antepartum problems 2

Question 1

complete placenta previa

Answer 1

across vaginal opening, must have c-section

Question 2

marginal/ low-lying placenta previa

Answer 2

not across vaginal opening, delivery method depends on degree

Question 3

placenta previa

Answer 3

abnormal implantation of the placenta

Question 4

PP risk

Answer 4

hx c/s
advanced maternal age
multiparity
hx of suction curettage
smoking
nonwhite
maternal cocaine use
assisted reproductive tech
male fetus

Question 5

PP cues

Answer 5

painless bright red vaginal bleeding in 2nd/3rd trimester
-high fundus, malpresentation

Question 6

PP solutions

Answer 6

• ultrasound to diagnose
• management dependent on gestational age, amount of bleeding, fetal condition
• active if >36 wks or bleeding excessive, concern for fetus, c section delivery, be prepared for blood replacement
• expectant: activity restriction, nothing in the vagina, deliver 36-37wks

Question 7

Placental Abruption

Answer 7

premature separation of placenta (abruptio placentae)

Question 8

types

Answer 8

detachment of part or all of a normally implanted placenta from uterus
1- mild
2- moderate
3- severe- classic >50% off wall; usually surgical emergency

Question 9

PA cues

Answer 9

vaginal bleeding, dark red
abdominal pain
uterine tenderness
contractions and board-like abdomen
majority of live fetuses exhibit abnormal FHR patterns

Question 10

PA risk factors

Answer 10

• HTN (chronic or gestational)
• trauma
• PPROM- preterm, premature, rupture of membranes
• smoker
• cocaine or methamphetamine use

Question 11

PA solutions

Answer 11

expectant vs management depends on blood loss and fetal maturity

Question 12

substance use disorder

Answer 12

issue in pregnancy as a whole
ETOH and other drugs pass through placenta; congenital anomalies

Question 13

substance use disorders barriers to treatment

Answer 13

• social stigma, labeling, guilt
• women fear losing custody of child and criminal prosecution
• substance use treatment programs do not address issues affecting pregnant women
• long waiting lists and lack of health insurance present further barriers to treatment

Question 14

Substance use disorder solutions

Answer 14

• screen all pregnant women, may involve toxicology testin
  -educate on effects on pregnancy of each substance and advise abstinence
• breastfeeding definitely contraindicated in women who continue to use amphetamines, alcohol, cocaine, heroin, or marijuana, smokers shouldn’t smoke for 2 hours before feeding and not smoke in same room as infant
• substance abusers difficult to care for particularly during intrapartum and postpartum periods
  -illness, women deserve to be treated with patience, kindness, consistency, firmness

Question 15

SUD before discharge

Answer 15

• home situation must be assessed for safe environment
  -someone available to meet the infant’s needs if mother is unable
• family members or friends should become actively involved with mother before discharge
• if infant’s well-being is questionable, case will be referred to child protective srevices agency

Question 16

infections

Answer 16

Toxoplasmosis
O- other: gonorrhea, chlamydia, HIV, hepatitis, GBS
Rubella
Cytomegalovirus
Herpes

UTI
Influenza
Covid 19
others