Antepartal Hemorrhagic Disorders Flashcards
List Threatened miscarriage interventions
Bed rest; progesterone injections;
Define threatened miscarriage
No miscarriage yet but the threat is real. Some spotting of blood, no dilation or delivery
Define inevitable miscarriage
Miscarriage will occur; cervical dilation and possibly body parts are out
Inevitable miscarriage interventions
Just let it happen on it’s own; D&C to accelerate the miscarriage- this is only done as a last resort.
However, if mother has an infection or is bleeding heavily, surgical intervention is needed.
Define incomplete miscarriage
Bleeding and passage of some parts of gestation but not all
Incomplete miscarriage interventions
Same as inevitable- try for mom to pass, maybe even days if no signs of infection or hemorrhage
Define complete miscarriage
Mom passes all products of conception own- mostly no interventions- watch for s/s
Define missed miscarriage
Still pregnant with baby, but no heartbeat
Missed miscarriage interventions
D&C or even dilation and extraction-
If baby is about 16 wks then the baby is a good size, then must bring mom to hospital and give cytotec or pitocin to induce the labor- try to give mom baby to bond
What lab value is helpful in diagnosing very early pregnancy loss?
HcG
At what rate should HcG increase in normal pregnancy?
Should double every 2 days until day 70
What does a drop in HcG indicate?
Miscarriage
What does an HcG under 5mlU/ml indicate?
Negative for pregnancy
What does an HcG of greater than 25 mlU/ml indicate?
Positive for pregnancy
Ultrasounds can measure what about the cervix?
Length and any changes
What is the plan of care for miscarriage?
Bed rest ; supportive care ; D&C (always get a blood type and maybe cross match for blood units) ; D&E may be performed after 16 weeks but not usual ; outpatient management with cytotec ; prostaglandins to induce labor 16-20 weeks ; get IV
Hemabate usage needs what meds to go along with it?
Limopel for diarrhea
Antipyretic
Antiemetic
Methergine shouldn’t be given for post delivery miscarriage to decrease bleeding if the patient has a history of what?
Preeclampsia or hypertensive disorders- cytotec would be better in that case
What is the post delivery home care for miscarriage?
Patients must recognize s/s of infection /hemorrhage (onset of pain pain) ;
D/C meds like antibiotics (doxycycline-can cause photosensitivity), methergine (or cytotec) and analgesics
Foods high in iron and protein
Follow up in 2 weeks
No sex for 2 weeks
How much bleeding after a D&C is too much?
1 pad per hour- should only see small spots
How is incompetent cervix diagnosed?
OB history followed by transvaginal ultrasound (transvaginal ultrasound is the best way to measure the cervix)
What are the measurement thresholds for a shortened cervix?
< 25 - 30 mm in length
What is medical management for incompetent cervix?
Bed rest; hydration and tocolysis; elective cerclage around 10-14 weeks; urgent or emergent cerclage for high risk of ROM, PTL,
closely observe for labor, bleeding and infection
Cerclage removed at 37 weeks
