Chapter 28

Question 1

What are the risks associated with maternal blood loss

Answer 1

Hypovolemia
Anemia
Infection
Preterm labor
Impaired oxygen delivery to the fetus

Question 2

What are the fetal risk from maternal hemorrhage ?

Answer 2

Blood loss, anemia
Hypoxemia
Hypoxia
Anoxia
Preterm birth

Question 3

define miscarriage (spontaneous abortion)

Answer 3

a pregnancy that ends as a result of natural causes before 20 weeks of gestation

Question 4

What are the types of miscarriages?

Answer 4

Threatened
Inevitable
Incomplete
Complete
Missed
Recurrent

Question 5

What is a threatened miscarriage?

Answer 5

when body is showing sighs you may miscarry , vaginal bleeding that can vary in amount
lower abdominal pain present
can lasts days or weeks but cervix remains closed
pain and bleeding may go away and can still have healthy pregnancy and baby, or can get worse and have miscarriage

Question 6

what is an inevitable miscarriage?

Answer 6

can come after threatened miscarriage or without warning,
stronger lower abdominal pain, cervical dilation, more vaginal bleeding

Question 7

what is an incomplete miscarriage

Answer 7

some of the tissue will remain in uterus, vaginal bleeding and uterine contraction will continue as uterus tries to clear itself, D&C

Question 8

what is a complete miscarriage

Answer 8

taken place when all pregnancy tissue has left uterus, vaginal bleeding can happen for several days, cramping pain is like labor pain or severemenstrual pain

Question 9

what is a missed miscarriage ?

Answer 9

where baby has died but stays in uterus, brownish discharge , continued to have symptoms of pregnancy like nausea, tiredness

Question 10

what is a recurrent miscarriage

Answer 10

after 3 or more miscarriages

Question 11

why is misoprostol given for miscarriage

Answer 11

to help uterus contract and minimize bleeding or to get body to expel remaining tissue
also given for induction, IV or PO

Question 12

what is cervical insufficiency

Answer 12

aka incompetent cervix
Passive and painless dilation of the cervix during the second trimester
May be either acquired or congenital

Question 13

how is cervical insufficiency diagnosed

Answer 13

Speculum/digital pelvic exams
transvaginal U/S
Cervical funneling

Question 14

How is cervical insufficiency treated?

Answer 14

Cerclage: may be placed either prophylactically or as a therapeutic or rescue procedure after cervical change has been identified
Removed by 36 weeks of gestation
Bed rest for a few days following cerclage
Watch for and report signs of preterm labor, rupture of membranes, and infection.

Question 15

what is cerclage ?

Answer 15

closing the cervix by sewing it up with sutures
sutures removed when signs of labor

Question 16

What is an ectopic pregnancy?

Answer 16

the fertilized ovum is implanted outside the uterine cavity; also called “tubal pregnancies”

Question 17

symptoms of ectopic pregnancy ?

Answer 17

symptoms start 6 -8 weeks after the last normal period
Severe Abdominal pain
Delayed menses
Abnormal vaginal bleeding (spotting)

Question 18

how is an ectopic pregnancy diagnosed

Answer 18

Quantitative β-hCG levels
transvaginal ultrasound examination; progesterone level

Question 19

What is the treatment for ectopic pregnancy

Answer 19

methotrexate to dissolve fetal cells
surgery to remove fallopian tube if ruptured

Question 20

what is a hydatidiform mole (molar pregnancy)?

Answer 20

Type of gestational trophoblastic disease

Benign proliferative growth of the placental trophoblast in which the chorionic villi develop into edematous, cystic, avascular transparent vesicles that hang in a grapelike cluster

Question 21

what are the types of molar pregnancies

Answer 21

Complete: no embryonic or fetal parts
Partial: often have embryonic or fetal parts and an amniotic sac

Question 22

symptoms of molar pregnancy

Answer 22

Anemia from blood loss, excessive nausea and vomiting (hyperemesis gravidarum), and abdominal cramps

Question 23

how is a molar pregnancy diagnosed?

Answer 23

Transvaginal ultrasound and serum hCG levels
HCG levels will be elevated

Question 24

What is a possible risk associated with molar pregnancies ?

Answer 24

increased risk for development of uterine cancer
Elevated HCG levels are used to diagnose uterine cancer
Recommended to not get pregnant for a year after molar pregnancy, will not be able to tell difference between cancer

Question 25

what is placenta previa?

Answer 25

Placenta implanted in lower uterine segment near or over internal cervical os

Question 26

what are the types of placenta previa?

Answer 26

Complete – whole cervical opening is covered
Marginal – portion of placenta is covering opening
Low-lying – close to cervical os

Question 27

what are the symptoms of placenta previa?

Answer 27

Painless bright red vaginal bleeding during second or third trimester

Question 28

What are the complications associated with placenta previa?

Answer 28

hemorrhage
Fetal death (caused by preterm birth)
Stillbirth
malpresentation
fetal anemia
intrauterine growth restriction

Question 29

how is placenta previa diagnosed?

Answer 29

Transabdominal ultrasound examination
no cervcal exams with this

Question 30

how is placenta previa treated

Answer 30

bedrest
frequent monitoring
blood and fluid replacement , delivery

Question 31

What is placental abruption?

Answer 31

Detachment of part or all of placenta from implantation site after 20 weeks of gestation
detachment before is a miscarriage

Question 32

what is the primary risk factor for placental abruption?

Answer 32

maternal HTN

Question 33

symptoms of placental abruption?

Answer 33

Separation may be partial, complete, or only involve margin of placenta
Vaginal bleeding, abdominal pain, and uterine tenderness and contractions
Boardlike abdomen; Couvelaire uterus

Question 34

extra info on placental abruption

Answer 34

Placenta will look like clot if any type of abruption has occurred upon inspection
Can be noticed after delivery
Abruptions can be difficult to diagnose, wont always have bleeding, can be silent

Question 35

what is vasa previa?

Answer 35

fetal vessels lie over the cervical os, and the vessels are implanted into the fetal membranes rather than into the placenta

Question 36

what is velamentous insertion of the cord?

Answer 36

cord vessels branch at membranes and then onto placenta
vessels will be weaker

Question 37

what is succenturiate placenta?

Answer 37

placenta has divided into two or more lobes

Question 38

battledore (Marginal) insertion of the cord?

Answer 38

marginal insertion of cord
hanging more on end instead of centrally increases risk of fetal hemorrhage

Question 39

What is Disseminate intravascular coagulation (DIC)?

Answer 39

Pathologic form of diffuse clotting that consumes large amounts of clotting factors, causing widespread external bleeding, internal bleeding, or both
DIC is never a primary diagnosis: result of other acute or traumatic event

Question 40

what can cause DIC in pregnancy?

Answer 40

HELLP syndrome, sepsis