Complications in Pregnancy Flashcards
Implantation occurred outside the uterine cavity
Ectopic Pregnancy
The most common site for ectopic pregnancy
Fallopian tubes
Fallopian tube sites for ectopic pregnancies
80% - ampullar portion
12% - isthmus
8% - interstitial or fimbrial
Fertilization occurs as usual in the fallopian tubes
Ectopic Pregnancy
Ectopic pregnancy factors
- Congenital anomalies like webbing
- Smoking tobacco
3.
Sharp stabbing pain in lower abdominal quadrant
Vaginal spotting
Ruptured Ectopic Pregnancy
Amount of bleeding not evident
May lead to shock
Falling hCG level
Ruptured Ectopic Pregnancy
Abnormal proliferation and then degeneration of the trophoblastic villi or cells become filled with fluid and appears as fluid filled grape sized vesicles
Gestational Trophoblastic Disease (Hydatidiform mole)
Two types of moles
Complete Mole
Partial Mole
A type of mole that all trophoblastic villi swell and become cystic
Complete mole
A type of mole that some of the villi forms normally
Partial mole
Uterus tends to expand faster
Strong (+) result of hCG- 1 to 2 M IU compared to a normal of 400,000IU)
Symptoms of pregnancy induced hypertension may appear before the 20th week (5th month)
Ultrasound-no fetal growth and fetal heart sound
Marked nausea and vomiting
Dark brown blood, profuse flesh flow(16 weeks) with clear fluid filled vesicles ( dark brown resembles prune juice)
Assessment for Gestational Trophoblastic Disease
Suction curettage
Post surgery:
Pelvic examination, chest radiograph,hCG level
hCG monitoring
Half of woman positive at 3 weeks
¼ positive result at 40 days
Assess every 2 weeks until normal
Every 4 weeks for the next 6 to 12 months
Should use reliable. contraceptive method
Plan pregnancy at 12 months if hcg is normal
Therapeutic Management for Gestational Trophoblastic Disease
Medication to end ectopic pregnancy or trophoblastic disease
Methotrexate
used only in cancer chemotherapy slowly stops the growth of cancer cells of the body only if it has metastasis
Dactinomycin
Primary Causes of Bleeding during Pregnancy
Vaginal spotting, perhaps slight cramping
Threatened Spontaneous Miscarriage
Primary Causes of Bleeding during Pregnancy
Vaginal spotting, cramping, cervical dilatation
Imminent (inevitable) Miscarriage
Primary Causes of Bleeding during Pregnancy
Vaginal spotting, perhaps slight cramping, no apparent loss of pregnancy
Missed Miscarriage
Primary Causes of Bleeding during Pregnancy
Vaginal spotting, cramping, cervical dilatation, but incomplete expulsion of uterine contraction
Incomplete Spontaneous MIscarriage
Primary Causes of Bleeding during Pregnancy
Vaginal spotting, cramping, cervical dilatation, and complete expulsion of uterine contents
Complete Spontaneous Miscarriage
It is always a serious situation in pregnancy because it has the potential to diminish the blood supply to both the pregnant patient and fetus
Vaginal bleeding
It is the loss of a pregnancy before 20 weeks
Spontaneous miscarriage
Implantation outside of the uterus, usually in a fallopian tube
Ectopic pregnancy
A procedure is necessary to remove the conceptus and repair or remove the tube to half bleeding
Laparoscopic
An abnormal overgrowth of trophoblastic cells
Gestational Trophoblastic Disease
If gestational trophoblastic disease is not yet discovered under an ultrasound, what will happen?
Bleeding and expulsion of the abnormal growth occur at about the 16th week of pregnancy
Patients with gestational trophoblastic disease needs a close follow-up because of what situation?
It can lead to choriocarcinoma (malignancy)
Occurs when the cervix dilates early in pregnancy before viability of the fetus
Premature Cervical Dilatation
What kind of suture can be placed to prevent the cervix from dilating when having a premature cervical dilatation?
Cervical cerclage
Premature Cervical Dilatation
A kind of procedure where a nylon sutures are placed horizontally and vertically across the cervix and pulled tight to reduce the cervical canal
McDonald procedure
Premature Cervical Dilatation
A kind of procedure where sterile tape is threaded in a purse-string manner under the submucous layer of the cervix and sutured in place to achieve a closed cervix
Shirodkar technique
The low implantation of the placenta so that it crosses the cervical os
Placenta Previa
What will happen when placenta previa is not yet discovered?
Cervical dilatation may cause the placenta to tear, causing severe blood loss
Four Degrees of Placenta Previa
Implantation in the lower rather than in the upper portion of the uterus
Low-Lying Placenta
Four Degrees of Placenta Previa
The placenta edge approaches that of the cervical os
Marginal implantation
Four Degrees of Placenta Previa
Implantation that occludes a portion of the cervical os
Partial Placenta Previa
Four Degrees of Placenta Previa
Implantation that totally obstructs the cervical os
Total Placenta Previa
A blood disorder that may occur with any trauma, so it can accompany such conditions as premature separation of the placenta and hypertension in pregnancy
Disseminated Intravascular Coagulation (DIC)
Blood coagulation is extreme at one site of the circulatory system that clotting factors become diminished, resulting in their absence in the remainder of the system
Disseminated Intravascular Coagulation (DIC)
Labor that occurs after 20 weeks and before the end of the 37th week of pregnancy
Preterm Labor
Tearing of the fetal membranes with loss of amniotic fluid before the pregnancy is at term
Preterm rupture
A unique disorder that occurs with two classic symptoms: hypertension and proteinuria
Preeclampsia
A unique form of gestational hypertension marked by hemolysis of red blood cells, elevated liver enzymes, and a low platelet count
HELLP Syndrome
Pregnancy that extends beyond 42 weeks
Postterm Pregnancy
Overproduction of AF
Polyhydramnios
Too little AF
Oligohydramnios
Normal AF measurement
500 - 1000ml
A possibility when a patient who is Rh negative is sensitized and carries a fetus who is Rh positive
Isoimmunization
If with threatened miscarriage, coitus should proceed or not?
Abstain from coitus at least 2 weeks
It refers to the cervix that dilates prematurely and therefore cannot retain a fetus until term
Premature Cervical Dilatation
Suggested bed rest position after suture surgery from premature cervical dilatation
Slight or modified Trendelenburg position
Occurs when weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy
Premature Cervical Dilatation
Developed an elevated BP of 140/90mmHg after 20 weeks of gestation but no proteinuria or edema
Gestational Hypertension
Having seizure from preeclampsia
Eclampsia
Above of gestational hypertension but below levels of having seizures
Preeclampsia
Preeclampsia without severe features
- Having proteinuria
- BP rise to 140/90mmHg, taken on two occasions at least 4hrs apart
BP rises to 160/110mmHg or above on at least two occasions 4hr apart at bed rest
Preeclampsia with severe features
Factors of having preeclampsia with severe features
- BP reading 160/110mmHg or diastole of 30mmHg in addition to current BP reading
- Platelet count below 100,000
- Elevated liver enzymes above twice the normal limit
- Serum creatinine level above 1.1mg/dL
- Pulmonary edema
- New-onset severe backache - not relieved with medications
- Visual disturbances
Most severe classification of pregnancy-related hypertensive disorders
Eclampsia
Antiplatelet therapy medication for preeclampsia without severe features
Low-dose aspirin
Examples of hypotensive drugs
- Hydralazine (Apresoline)
- Labetalol (Normodyne)
- Nifedipine