Exam 2 Content Flashcards
Tachysystole & treatment
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5+ contractions in a 10 minute window averaged over a 30 minute period
- too many contractions
Tx = terbutaline
What is tachysystole?
5+ contractions in a 10 minute segment / window averaged over a 30 minute period
- too many contractions
What is the treatment for tachysystole?
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Terbutaline
Chorioamnionitis
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Bacterial infection of the amniotic cavity
- Tx = broad spectrum antibiotics
What is chorioamnionitis?
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Bacterial infection of the amniotic cavity / sac
What is the treatment for chorioamnionitis?
KNOW THIS!!!!!
Broad spectrum antibiotics
Gestational Hypertension
Development of HTN after week 20 of pregnancy in a previously normotensive woman without proteinuria or other findings
Preeclampsia
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Development of hypertension AND proteinuria after 20 weeks gestation in a previously normotensive woman
Can also involve HTN with new onset of:
- thrombocytopenia
- renal insufficiency
- impaired liver function
- pulmonary edema
- cerebral or visual symptoms
Eclampsia
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Development of seizures or coma NOT attributable to other causes in women with preeclampsia
Chronic Hypertension
HTN in a pregnant woman present before pregnancy
Superimposed preeclampsia
Chronic HTN in association with preeclampsia
What medications is used for preventing & treating seizure activity (eclampsia)?
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Magnesium Sulfate via IV
- initial loading dose of 4-6 g IV over 15-30 minutes
- maintenance of 2-3 g/hr
- Therapeutic Magnesium level is 4-7 mEq/L
- Given for neuroprotection
*
Antidote = calcium gluconate
What is Magnesium Sulfate used to treat in pregnancy and what is the antidote for it?
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Preventing & treating seizure activity (eclampsia)
- antidote = calcium gluconate
S/S of Magnesium Toxicity
* absent DTRs
* decreased RR
* decreased LOC
What medications can be used to control blood pressure in patients with preeclampsia?
- Nifedipine
- Labetalol
- Hydralazine
Shoulder Dystocia
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Head is born but the anterior shoulder can NOT pass under the pubic arch
- apply suprapubic pressure above the pubic bone
Prolapsed Cord
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Umbilical cord lies below the presenting part of the fetus
- change position
Group Beta Strep (GBS)
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Leading cause of perinatal infections including bacteremia, endometritis, chorioamnionitis, & UTIs
Tx: IAP antibiotics (intrapartum antibiotic prophylaxis)
Can cause severe respiratory distress, pneumonia, shock, & in rare cases meningitis in newborns
Postpartum Hemorrhage
- Early PPH
- Late PPH
- Medications
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Cumulative blood loss ≥ 1000 mL or s/s of hypovolemia with in 24 hours after birth
- Early (within 24 hr of birth) – atony, bladder distension, trauma
- Late (> 24 hr to < 6 weeks) – infection, subinvolution, retained placenta, coagulation defects
Medications = Methergine or Hemabate
Early Postpartum Hemorrhage
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within 24 hours after birth
- uterine atony
- bladder distension
- cervical laceration
Late Postpartum Hemorrhage
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More than 24 hours but less than 6 weeks after birth
- infection
- subinvolution
- retained placenta
What medications can be used to treat Postpartum Hemorrhage?
* indicate any contraindications
KNOW THIS!!!!!
Methergine
* contraindicated w/ HTN
Hemabate
contraindicated w/ Asthma
Oxytocin
Cytotec
What are the 2 main medications to treat postpartum hemorrhage?
KNOW THIS!!!!!
Hemabate & Methergine
Contraindications for Hemabate
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Asthma patients
Contraindications for Methergine
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HTN
What is the treatment for preeclampsia / eclampsia (seizures)?
KNOW THIS!!!!!
Magnesium sulfate
What is the antidote for magnesium sulfate?
KNOW THIS!!!!!
Calcium gluconate
Placenta Previa
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Placenta is implanted in LOWER uterine segment
Signs & Symptoms:
* painless bright red vaginal bleeding during 2nd or 3rd trimester
* soft, relaxed, non-tender uterus w/ normal tone
Placental Abruption
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Premature separation / detachment of part or all of the placenta from the uterus
Signs & Symptoms:
* vaginal bleeding
* abdominal pain
* uterine tenderness
* contractions
* board-like abdomen
What is the difference in placenta previa & placental abruption?
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Previa = placenta is attached in lower uterine segment
* PP = attachment issue
* PA = detachment issue
Placental Abruption = premature separation / detachment of placenta from uterus
Differentiate the signs & symptoms associated with placental abruption & placenta previa.
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Placenta Previa
* painless, bright red vaginal bleeding
* non-tender uterus
*
Placental Abruption:
* board-like abdomen
* uterine tenderness
* bleeding WITH pain
Key Symptom associated with Placenta Previa & Placental Abruption!!!!!
KNOW THIS!!!!!
Placenta Previa = painless, bright red bleeding
*
Placental Abruption = board-like abdomen & painful vaginal bleeding
Gestational Diabetes
Risk Factors
* family hx of DM
* previous pregnancy that resulted in unexplained stillbirth or birth of a malformed or macrosomic fetus
* obesity, HTN, glycosuria, maternal age > 25 years
* more than half of women with GDM have none of these risk facotrs
Diagnosed in 2nd half of pregnancy
Gestational Hypertension
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- Onset of HTN without other findings after 20 weeks gestation
*
- BP > 140/90 (resolves after giving birth)
What are Macrosomic Infants at risk for?
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Hypoglycemia (after birth)
* polycythemia (RBCs)
* Birth injuries (shoulder dystocia)
* Metabolic issues (obesity, diabetes, cardiovascular disease)
Preconception Guidance for Gestational Diabetes
Know the Bold
- Frequent monitoring in pregnancy
- Primary Goal: achieve & maintain constant euglycemia
- diet, exercise, insulin therapy, self monitoring blood glucose, urine testing
How to calculate Newborn Weight Loss Percentage
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(weight at birth - current weight)
/
birth weight x 100
100 - (current weight / birth weight)
- 100 - (3000/3500) = 0.857
- 0.857 = 85.7
- 100 - 85.7 = 14.3
What are the 3 Tocolytic drugs & what are they used for?
KNOW THIS!!!!!
Tocolytic = INHIBIT contractions
Not My Time
- Nifedipine
- Magnesium sulfate
- Terbutaline
What medications are used for postpartum hemorrhage?
KNOW THIS!!!!!
- Cytotec (misoprostol)
- Hemabate – do NOT use w/ asthma
- Methergine – do NOT use w/ HTN
- Oxytocin / pitocin
What is methotrexate used for?
KNOW THIS!!!!!
Used for medical treatment of ectopic pregnancy
