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OB Exam 2 > Chapter 33 > Flashcards

Chapter 33 Flashcards

1
Q

This term is defined as - excessive bleeding after childbirth defined as a blood loss of _____ ml or more after a vaginal birth and ____ ml after a cesarean birth

Also defined as a 10% drop in ______

A 
Postpartum Hemorrhage 
500
1000
Hct
Tip - : lochia accounts for 25% of total blood loss. Largest loss occurs during delivery and immediately after.
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2
Q

How do we remove retained placental fragments?

What is the test that confirms presence of retained products of conception?

A

Manual exploration done to remove fragments

Ultrasonography confirms retained products of conception

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3
Q

Will separation occur if there is abnormal adherence of placenta?

A

No, separation will not occur in these instances

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4
Q

What is the cause of abnormal adherence of placenta related to?

A

Related to implantation of zygote in area of defective endometrium

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5
Q

What are the types of placental attachments?

A

Placenta acreta – slight penetration of myometrium
Placenta increta – deep penetration of myometrium
Placenta percreta – perforation of uterus

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6
Q

Placenta Acreta is…

A

A Type of placental attachment -> Slight penetration of myometrium

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7
Q

Placenta Increta is…

A

A type of placental attachment -> Deep penetration of myometrium

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8
Q

Placenta Percreta is…

A

A type of placental attachment -> Perforation of Uterus

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9
Q

If your assessment revealed that the uterus is firm and well contracted but constant trickle is present or frank bleeding - What may be the cause? How To Manage?

A

Genital tract lacerations
Usually cervix, vagina, perineum (most common)
Sutures

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10
Q

Definition: Collection of blood in connective tissue of pelvis, vagina, vulva

A

Hematoma

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11
Q

Most common symptom of a hematoma?

A

Pain

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12
Q

Patient presents with hemorrhage, shock, pain, non-palpable uterus on assessment - What may be the cause
(Hint)
The Uterus is turned inside out

A

Uterine Inversion

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13
Q

Management of uterine inversion

A

Replace uterus by obstetrician, must be relaxed, treat shock

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14
Q

Fundal implantation of placenta (abnormal), vigorous fundal pressure, excessive traction to cord, short cord, and uterine relaxant (Mg SO4) are all causes of what disorder?

A

Uterine Inversion

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15
Q

Is Uterine Inversion considered an Emergency?

A

YES

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16
Q

Definition: Delayed return of enlarged uterus to normal size and function

A

Subinvolution of the uterus

17
Q

Common causes of subinvolution of the uterus

A

retained placental fragments and infection

18
Q

S/S of this disorder include prolonged lochial discharge, excessive bleeding, and pain

A

Subinvolution of the uterus

19
Q

Management of subinvolution of the uterus?

A
  • Treatment is based on cause. D&C may be needed,
  • Methergine 0.2 mg q 3-4 hr x 24 hrs contraindication is HTN
  • ABX therapy
20
Q

Management of PPH?

A
  • Identify cause of PPH
  • Assess uterine fundus – palpate (first action)
    if boggy, perform fundal massage
    if firm but blood trickle present, inspect m
    perineum, vagina uterus, cervix
  • Assess bladder
    if distended straight catheterization may be
    indicated
  • Continue infusion of oxytocin (20 units/1L RL, 30
    units/500 ml LR)
  • Laboratory studies: hemoglobin & hematocrit (h/h)
  • Adhere to PPH protocol of unit
21
Q

If atony of uterus persists - even after a firm massage of fundus, emptied bladder, and continued IV oxytocin - then what do you do?

A

Administer other uterotonic medication:

22
Q

Besides oxytocin, name other uterotonic meds

A

Misoprostol (Cytotec) a synthetic prostaglandin E1 given rectally, sublingually, or orally

Methylergonovine (Methergine) given IM or po to produce sustained uterine ctx

Hemabate IM

Prostaglandin E2 (Dinoprostone) given vaginally or rectally

Blood or blood products, LR or NS

Oxygen therapy and foley catheter placed if needed
If bleeding persists, bimanual compression is performed

23
Q

Surgical management optons for hematoma and bleeding

A
  • Hematoma - Incision and drainage
  • Uterine Tamponade - uterine packing with thrombin or insertion of intrauterine balloon
  • Bilateral Uterine Artery Ligation
  • Ligation of utero-ovarian arteries and infundibulopelvic vessels
  • Total Abdominal Hysterectomy (TAH)
24
Q 
Give the common weights in grams (ie if a person soaked a chux pad, estimate how much blood loss there would be)
Chux 
Peri-pad 
Vaginal pack 
Bath towel 
Hospital gown 
Flat sheet
A 
40 gm - Chux
15 gm - Peri pad
20 gm - Vaginal pack
200 gm - Bath Towel
370 gm - Hospital Gown
75 gm - Flat Sheet
25
Q

Continuous bleeding with unidentifiable cause _____ can be suspected

A

Coagulapathy

26
Q

Define: Idiopathic Thrombocytopenic Purpura (ITP)

A

Autoimmune disorder in which antiplatelet antibodies decrease the life span of platelets

27
Q

Coagulation studies will include_________, ____________, and _________, to assess blood clotting function in patients

Order a ______ for platelet count

A

Prothrombin time(PT)
Activated partial thromboplastin time (aPTT)
Thrombin Time (TT)

CBC

28
Q

Most common type of hemophilia; defect in blood clotting protein (vWf)

A

von Willebrand Disease

29
Q

Symptoms and Treatment of von Williebrand Disease

A

Symptoms: bruising easily, nose bleed, bleeding after dental extraction
Tx administration of factor VIII (nasal, IV, PO)

30
Q

Definition: Formation of a blood clot(s) within a blood vessel caused by inflammation (thrombophlebitis) or partial obstruction

A

VTE (Venous Thromboembolic Disorder

31
Q

What are the two causes of VTE

Give three S/S of VTE

A

Causes: venous stasis (compression of blood vessels by gravid uterus), hypercoagulation (condition of pregnancy and early pp)
s/s: pain and tenderness to lower extremity, swelling

32
Q

Name the three diagnosis of VTE and how do you treat?

A

superficial venous thrombosis- analgesia (non-steroidal anti-inflammatory agents), rest, compression stockings

deep venous thrombosis (DVT)- Anticoagulant Therapy (Heparin or Levenox)

pulmonary embolism (PE)- Emergent Situation

33
Q

Definition: Any clinical infection of the genital tract that occurs within 28 days after miscarriage, induced abortion, or birth

A

Puerperal Infection

34
Q

What is Endometritis

A

an infection of the endometrium that usually starts at the placental site and can spread to encompass the entire endometrium

35
Q

What are the s/s of endometritis and how do you manage?

A

s/s: fever, chills, headache, elevated pulse rate, uterine tenderness, subinvolution

Nursing mx: treat symptoms, administer ABX, maintain IV fluids, encourage oral fluids

36
Q

What are the predisposing factors of a UTI?

A

urinary catheterization
frequent pelvic exams
genital tract injury
h/o UTI

37
Q

What are the S/S of a UTI and how do you manage?

A

s/s: pain/burning on micturition, fever, chills, malaise, frequency & urgency

Nursing mx: treat symptoms, administer ABX, IV and oral fluids

38
Q

Give the three PP infections discussed

A 
Endometritis
UTI
Wound Infection (occurs mostly with C-section)

OB Exam 2 (3 decks)

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