Exam 2 - Test Map (Units C&D) Flashcards
Does placenta previa or abruptio placentae involve painful bleeding?
Abruptio placentae
What are the 3 classifications of abruptio placentae?
Marginal abruption (grade 1=10-20% detached); Partial abruption (grade 2=20-50% detached); Complete abruption (grade 3=>50% detached)
What is abruptio placentae the leading cause of?
Maternal deaths
What is abruptio placentae?
The detachment of part or all of the placenta from the implantation site
When does abruptio placentae usually occur during pregnancy?
After 20wks of gestation and before birth of baby
What are the risk factors for abruptio placentae?
Maternal HTN, MVA, maternal battering, cocaine abuse resulting in vasoconstriction, previous abruptio placentae, cig. smoking, PROM, & multifetal preg
What labs are done for abruptio placentae?
Hgb & Hct decrease; Coagulation factors decrease; Clotting (fibrinogen) defects (DIC); Type & cross match (for possible blood transfusion)
How could a woman with abruptio placentae end up with DIC?
Her body uses all her fibrinogen to form clots to stop the bleeding
What are the s/s of abruptio placentae?
Sharp/stabbing pain localized in the uterus/fundus, occult (bright red or dark) vaginal bleeding, board-like abd that’s tender, uterine hypertonicity (firm, rigid uterus with contractions), fetal distress, & s/s of hypovolemic shock
Why is a vaginal, abd, pelvic, or rectal exam never done on a woman with abruptio placentae?
It can dislodge the placenta
What is normal urine output per hr?
1-2 mL/kg/hr
What is a quick test to see if a pt with abruptio placentae now has DIC?
Put 5mL of blood in a dry test tube for 5 min, if there’s no clot then its suspected DIC
What is the tx for abruptio placentae?
IV Heparin (to stop clotting cascade), O2 8-10L via face mask, VS q5-15min, lateral maternal position, prepare for stat birth, monitor urine output, FFP or platelets, Betamethasone (Celestone) given
Why is Betamethasone (Celestone) given to a woman with abruptio placentae?
A corticosteroid given for fetal lung maturation
What are Indomethacin (Indocin) & Terbutaline (Brethine) given for?
Used to tx preterm labor
What is Methylergonovine (Methergine) used to tx?
Postpartum hemorrhage
What is gestational trophoblastic disease (Hydatidiform mole, choriocarcinoma, & molar pregnancy)?
An abnormal proliferation and degeneration of the trophoblastic villi in the placenta. As cells degenerate they fill with clear fluid and appear as grape-like vessels. The embryo fails to develop beyond the primitive start
What is choriocarcinoma and what is it associated with?
Rapidly metastasizing malignancy associated with molar preg. (hydatidiform mole)
Is the genetic material in a complete molar pregnancy derived maternally, paternally, or both?
Paternally; Nucleus of sperm (23X) duplicates itself = diploid # (46XX)
Is the genetic material in a partial molar pregnancy derived maternally, paternally, or both?
Both maternally and paternally
Describe the ovum in a complete molar pregnancy.
Has no genetic material or the material is inactive
Describe the ovum in a partial molar pregnancy.
Is fertilized by 2 sperm or one sperm in which meiosis or chromosome reduction and division didn’t occur
Since there is no placenta to receive maternal blood in a complete molar preg., what happens?
Hemorrhage into the uterine cavity occurs and vaginal bleeding results
What does a complete molar preg. contain?
No fetus, placenta, amniotic membranes, or fluid
What does a partial molar preg. contain?
Often contains abnormal embryonic or fetal parts, an amniotic sac, and fetal blood, but congenital anomalies are present
What are the risk factors for a hydatidiform mole?
Low protein intake, 35yrs of age, Asian population & women with blood type A with a man with type O
What are the s/s of a hydatidiform mole?
Vaginal bleeding (bright red or dark brown), hyperemesis gravidarum (d/t increases hCG levels), rapid uterine growth, higher fundus, s/s of PIH prior to 20 wks (HTN, edema, & proteinuria)
How often does a woman with a hydatidiform mole need their hCG levels checked?
q1-2wks until levels are normal, q2-4wks for 6mo, & q2mo for 1yr
What do hCG levels that plateau or increases with a hydatidiform mole suggest?
Malignant transformation (choriocarcinoma)
What is placenta previa?
Occurs when the placenta abnormally implants in the lower segment of the uterus near or over the cervical os instead of attaching to the fundus
What are the risk factors for placenta previa?
Previous placenta previa, uterine scarring (previous c-section, curettage, endometritis), maternal age >35yrs, multifetal gestation, & multiple gestation or closely spaced pregnancies
What are the 3 types of placenta previa dependent upon?
Dependent on the degree to which the cervical os is covered by the placenta
What are the 3 types of placenta previa?
Marginal (low-lying), Incomplete (partial) & Complete (total)
Describe marginal placenta previa
When the placenta is attached in the lower uterine segment but doesn’t reach the cervical os
Describe incomplete placenta previa
Cervical os is only partially covered by the placental attachment
Describe complete placenta previa
Cervical s is completely covered by the placental attachment
Why must you never do a vaginal or rectal exam on a pt with placenta previa?
It can dislodge the placenta
When does placenta previa usually occur during a pregnancy?
30wks gestation
How is placenta previa managed?
Bedrest until viability, NST or BPP wkly, c-section
What are the s/s of placenta previa?
Painless, bright red vaginal bleeding that increases as the cervix dilates; soft, relaxed, nontender uterus with normal tone; Fundal ht that is greater than usually expected for gestational age; Fetus in breech, oblique, or transverse position; Palpable placenta; VS are WNL; Decreased urinary output
At what % of placenta previa does a woman have a SVD? C-section?
SVD = 30% previa
What is a Lecithin/sphingomyelin (L/S) ratio, how is it obtained, and what is the normal ratio?
A L/S ratio is obtained from amniotic fluid to determine fetal lung maturity. Normal = 2:1 & for DM = 3:1
What is hyperemesis gravidarum?
Excessive N/V (r/t increased hCG levels) that is prolonged past 12wks of gestation
What does hyperemesis gravidarum result in?
A 5% wt loss from prepregnancy wt, electrolyte imbalance, acetonuria, & ketosis
What are the risk factors for hyperemesis gravidarum?
Maternal age <20yrs, obesity, 1st preg, multifetal gestation, gestational trophoblastic disease, hx of psyc disorders, transient hyperthyroidism, Vit B deficiencies, high stress levels
What are the s/s of hyperemesis gravidarum?
Excessive vomiting for prolonged periods, dehydration, wt loss, increased pulse rate, decreased BP, and poor skin turgor
What will lab results show in hyperemesis gravidarum?
Urinalysis for ketones and acetones (breakdown of protein & fat) is most important initial lab; Increased specific gravity; Decreased sodium, potassium, & chloride (from low intake); Acidosis (from excessive vomiting); Increased liver enzymes; Thyroid tests (Hyperthyroidism); Increased Hct (inability to retain fluid results in hemoconcentration)
What is the tx for hyperemesis gravidarum?
IV therapy, NPO status until vomiting free X’s 48hrs, Antiemetics (Inapsine, Reglan, or Phenergan), strict I&O, & a restful environment
What med is given to tx refractory hyperemesis gravidarum?
Corticosteroids
What can cause fetal bradycardia (FHR <110/min for 10 min or more) or late decels in FHR?
Uteroplacental insufficiency
How is uteroplacental insufficiency tx?
Pt in side-lying position, IV therapy, discontinue oxytocin, admin 8-10L O2 via mask, notify PCP, possibly admin tocolytic meds, and prepare for SVD or c-section
What are Leopold maneuvers?
Abdominal palpation of the # of fetuses, the fetal presenting part, lie, attitude, descent, and the best location for fetal heart tones
What is a prolapsed cord?
When the umbilical cord is displaced, preceding the presenting part of the fetus, or protruding thru the cervix
What does a prolapsed cord result in?
Cord compression and compromised fetal circulation
What are the risk factors for a prolapsed cord?
ROM, abnormal fetal presentation, transverse lie, SGA, cord length >100cm, multiparity, cephalopelvic disproportion, placenta previa, intrauterine tumor, & polyhydraminos
What is polyhydraminos?
Excessive amniotic fluid >2,000mL
What are the s/s of a prolapsed umbilical cord?
Fetal bradycardia with variable or prolonged decels, cord is seen/felt/protruding from the vagina, extreme increase in fetal activity & then ceases (suggestive of severe fetal hypoxia)
What happens if blood flow is occluded to and from the fetus for more than 5 min?
Usually results in CNS damage or fetal death
What are the interventions for a prolapsed umbilical cord?
Extreme Trendelenburg, Modified Sim’s, or knee-chest position, O2 via mask @ 8-10L/min until birth, Increase IV fluids, continuous FHR monitoring, immediate vag delivery if fully dilated or c/s if not
What interventions are done if the prolapsed cord is seen/felt?
Insert 2 fingers & exert upward pressure against the presenting part or wrap the cord loosely in sterile towel soaked with warm saline
What is Nagele’s rule for EDD?
1st day of LMP, subtract 3 mo, add 7 days & 1yr OR count forward 9 mo & add 7 days
When does engagement occur during labor?
When the presenting part passes the pelvic inlet at the level of the ischial spines. Referred to as station 0 (zero).
What is the fetal “lie”?
The relationship of the fetal spine to maternal spine. Primary lies: Longitudinal (vertical) & transverse (horizontal or oblique); Vertical lie: either cephalic or breech. Vag birth isn’t possible with transverse lie
What are the 5 P’s affecting labor?
Passenger, passageway, powers, position, & psychologic response
When does an AFE occur?
When amniotic fluid containing debris (vernix, hair, meconium, etc.) enters maternal circulation & obstructs pulmonary vessels = respiratory distress & circulatory collapse
What are the risk factors for AFE?
Multiparity, tumultuous labor, abruptio plancentae, oxytocin admin, fetal macrosomia, hydramnios, fetal demise, & meconium-stained amniotic fluid
What are the s/s of respiratory distress with an AFE?
Restlessness, dyspnea, cyanosis, pulmonary edema, and respiratory arrest
What are the s/s of circulatory collapse with an AFE?
Hypotension, tachycardia, shock, cardiac arrest
What are the hemorrhage s/s with an AFE?
Coagulation failure (bleeding and uterine atony)
What are the AFE interventions?
O2 (8-10L/min via mask or rebreather @ 100%, intubation & mechanical ventilation, CPR, & tilt woman 30 deg to side); Maintain cardiac output & replace fluid losses & VS (PRBCs, FFP, hourly I&O)
When are nursing interventions most important during labor?
During the 3rd & 4th stages
What type of medication is used to control BP during an AFE?
Vasopressor
What must be monitored for an AFE until a pulmonary catheter is placed?
Pulse oximetry
What labs are done for an AFE?
CBC, platelet count, type & cross match, PT, PTT, fibrinogen, chem panel, and renal fxn
What are some signs that precede labor?
Lightening, Braxton Hicks contractions become stronger, Increased vaginal mucus (white/gray discharge with no odor), bloody show 24-48hrs before, nesting, & wt loss (btwn 1-3 lbs)
What is lightening?
Presenting part descends into the true pelvis
What factors are included in the onset of true labor?
Changes in uterus, cervix, and pituitary gland
Define prodromal/false labor
No change in cervix within 1-2hrs
Define true labor
Cervical changes/dilation
What are some childbirth complications?
Preterm labor, prolapsed umbilical cord, AFE, & shoulder dystocia
Describe FHR baseline variability?
Fluctuations in the FHR baseline that are irregular in frequency & amplitude
What are the classifications of variability?
Absent or undetectable (0-2bpm, nonreassuring), Minimal (3-5bpm), Moderate (6-25bpm), & Marked (>25bpm)
What is the average variability in a FHR?
6-10bpm
What FHR variability is exhibited in a normal, healthy fetus?
Moderate variability
What type of FHR variability is seen with fetal sleep, maternal meds or fetal anomalies?
Decrease in variability
What is persistent minimal or absent variability a sign of?
Inadequate fetal oxygenation
What are some causes of decreased variability in a FHR?
Fetal hypoxia, acidosis, congenital heart defects and fetal tachycardia
What are the nonreassuring FHR patterns?
Fetal bradycardis and tachycardia, absence of FHR variability, late decels & variable decels
What is the FHR in fetal bradycardia?
FHR <110bpm for 10min or more
