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exam 3! Flashcards

1
Q

can be secondary arrest of labor occurring during active phase.

A

labor dystocia

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2
Q 
sudden and stormy
bleeding is external or concealed and dark 
possible anemia and shock 
preeclampsia may be present 
pain is severe and steady 
uterine tenderness tone is firm or hard 
uterus enlarges or changes shape
A

placental abruption

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3
Q 
onset quiet
external bleeding, bright red 
possible anemia and shock
preeclampsia absent 
painless unless in labor 
no uterine tenderness and tone is soft
A

placenta previa

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4
Q

Characterized by proliferation and edema of the chorionic villi

A

hydatidiform molar

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5
Q

whos at risk for hydatidiform molar

A

common in older women and asian

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6
Q

dark brown discharge
higher levels of hcg
extreme n/v
larger uterus than normal for gestational age

A

hydatidiform molar

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7
Q

cause of uterine rupture

A

previous c/s or uterine surgery

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8
Q

fetal particulate is drawn into the maternal circulation and the particulate obstructs pulmonary vessels which causes respiratory distress, cardiac collapse, DIC and usually death.

A

amniotic fluid embolism

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9
Q

member of herpes group – through sex

A

Cytomegalovirus

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10
Q

congenital is very severe consequences for fetus.

  1. Prevention – not during pregnancy
  2. DO NOT get pregnant for 28 days after vaccination
A

rubella

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11
Q
  1. Baby born with spots and nerve damage
A

varicella zoster

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12
Q

greatest congenital risk for varicella zoster

A

13-20 weeks

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13
Q

what trimester is the baby most at risk for varicella zoster

A

2nd

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14
Q

detect with bright light – active lesions – c-section

A

herpes simplex

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15
Q

fifth disease, fetal death can occur if contracted in 1st trimester They get at daycare.

A

parvovirus b19

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16
Q

If mom +, baby gets HBIG + hep B vaccine within 12 hrs. of life

A

hep b

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17
Q

hiv

A

Keep viral load <1000, no breastfeeding

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18
Q

what viruses do we worry about most

A

TORCH

Toxoplasmosis, rubella, cytomegalovirus, herpes

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19
Q

Total separation of implanted placenta before fetus is born

A

abruption

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20
Q

Implantation of the placenta in the lower uterus

A

placental previa

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21
Q

lower border of the placenta is within 3cm of the internal cervical os but dies not completely cover the os

A

partial previa

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22
Q

placenta completely covers internal cervical os

A

total previa

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23
Q

Sudden onset of painless uterine bleeding in the last half of the pregnancy

A

placental previa

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24
Q

How do we treat abruptions and previas?

A

Bed rest and off work if light spotting
Abruption
 at risk for DIC assess for excess bleeding at iv, gums, out of nose. Give fluids monitor I&O, BP
 no vaginal exams
 total needs c-section
Administer surfactant to mature lungs if she is not hemorrhaging
 Betamethasone (steroid)
If partial, watch them (keep in hospital)
 If moderate variability, or minimal, observe – can be at home if close to hospital
• Don’t rush to C-section and delivery baby with premature lungs if don’t have to

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25
Q

what is the HELLP syndrome

A

Hemolysis Elevated Liver enzymes Low Platelets

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26
Q

s/s of HELLP

A

extreme epigastric pain, low platelet <50,000, RUQ pain

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27
Q

what assessment is most important for preeclampsia patient

A

continous BP, FHR

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28
Q

head to toe assessment for preeclampsia

A 
●	CHHURN (head to toe)
○	Cardiovascular System (increased BP)
○	Hematologic System
○	Hepatic System 
○	Uteroplacental system 
○	Renal System (decreased urine output, Proteinuria)
○	Neurological System
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29
Q

how will you know if your preeclampsia patient might be becoming eclamptic?

A

pt has 1 or more seizures

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30
Q

to test eclamptic

A

tonic-clonic movement

Dorsi flex the foot and count how many times it beats back if it beats back they have clonus of 3

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31
Q

warning signs of preeclampsia

A 
	BP > 140/90
	proteinuria (0.3g in a 24hr urine) (urine dip is +1)
	SEVERE headache, 
	Vision changes
	epigastric pain, 
	edema
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32
Q

anticonvulsant meds for preeclampsia

A

magnesium sulfate

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33
Q

Antihypertensive medications for preeclampsia

A

Apresoline (Hyralyzine), Labetalol, Nifedapine (Procardia)

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34
Q

can you push anything through an iv with mag sulfate running

A

no

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35
Q

uses for magnesium sulfate

A

 Beta-andrenergic agent
 Anticonvulsant – to stop seizures
 Tocolytic – inhibits contractions
 Protection for baby – if given before 32 weeks of pregnancy

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36
Q

assess when on mag sulfate

A 
monitor magnesium and calcium levels (4-8)
monitor DTR 
FHR
baseline VS
RR
strict I&amp;o
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37
Q 
–	Flushing
–	HA 
–	Dry mouth 
–	Dizziness 
–	Lethargy 
–	Pulmonary edema
A

maternal side effects of magnesium sul

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38
Q 
–	Drug readily crosses placenta
–	Decreases in FHR variability
–	Hypotonia
–	Lethargy
–	Respiratory depression
A

fetal side effects of mag sulfate

39
Q

o Respiratory rate < 12/min
o Absence of DTR’s (Patellar)
o Sweating and flushing (after the initial bolus)
o Altered Sensorium

A

signs of mag toxicity

40
Q

reversal agent for mag sul

A

calcium gluconate

41
Q

what to do for cord prolapse

A

Oxygen, tocolytic, vaginal elevation, knee to chest, trendelenburg

42
Q

early signs of post partum hemorrhage

A

1st 24 hours
 Most often uterine atony (boggy fundus)
 Average blood loss vaginal – 500ml/ c-section – 1000mL

43
Q

late signs of post partum hemorrhage

A

24 hr- 6/12 weeks
 subinvolution (delayed return of uterus), retained placental fragments, infection
 lochia going backwards! Alba to rubra

44
Q

 Firm fundus but continued bright red bleeding

A

laceration

45
Q

meds that manage hemorrhage and makes the uterus contract

A

Carboporst and Methylergonovine

46
Q

dont give Methylergonovine for pt with

A

htn cause it will increase bp

47
Q

contraindications for Carboporst

A

asthma and can cause diarrhea; causes pulmonary edema

48
Q

when to choose Carboporst or Methylergonovine

A

pt w htn use carboporst

49
Q

first sign of hypovolemic shock

A

tachycardia

50
Q

last sign of hypoolemic shock

A

hypotension

51
Q

pt

A

10-14 seconds

52
Q

INR

53
Q

ptt

A

20-30 seconds

54
Q

tt

A

1-15 SECONDS

55
Q

what to check when giving mag sulfate

A

DTR, urinary output, respiratory

56
Q

what contractions are in uterine rupture

A

late decels or absent variability

57
Q

threatened abortion

A

vaginal bleeding during first months of pregnancy

58
Q

membranes rupture and cervix dilates

A

inevitable abortion

59
Q

some of the products of conception are expelled from the uterus

A

incomplete abortion

60
Q

manifestations of incomplete abortion

A

active uterine bleeding and severe abdominal cramping

61
Q

fetus dies during the first half of pregnancy but is retained in the uterus

A

missed abortion

62
Q

when all products of conception are expelled

A

complete abortion

63
Q

3 or more spontaneous abortions . primary cause is genetic or chormosomal abnormalities or bicornuate uterus

A

recurrent spontaneous

64
Q

Implantation of a fertilized ovum outside of uterine cavity; 97% occur in fallopian tube

A

ecotopic pregnancy

65
Q

high levels of hcg

A

Hydatidiform mole trophoblasts

66
Q

manifestations of Gestational trophoblastic disease

A

Hyperemesis

Dark brown discharge

67
Q

marginal abruption

A

external bleeding

68
Q

dic is common in

A

abruptio placenta or htn

69
Q

A severe type of nausea and vomiting during pregnancy.

A

Hyperemesis Gravidarum

70
Q

what to do for patient with Hyperemesis Gravidarum

A 
assess skin turgor
iv fluids for dehydration 
urine for ketones
electrolytes and hemoglobin/hematocrit
daily weight
71
Q

meds for Hyperemesis Gravidarum

A

Diphenhydramine (Benadryl)
Histamine-receptor antagonists (Pepcid/Zantac)
Gastric acid inhibitors (Nexium/Prilosec)
Metoclopramide (Reglan)
Pyridoxine/doxylamine (Diclegis)

72
Q

Onset after 20 weeks without proteinuria

A

gestational htn

73
Q

Onset after 20 weeks that may be accompanied by proteinuria >300mg in 24 hr. collection

A

preeclampsia/eclampsia

74
Q

preeclampsia or htn

75
Q

s/s of hellp

A

ruq pain
thrombocytopenia
Hyperbilirubinemia

76
Q

most likely to develop in preexisting diabetes

A

preeclampsia

77
Q

preexisting dm fetal effects

A

Hypoglycemia
Hypocalcemia
Hyperbilirubinemia
Respiratory distress syndrome

78
Q

abnormal glucose challenge test

79
Q

1 cup

80
Q

1 g

A

1 ml of blood

81
Q

early pp hemorrhage causes

A

uterine atony; trama to birth canal

82
Q

firm fundus but continued bright red bleeding

A

laceration

83
Q

discolored bulging mass that is sensitive to touch

84
Q

difference between uti and laceration

A

laceration burns later ; UTI burns immediately

85
Q

magnesium

86
Q

meds to accelerate lung maturity

A

corticosteriods

  • betamethasone
  • dexamethasone
87
Q

what to do for a prolapsed cord

A

trendelenburg

c/s

88
Q

low backache, pelvic pressure/pain, balling up

A

preterm labor

89
Q

More common in older women, multiparas, previous C-section, prior uterine surgery

A

placenta previa

90
Q

abruption we are worried about

91
Q

tx for preeclamp

A

platelets or fibrinogen

fluids

92
Q

severe preeclamp

A 
>160/110 
pulmonary edema
ogliguria 
thrombocytopenia
proteinuria
93
Q

antihypertensive meds

A

Apresoline (Hyralyzine), Labetalol, Nifedapine (Procardia)

OB (5 decks)

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