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OB Test 3 > Chapter 28 > Flashcards

Chapter 28 Flashcards

1
Q

bleeding during pregnancy

A 
ABORTION
ECTOPIC PREGANACY (tubal pg)
GESTATIONAL TROPHOBLASTIC DISEASE- (Hydatidiform mole or “molar pg”)
PLACENTA PREVIA
ABRUPTIO PLACENTA
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2
Q

spontaneous abortions

A
  • 10-15% of all pregnancies end in a spontaneous abortion
  • An abortion is the termination of a pregnancy before viability (20 weeks or 500 gm/16ozs)
  • 80% occur before 12 weeks
  • 50% are caused by severe congenital anomalies
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3
Q

early AB

A

prior to 12 wks

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4
Q

late AB

A

12-20 wks

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5
Q

other causes for AB’s

A 
Immunologic factors (antibodies turn against fetus)
Varicella infection / small pox
Malnutrition
Endocrine imbalances
Chronic maternal diseases
Trauma (rare) 
Incompetent cervix - opens up too early
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6
Q

abortion types

A 
Recurrent
Threatened
Inevitable
Missed
Incomplete
Complete
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7
Q

management with slight bleeding and no pain

A 
Bed rest
Eat light
Avoid straining with bowel movement
Possible mild sedative
Save all pads, tissue and clots
If no bleeding or infection continued pregnancy management
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8
Q

management with heavy bleeding

A

prognosis is poor for saving the pregnancy

Give Pit or Cytotec if needed and do D&C if indicated

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9
Q

recurrent -

A

loss of 3 or more

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10
Q

threatened -

A

jeopardized pregnancy

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11
Q

inevitable -

A

s/s gone so far that can’t stop

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12
Q

missed -

A

when fetus dies in utero and is not expelled, can cause infection to mother so give antibiotics

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13
Q

incomplete -

A

not all parts are expelled

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14
Q

complete -

A

all parts are expelled

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15
Q

incompetent cervical os -

A

(when cervix opens early)

  • Cause of habitual 2nd trimester abortions- PASSIVE AND PAINLESS DILATION OF THE CERVIX
  • Based on history of pregnancy loss at progressively earlier gestational ages, advanced dilation at early stage of pregnancy and prior cervical surgery
  • ULTRASOUNDS DONE: SHORT CERVIX (<25MM) INDICTIVE OF INCOMPETENCE
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16
Q

cerclage -

A
  • usually done at 14-18weeks with 80-90% success rate (Shirodkar Technique) Done at this time to avoid having to remove the suture for a first trimester AB
  • It prevents dilation of the cervix by suturing the cervical os closed
  • if any bleeding or uncomfortable at all notify immediately, bc could rupture if the cerclage isn’t cut
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17
Q

incompetent cervix after procedure

A
  • Watch for ROM & contractions- possible uterine rupture

- If contractions occur, try to stop with tocolytic drugs or remove suture

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18
Q

ectopic pregnancy

A

(not in uterus)

  • A common cause of bleeding in the first trimester, 2% of all pregnancies, highest in non-white women >35 yrs. old
  • DEF: any gestation located outside the the uterine cavity- 95% in fallopian tubes
  • 5% of abdominal pgs. reachviability
19
Q

ectopic caused by

A

conditions that narrow the tube-STD’s, tubal damage w/surgery, IUD’s
-Transvaginal ultrasounds and more sensitive measurement of HCG have helped to detected before rupture occurs

20
Q

ectopic before rupture

A

abd. pain, no menses, spotting (dk. red or brown) possible 6-8 wks after LMP

21
Q

ectopic s/s with rupture

A

within 2-3 weeks of LMP: knifelike pain in one side, Abdominal tenderness, posterior fornix bulges w/ bimanual exam, may show signs of shock: >pulse & < B/P, or ecchymotic blueness around umbilicus (Cullen sign)

22
Q

ectopic treatment

A

Medical:Methotrexate if rupture has not occurred
-give chem drugs to kill the rapidly multiplying cells
Surgical: a)Remove the tube with rupture or b)remove the products of conception and leave the tube to heal itself when there has not been a rupture

23
Q

ectopic goals

A

repair, control bleeding and prevent shock

-If one ectopic likely to have another

24
Q

hydatidiform mole

A
  • Also called “ molar pregnancy”
  • 1:1000 pgs, Increased w/ age and previous occurrence
  • Benign proliferative growth of placenta trophoblast in which the chorionic villi develop abnormally and degenerate into grape like clusters of transparent vesicles that contain clear, viscid fluid
25
Q

complete molar preg

A

occurs when only the sperm chromosomes multiply and there is no fetus present

26
Q

partial molar preg

A

fetal tissue/membranes are present

27
Q

molar preg symptoms

A

Nausea more severe, starts earlier and lasts longer ,Blood stained vaginal discharge (95%), Rapid uterine enlargement, Strongly positive pregnancy test, S/S of pregnancy induced
hypertension BEFORE 20 weeks

28
Q

molar preg treatment

A
  • Empty the uterus, spontaneous AB sometimes occurs or suction curettage is done—induction of labor contraindicated due the possible emboli formation of the of the trophoblastic tissue
  • Make sure ALL tissue is removed- HCG levels for 1 year
  • Treat with Methotrexate to prevent choriocarcinoma
29
Q

placenta previa

A
  • One of the two main causes of bleeding after the 20th week (abruptio is the other)
  • 1:200 pregnancies
  • DEF: abnormal implantation of the placenta involving the internal os and lower uterine segment
  • Classified in relationship to where it is to cervical os- Marginal,Partial and Total
30
Q

previa cause

A

unknown but predisposing factors include: previous c-section, Multipara, Smoking/Cocaine use, Rapid succession of pgs., older women (35-40), history of a S&C; previous previa
-In the past usually painless vaginal bleeding before assessment and diagnosis. Now with routine ultrasounds many times picked up early.

31
Q

previa complications

A

spontaneous AB, PROM w/ perterm labor, malpresentations, postpartum hemorrhage, DVT, Infection

32
Q

with previa no vaginal exam if**

A

woman reports vaginal bleeding

33
Q

previa abdominal exam -

A

soft non-tender uterus, high presenting part with increased fundal height, malpresentations

34
Q

with previa diagnosis ( and no active bleeding for 48 hours) Home Care

A

bed rest, assess vaginal discharge, count kicks, contraction assessment, no intercourse

35
Q

previa expectant care (inpatient)

A
  • Observation and Evaluation with fetus <36 weeks, normal FHR and bleeding has stopped and not in active labor
  • Evaluate bleeding, Fetal status assessment, Labor contractions, Intermittent fetal monitoring (NST) At 36wks+ check for fetal lung maturity (L/S ratio)
  • Greatest risk of fetal death is preterm delivery
36
Q

previa active management (inpatient)

A
  • beyond 36 weeks, bleeding excessive or persistent
  • If labor starts, decide if vaginal delivery can be done-placenta lies more than 2cms from cervical os. Otherwise do c-section and proceed with delivery
37
Q

abruptio placenta

A

The partial or complete premature separation of a normally implanted placenta
1 in every 75-226 pregnancies.
Severity of complications depends on the amount of bleeding and the size of the hematoma formation.
-Separation may be partial or complete

38
Q

abruptio placenta causes

A

Hypertension, smoking, multipara, short umbilical cord, abd. Trauma (MVA’s or abuse), hx. of previous abruptio, cocaine use

39
Q

overt hemorrhage - (abruptio)

A

vaginal bleeding , abd. pain, uterine contractions, uterine tenderness, high uterine resting tone
- 70-80% of all cases

40
Q

concealed hemorrhage - (abruptio)

A

increase in fundal height, hard board like abdomen(COUVELAIRE UTERUS), high uterine resting tone, continuous abd. pain, early s/s of shock, late decelerations, decreased FHR variability,

41
Q

Signs and Symptoms of Impending Hypovolemic Shock Caused by Blood Loss

A
  • Increased pulse rate, falling blood pressure, increased respiratory rate
  • Weak, diminished, or “thready” peripheral pulses
  • Cool, moist skin, pallor, or cyanosis (late sign)
  • Decreased urinary output (<30 ml/hr)
  • Decreased hemoglobin, hematocrit levels
  • Change in mental status
42
Q

couvelaire uterus

A

Blood clot behind uterus has no place to go and the blood invades the myometrium tissue
Uterus becomes hard and boardlike
Can impede uterine contractions

43
Q

couvelaire uterus can lead to

A

Disseminated Intravascular Coagulation (DIC) caused by large amts of thromboplastin being released in response to bleeding and clot formation. This causes depletions of clotting factors(fibrinogen, platelets) and uncontrolled bleeding can occur

44
Q

abruptio management

A
  • Management depends on degree of detachment , amount of blood loss, degree of coagulopathy present and how close to delivery.
  • if mother and baby stable can watch and wait—if condition starts to worsen decide on vaginal verses c-section delivery
  • Promote tissue oxygenation: Turn on side, limit maternal movements to decrease O2 tissue demand, give emotional support

OB Test 3 (8 decks)

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