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Women's Health > Books Chapter 19 > Flashcards

Books Chapter 19 Flashcards

1
Q

How many pregnant women experience a high-risk pregnancy?

A

1 in 4

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2
Q

What’s the biggest cause of maternal death?

A

hemorrhage

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3
Q

What are the conditions associated with early bleeding? with late bleeding

(have this slide b/c it lists all of the pathos we’ll be reviewing organized by when bleeding happens)

A

Early

  • spontaneous abortion
  • ectopic pregnancy
  • gestational trophoblastic disease
  • cervical insufficiency

Late

  • placenta previa
  • abruptio placentae
  • placenta accreta
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4
Q

What is the medical definition of abortion ?

A

loss of an early pregnancy before 20 weeks gestation

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5
Q

What are the two types of abortion?

A

1) spontaneous abortion (miscarriage): result from natural causes, usually not elective or therapeutically induced by procedure
2) induced abortion

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6
Q

When do 80% of spontaneous abortions occur?

A

within the 1st trimester

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7
Q

What’s the difference between miscarriage and stillbirth? which one’s more common?

A
  • Stillbirth is a spontaneous abortion after 20th week and miscarriage is before 20th week
  • miscarriage is more common
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8
Q

What is the most common cause of spontaneous abortion?

A

usually chromosomal/genetic abnormality in 1st trimester

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9
Q

If a spontaneous abortion occurs during the 2nd trimester, what’s most likely the cause?

A

abnormality related to the mother

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10
Q

After a spontaneous abortion occurs, why is it important to keep monitoring hCG levels?

A

to make sure all tissues have been expelled
- a similar example is if you have an ectopic pregnancy and use methotrexate as a medical regime to expel the zygote, you will monitor hCG levels to predict success

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11
Q

When assessing bleeding, what signs would indicate significant bleeding (think color, amount, what you don’t want to find)?

A

significant bleeding = bright red, saturate one or more peripad per hour
- bad: clots, tissue in blood

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12
Q

If woman experiences a spontaneous abortion and is Rh negative, what drug should you expect to administer? When should this be administered?

A
  • expect to administer RhoGAM (so if fetus/zygote had developed a Rh+ blood type, the mother won’t form antibodies against it which could complicate later pregnancies)
  • this must be administered within 72 hours after the abortion is complete
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13
Q

What are the categories of abortion and the signs/symptoms of each?

A

1) Threatened abortion
- vaginal bleeding early in pregnancy
- no cervical dilation and closed cervical os
- mild ab cramping
- no fetal tissue passage

2) Inevitable abortion
- vaginal bleeding more than threatened
- membrane rupture
- cervical dilation
- strong ab cramping
- possible tissue passage

3) Incomplete abortion (passage of some products)
- intense ab cramping
- heavy vaginal bleeding
- cervical dilation

4) Complete abortion (passage of all products)
- hx of vag bleeding and ab pain
- after product passage: decreased pain/bleeding

5) Missed abortion (nonviable embryo maintained in uterus for at least 6 weeks)
- no uterine contractions
- irregular spotting

6) Habitual abortion
- hx of 3 or > consecutive spontaneous abortions

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14
Q

What are four drugs used with spontaneous abortions and a short description of what they do?

A

1) misoprostol (Cytotec): stimulates contraction to terminate pregnancy and can evacuate uterus of remaining tissue
2) mifepristone (RU-486): progesterone antagonist, stimulates uterine contraction, causes endometrium to slough, sometimes followed by misoprostol within 48 hours
3) PGE2, dinoprostone (Cervidil, Prepidil Gel, Prostin E2): stimulates uterine contraction to expel uterine contents, also used to thin/dilate cervix in term pregnancies
4) Rh(D) immunoglobulin (RhoGAM): suppresses immune response of nonsensitized Rh-negative clients to prevent antibody formation

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15
Q

What is the site of administration for RhoGAM?

A

IM in deltoid

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16
Q

What is an ectopic pregnancy?

A

preg where the zygote implants outside of uterus

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17
Q

what’s the most common place of implantation for an ectopic pregnancy?

A

the fallopian tubes

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18
Q

What’s the most common cause of ectopic pregnancy?

A

tubal scarring due to pelvic inflammatory disease (think STI infections)

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19
Q

When is medical treatment an option for an ectopic pregnancy?

A

if the fallopian tubes are still intact (assuming implantation is in fallopian tube), mass is unruptured, and the client is hemodynamically stable

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20
Q

what is considreed the treatment of choice over surgical interventions for ectopic pregnancies? how do we determine the dose?

A

methotrexate, IM determined by client’s body SA

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21
Q

What are the hallmark sign of ectopic pregnancy?

A

a triad

  • ab pain
  • spotting
  • symptoms within 6-8 weeks after missed period
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22
Q

What is GTD?

A

gestational trophoblastic disease

  • a spectrum of abnormal growth disorders that originate in the placenta, so gestational tissue present but not viable
    (note: more common in Asian countries)
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23
Q

what are the two most common types of GTD?

A

1) hydatidiform mole (there’s partial and complete)

2) choriocarcinoma

24
Q

What is a hydatidiform mole?

A
  • benign, abnormal growth of the chorion

- chorionic villi degenerate and becomes transparent sacs containing clear fluid

25
Q

What’s the difference between complete and partial hydatidiform mole?

A

1) Complete
- no fetal tissue, fertilized by normal sperm (46 chromosomal number)
- pt presents with vag bleeding, anemia, enlarged uterus, preeclampsia, hyperemesis

2) Partial
- triploid (69) chromosomal number b/c 2 sperms fertilized
- pt presents with missed/incomplete abortion, vag bleeding, small or nomal size uterus

26
Q

what is a complete mole associated with

A

the development of choriocarcinoma, partial rarely develop into choriocarcinoma

27
Q

what are are the main nursing management concerns for a woman with GTD?

A
  • prepare for D&C to evacuate uterus (will need immediately after diagnosis)
  • educate on risk of cancer (may use methotrexate as a prophylaxis)
  • stress importance of frequent follow up, especialy in next 12 months (promote use of reliable contraceptive to prevent pregnancy during this time)
28
Q

What is cervical insufficiency?

A

weak, structurally defective cervix that dilate prematurely resulting in fetal loss

29
Q

hypothetically, what are women with a short cervix at risk for?

A

pre-term birth

30
Q

If the cervix dialates too early, what’s a surgical intervention?

A

cervical cerclage, using sutures to support os of cervix

31
Q

when should you proceed with caution in performing a cerclage? up until how many weeks is a cerclage ok to perform?

A
  • 20 weeks or after, can perform up to 28 weeks
32
Q

what’s the biggest indicator of cervical insufficiency?

A

previous loss during second or third trimester

others include pink-tinged vaginal discharge, backache, contractility

33
Q

when is it the easiest to detect a short cervix with an ultrasound?

A

between 16 and 24 weeks, so ultrasound definitely needs to be done between these times

34
Q

What length of cervix requires intervention in the pregnant woman?

A

25mm or less

35
Q

What is placenta previa

A

placenta implants into cervical os, bleeding condition

36
Q

what’s a common risk factor that can increase the incidence of placenta previa?

A

cesarean section

37
Q

What initiates placenta previa?

A
  • embryo can’t implant in upper uterus (perhaps due to scarring) so implants in lower uterus and placenta needs SA to grow and extends into lower fetus
38
Q

What’s the difference between placenta previa - accreta, increta, and percreta

A

accreta: placenta attaches directly to myometrium
increta: deeply in myometrium
percreta: infiltrates myometrium

39
Q

how is placenta previa generally classified?

A
  • total: internal cerbical os completely covered
  • partial
  • marginal: placenta at margin or edge of os
  • low-lying: implanted in lower uterine segment and near internal os but does not reach it
40
Q

in what ethnic group is placenta previa of high incidence?

A

asian cultural groups, not sure what they mean

41
Q

what’s the classical presentation of placenta previa and when does it occur?

A

painless, brigh-red vaginal bleeding usually between 27-32 weeks gestation

42
Q

why does bleeding often occur in placenta previa?

A

lower uterus not equipped to contract enought o restrict blood flow

43
Q

what do you need to avoid doing in a woman with placenta previa?

A

vaginal exams

44
Q

whenever a bleeding is suspected what preemptive step should the nurse prepare for?

A

blood typing and cross-matching

45
Q

What is abruptio placentae

A
  • sepration of normally located placenta after 20th week but prior to birth
46
Q

what do they think causes abruptio placentae?

A
  • thinks it starts with degenerative changes in maternal arterioles leading to thrombosis and rupture of vessel and pressure causes placenta to separate
47
Q

what are the hallmark signs of abruptio placentae?

A

abdominal pain and rigid, tender uterus

48
Q

how is abruptio placentae classified?

A

according to amount of separation and maternal blood loss

  • mild/grade 1: minimal bleeding, marginal separation (less than 500mL, 10-20% separation), no coagulopathy, no signs of shock, no fetal distress
  • moderate/grade2: moderate bleeding/separation (1000-1500mL, 20-50%), ab pain
  • severe/grade 3:(more than 1500mL, more than 50%, profound shock, dark vaginal bleeding, coagulopathy
  • also classified as partial or complete AND concealed or apparent by type of bleeding
49
Q

What is DIC?

A

disseminated intravascular coagulation: bleeding disorder with less blood clotting factors available due to IV clotting (can occur secondary like in abruptio placentae)

  • treat with transfusion of fresh-frozen plasma with cryoprecipitate
50
Q

describe the difference between placenta previa and abruptio placentae

A

previa
- insidious onset, bleeding always visible and sligh, bright red, painless, soft and relaxed uterus, normal fetal HR, possible breech

abruptio
- sudden onset, concealed or visible bleeding, dark red, pain, firm rigid uterus, fetal distress or absent HR

51
Q

What’s the Kleihauer-Berke test

A
  • detects fetal RBCS in maternal circulation, determines degree of fetal-maternal hemorrhage and helps circulate appropriate dosage of RhoGAM
52
Q

what’s a complication of placenta accreta?

A

hemorrhaging from manual removal attempt of placenta

53
Q

what is hyperemesis and what’s the problem with it?

A
  • severe morning sickness causing dehydration electrolyte imbalance and need for hospitalization
54
Q

what are the different classification of HTN disorders in pregnant women?

A

1) chronic HTN: exists prior to 20 weeks (140/90 or >)
2) gestational HTN: after
3) preeclampsia: most common and also with proteinuria, after 20 weeks, returns normal 12 weeks postpartum
4) eclampsia: onset of seizure activity in woman with preeclampsia

55
Q

how to diagnose gestational HTN

A

> 140/90 on at least 2 occasiona at least 6 hours apart after 20th week

56
Q

what’s the thrombozane/prostacyclin imbalance with preeclampsia?

A

increased thromboxane and decreased prostacyclin

57
Q

what med used to prevent eclampsia?

A

magnesium sulfate (calcium gluconate kept at bedsi

Women's Health (9 decks)

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