Exam 3 Flashcards
What are the causes of bleeding in the first trimester?
Spontaneous Abortion
Ectopic Pregnancy
What are the causes of bleeding in the second trimester?
Gestational trophoblastic disease
What are the causes of bleeding in the third trimester?
Placenta Previa
Abruptio Placenta
Vasa Previa
A sponaneous Aborption is?
A pregnancy that ends as result of natural causes before 20 weeks
What is a hydatidiform mole?
Gestational trophoblastic disease (GTD) is the proliferation and degeneration of trophoblastic villi in the placenta that becomes swollen, fluid-filled, and takes on the appearance of grape-like clusters. The embryo fails to develop beyond a primitive state and these structures are associated with choriocarcinoma, which is a rapidly metastasizing malignancy. Two types of molar growths are identified by chromosomal analysis.
Gestational Trophoblastic Disease is also referred to as?
Hydatidiform Mole
Molar Pregnancy
What are the qualifications for a complete mole?
All genetic materal is paternally derived
Ovum has no genetic material (or inactive)
No fetus, placenta, amniotic membrane or fluid
No placenta (hence hemorrage)
What are the qualifications for a partial mole?
Both maternal and paternal genetic material
Normal ovum is fertilized by 1/2 sperm but meiodid or chromosome reduction does not occur
Often contains abnormal embryonic/fetal parts, amniotic sac and fetal blood
6% of partial mole progresses to a choriocarcinoma
Some qualities of a hydatidiform mole are?
The clusters grow really fast
Fundal height is large
Belly grows both fast and big
Bleeding is often dark brown (resembling prune juice)
HcG us at a high level for 10-12 weeks gestation
What is an incompetent cervix?
Passive dilation of the cervix during the second trimester
What is the treatment for an incompetent cervix?
Cerclage at 12-14 weeks gestation for the best results that is removed at 37 weeks
What are the symptoms of an incompetent cervix?
Increased pelvix pressure or urge to push
Pink stained vagina discharge
Possible gush of fluids (ROM)
Contractions with expulsion fetus
US showing short cervix (<25mm/funneling or effacing)
What occurs in a placental abruption?
Premature separation of placenta from the uterus which can be partial or complete that normally occurs after 20 weeks in the 3rd trimester
What are the symptoms of a placental abruption?
Placenta detaches
Dark red blood
Painful uterus
Abdominal is board like
If fetal heart tones are detected->Emergency C section
If bright red bleeding in 3rd trimester accompanied by a soft uterus with no pain occurs, what is the likely diagnosis?
Placenta Previa
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 is the inervention for an ectopic pregnancy?
Salpingostomy (removal of the effected area of the tube)
Before rupture
Salpingectomy (removal of the tube)
If ruptured or no desire for future pregnancy
All surgeries may be followed by a dose of Methotrexate to destroy any remaining tissue.
What are the fetal complications of gestational diabetes?
Respiratory Distress
Hypoglcemia
What is Oliogohyramnios?
Lack of aminiotic fluid that could indicate a renal issue
What is polyhydramnios?
Too much amniotic fluid that could indicate a renal issue
Associated with diabetes
What are the lab values that could indicate hyperemesis gravidarum?
Ketones in urine
What are indications of positive rupture of membranes?
leakage of fluid
vaginal discharge/bleeding
pelvic pressure
no contractions
Fern test
nitrazine paper
What is a fern test?
The Fern Test is one of several tests used to detect rupture of the membranes. Vaginal secretions are inspected under a microscope for crystallization or a ferning pattern. The crystallization is due to an increased concentration of protein and electrolytes within the fluid.
When is a nitrazine paper test performed?
This test is done to ascertain the nature of fluid in the vagina during pregnancy especially when premature rupture of membranes (PROM) is suspect. This test involves putting a drop of fluid obtained from the vagina onto paper strips containing nitrazine dye. The strips change color depending on the pH of the fluid.
What is PPROM?
Premature spontaneous rupture of membrane before 37 weeks
What are the complications of PPROM?
Infection (like chorioamnionitis, sepsis, endometritis)
Prolapsed cord
Abruption placentae
Preterm labor
What is Chorioamnionitis?
Uterine tenderness
Foul smelling amniotic fluid
Fever
Fetal Tachycardia
What are you looking for during a Nitrazine test?
Since the amniotic fluid is alkaline, the solution should turn blue (you need to know when the membrane was ruptured)
What is the test for preterm labor?
A fetal fibronectin test that tests for the glycoprotiec glue found in plasma that predicts who will NOT go into preterm labor
A negative fetal fibronectin test indicates?
That there is less than a 1% chance of giving birth within two weeks
-tocolytic medications do what?
Supress uterine activity and are given if at risk of preterm labor
What medication is given to mothers in premature labor that helps with fetal lung maturity?
Celestone/Betamethason 12mgIM
then 12mg IM 24 hours after first injection
What is precipitous labor?
Labor that lasts less than 3 hrs from the onset of contractions to the time of birth
What is considered operative delivery?
Forcepts or vacuum guided birth
Forcepts or vacuum guided birth can have what complication?
It can cause a hematoma on the babies head
What is TOLAC?
trial of labor after cesaran
What are considered obstetric emergencies?
meconium stained amniotic fluid (dark green, pea green that can be caused from hypoxia in utero or breech presentation)
Shoulder dystocia
What are puerperal infections?
Infections of the uterus and surrounding tissue after birth
What symptoms indicate a puerperal infection?
Fever after 24 hours of 100.4
(Fever of 100.4 in first 24 hours is ok)
What is endometritis?
Inflammation of uterine lining
What are the symptoms of endometritis?
Late PPH sign
Pelvic pain
Chills
Fatigue
Loss of Appetite
Tender uterus
Prolonged cramping
Bleeding
Foul smelling lochia
When does endometritis normally present?
Usually begins of the 2nd-5th day of PP
What is the treatment of endometritis?
Antibiotics
What is uterine subinvolution?
Uterus remains enlarged with continued lochia discharge
What are the risks of uterine subinvolution?
retained placenta (could be cause)
Infection
If a mother is experiencing mastitis, how does this affect breastfeeding?
It doesn’t-mom can still breastfeed on both sides for 15-30 minutes because it does not hurt the baby to feed on infected side
What is the most common cause of PPH?
Uterine Atony
What are the indications for PPH?
Blood loss of:
500mL vaginal birth
1000mL c-section
(if they soak a pad in less than 10 minutes-it is too much PP)
Late PPH (after 24hrs to 12 weeks) is most likely caused by
Retained placental fragments
What is the 1st intervention for PPH?
fundal massage
What are the two classifications of PPH?
Early PPH
Late PPH
What are the most common causes of early PPH?
Uterine Atony
Trauma
Lacerations
Hematomas
What is oxytocin?
A uterine stimulant that promotes contractions
What are the adverse reactions for oxytocin?
Water intoxication->
lightheadedness
Nausea
Vomiting
Headache
Malaise
This can lead to seizures, coma and death
What is Methylergonovine?
A uterine stimulant that controls PPH
In what patient demographic should you never administer Methylergonovine?
Patients with hypertension
What adverse reactions should you monitor for Methylergonovine?
Hypertension
Nausea
Vomiting
Headache
What is Mistoprostol?
A uterine stimulant that controls PPH
What is carboporost tromethamine?
A uterine stimulant (hemabate)
What are the contraindicated patients for carboprost?
Asthma
What are the adverse reactions of carboprost?
Fever
Chills
Headache
Nausea
Vomiting
Diarrhea
What are the symptoms of RDS (respiratory distress syndrome) in newborn?
Blue lips
Nasal flaring
Grunting
Retractions
Seesaw breathing
What causes RDS in newborns?
Hyperglycemia (it prevents surfactant production in infant’s lungs-> the surfactant normally keeps lungs from closing)
Beractant, calfactant, and lucinactant are all?
Lung surfactant that can be given down ET tube
What is necrotizing enterocolitis?
A highly transerable inflammatory disease of the GI mucosa due to ischemia
What are the symptoms of necrotizing enterocolitis?
A distended abdomen
Bloody Stools
Impaired thermoregulation
What is short gut syndrome?
A condition that is secondary to removal of most or part of the necrotic small intestine from necrotizing enterocolitis
What is are the causes of small for gestational age?
IUGR
Hypoglycemia after delivery
Placental insufficency
What is retinopathy that is associated with prematurity?
Retinas of babies eyes are damaged due to complications of respiratory distress syndrome
A Postdate Newborn is?
A newborn that had a gestational age over 42 weeks
What are the risks of postdate newborns?
Meconium aspiration because of placental insufficency
What symptoms indicate neonatal abstinence?
High pitched cry
Resists being swaddled or held
Not consolable
Hands at face
What is macrosomia?
Uncontrolled hyperglycemia during pregnancy that increases risks of injuries during birth including shoulder dystocia from large shoulders
What are the interventions for hyperbilirubinemia? What are the precautions for the therapy?
Phototherapy
-Eye protection, turn baby every 2 hrs, assess for dehydration, and don’t interrupt feeding schedule
What is a sign of fetal alcohol syndrome?
A thin upper lip
When does PPD enter into the realm of post partum psychosis?
When they start to develop hallucinations
When does PP psychosis develop?
2-3 weeks after delivery
Biopolar depression puts mothers at higher risk
What can help initiate the process of grief?
Offer to hold/see the baby
Say I’m sorry your baby has died
