Q

list causes of early, variable, and later decelerations

A
  • early: head compression
  • variable: cord compression
  • late: uteroplacental insufficiency
51
Q

highest maternal risk of vaginal birth after cesarean

A
  • uterine rupture (1%)
52
Q

list factors that increase risk of uterine rupture after VBAC (vaginal birth after cesarean)

A
  • vertical incision in uterus
  • > 2 previous cesarean deliveries
  • induction of labor
  • previous uterine rupture
53
Q

define postpartum hemorrhage diagnosis criteria

A
  • vaginal: > 500 mL and cesarean: > 1000 mL (subjective)
  • 10% decrease in hematocrit
  • need for transfusion
  • Signs and symtpoms of blood loss
54
Q

most common cause of postpartum hemorrhage

A
  • uterine atony

Womens health final (3 decks)

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