Complications During Pregnancy Flashcards
Occur before 20 weeks gestation
Spontaneous Abortion (Miscarraige)
Three or more consecutive pregnancy losses
recurrent abortion
Separation of the Placenta from wall of Uterus before delivery of the baby
10 – 15% of perinatal deaths
Hemorrhage from the separation
Risk factors: Smoking, Cocaine, Trauma, Polyhydramnios, Age, Domestic Violence
Placental abruption
Implantation over or near cervix
Dilation exposes villi – bleeding
Risk factors: prior C/S or uterine surgery, Grand Multiparity, Age
Placental previa
Abruption Mnemonic
DETACHED
D - Dark red bleeding
E - Extended fundal height
T - Tender uterus
A - Abdominal pain; contractions
C - Concealed bleeding
H - Hard abdomen
E - Experience DIC (placenta is damaged so it releases thromboplastin, causing massive clotting)
D Distressed baby (placenta’s function is decreased)
Previa Mnemonic
PREVIA
P – Painless, bright red bleeding (vaginal)
R – relaxed, soft, non-tender uterus
E - episodes of bleeding
V - visible bleeding (not concealed)
I - inspect fetal heart rate
A - avoid vaginal exams
Hallmark signs of abruption
-Dark red vaginal bleeding
-Rigid Abdomen/painful
-Increasing abdominal size
-Fetal HR changes (late decels)
Hallmark signs of placenta previa
-Bright red vaginal bleeding
-Painless or w/ uterine activity
-Normal FHR pattern
Stable previa requires
pelvic rest
Fertilized egg implants outside of the uterine cavity
-Incompatible with life
-99% Implant in the fallopian tube
Ectopic pregnancy
A lower than normal human chorionic gonadotropin (hCG) may indicate
ectopic pregnancy
Treatment for ectopic pregnancy
Non-ruptured fallopian tube:
1) Methotrexate IM
2) Laparoscopy: Salpingostomy
Ruptured fallopian tube:
1) Laparotomy: Salpingectomy
Inability of the cervix to remain closed and support the growing pregnancy
Can be congenital or acquired (history of cervical trauma, previous spontaneous delivery in second trimester)
Associated with recurrent abortions and/or preterm births
Manifestations include increased pelvic pressure, pink-stained vaginal discharge or bleeding, uterine contractions
Cervical insufficiency
(Incompetent cervix)
A surgical procedure in which the cervical opening is closed with stitches to prevent or delay preterm birth
cerclage
Nausea sometimes accompanied by vomiting, subsides at 12 weeks or soon after, vomiting does not cause severe dehydration
morning sickness
Nausea accompanied by severe vomiting, nausea does not subside, vomiting that causes severe dehydration and electrolyte disturbance, weight loss of 5% or more of pre-pregnancy weight, may require hospital stay
hyperemesis gravidarum
Treatment of hyperemesis gravidarum
IV fluids, NG tube, Medications (metoclopramide, antihistamines, anti-reflux medication), bed rest, acupressure, ginger or peppermint, hypnosis, homeopathic remedies
Polyhydramnios
Too much amniotic fluid
Oligohydramnios
Not enough amniotic fluid
Causes of Oligohydramnios
premature rupture of membranes, placental insufficiencies, HTN, Preeclampsia, Diabetes, maternal dehydration, twin-to-twin transfusion syndrome, certain medications, like ACE inhibitors (they can cause fetal renal impairment)
Onset < 20 weeks
BP >140/90
Persists after 12 weeks postpartum
Chronic hypertension (CHTN)
New onset HTN after 20 weeks, no proteinuria, BP returns to normal by 6 weeks postpartum
BP >140/90
Gestational Hypertension (GHTN)
Preeclampsia complicating hypertension of another cause, most commonly chronic or “essential” hypertension.
New onset proteinuria in woman with HTN but no proteinuria before 20 weeks
Superimposed Preeclampsia
Onset > 20 weeks
BP >140/90 on 2 occasions at least 4 hours apart or BP >160/110
And >1+ proteinuria
Or in the absence of proteinuria, new-onset hypertension/ with new onset of any of the following:
-Thrombocytopenia: platelets < 100,000
-Renal insufficiency
-Impaired liver function
-Pulmonary edema
-New-onset headache unresponsive to medication
Pre-eclampsia/Eclampsia
