exam 3! Flashcards by olivia mcnamara

can be secondary arrest of labor occurring during active phase.

labor dystocia

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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

placental abruption

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

placenta previa

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Characterized by proliferation and edema of the chorionic villi

hydatidiform molar

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whos at risk for hydatidiform molar

common in older women and asian

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

hydatidiform molar

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cause of uterine rupture

previous c/s or uterine surgery

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

amniotic fluid embolism

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member of herpes group – through sex

Cytomegalovirus

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congenital is very severe consequences for fetus.

Prevention – not during pregnancy
DO NOT get pregnant for 28 days after vaccination

rubella

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Baby born with spots and nerve damage

varicella zoster

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greatest congenital risk for varicella zoster

13-20 weeks

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what trimester is the baby most at risk for varicella zoster

2nd

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detect with bright light – active lesions – c-section

herpes simplex

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

parvovirus b19

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

hep b

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hiv

Keep viral load <1000, no breastfeeding

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what viruses do we worry about most

TORCH

Toxoplasmosis, rubella, cytomegalovirus, herpes

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Total separation of implanted placenta before fetus is born

abruption

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Implantation of the placenta in the lower uterus

placental previa

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

partial previa

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placenta completely covers internal cervical os

total previa

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

placental previa

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How do we treat abruptions and previas?

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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what is the HELLP syndrome

Hemolysis Elevated Liver enzymes Low Platelets

s/s of HELLP

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

what assessment is most important for preeclampsia patient

continous BP, FHR

head to toe assessment for preeclampsia

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

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

pt has 1 or more seizures

to test eclamptic

tonic-clonic movement | Dorsi flex the foot and count how many times it beats back if it beats back they have clonus of 3

warning signs of preeclampsia

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

anticonvulsant meds for preeclampsia

magnesium sulfate

Antihypertensive medications for preeclampsia

Apresoline (Hyralyzine), Labetalol, Nifedapine (Procardia)

can you push anything through an iv with mag sulfate running

uses for magnesium sulfate

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

assess when on mag sulfate

``` monitor magnesium and calcium levels (4-8) monitor DTR FHR baseline VS RR strict I&o ```

``` – Flushing – HA – Dry mouth – Dizziness – Lethargy – Pulmonary edema ```

maternal side effects of magnesium sul

``` – Drug readily crosses placenta – Decreases in FHR variability – Hypotonia – Lethargy – Respiratory depression ```

fetal side effects of mag sulfate

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

signs of mag toxicity

reversal agent for mag sul

calcium gluconate

what to do for cord prolapse

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

early signs of post partum hemorrhage

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

late signs of post partum hemorrhage

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

 Firm fundus but continued bright red bleeding

laceration

meds that manage hemorrhage and makes the uterus contract

Carboporst and Methylergonovine

dont give Methylergonovine for pt with

htn cause it will increase bp

contraindications for Carboporst

asthma and can cause diarrhea; causes pulmonary edema

when to choose Carboporst or Methylergonovine

pt w htn use carboporst

first sign of hypovolemic shock

tachycardia

last sign of hypoolemic shock

hypotension

10-14 seconds

INR

1.0

ptt

20-30 seconds

1-15 SECONDS

what to check when giving mag sulfate

DTR, urinary output, respiratory

what contractions are in uterine rupture

late decels or absent variability

threatened abortion

vaginal bleeding during first months of pregnancy

membranes rupture and cervix dilates

inevitable abortion

some of the products of conception are expelled from the uterus

incomplete abortion

manifestations of incomplete abortion

active uterine bleeding and severe abdominal cramping

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

missed abortion

when all products of conception are expelled

complete abortion

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

recurrent spontaneous

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

ecotopic pregnancy

high levels of hcg

Hydatidiform mole trophoblasts

manifestations of Gestational trophoblastic disease

Hyperemesis | Dark brown discharge

marginal abruption

external bleeding

dic is common in

abruptio placenta or htn

A severe type of nausea and vomiting during pregnancy.

Hyperemesis Gravidarum

what to do for patient with Hyperemesis Gravidarum

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

meds for Hyperemesis Gravidarum

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

Onset after 20 weeks without proteinuria

gestational htn

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

preeclampsia/eclampsia

preeclampsia or htn

hellp

s/s of hellp

ruq pain thrombocytopenia Hyperbilirubinemia

most likely to develop in preexisting diabetes

preeclampsia

preexisting dm fetal effects

Hypoglycemia Hypocalcemia Hyperbilirubinemia Respiratory distress syndrome

abnormal glucose challenge test

> 140

1 cup

250 ml

1 g

1 ml of blood

early pp hemorrhage causes

uterine atony; trama to birth canal

firm fundus but continued bright red bleeding

laceration

discolored bulging mass that is sensitive to touch

hematoma

difference between uti and laceration

laceration burns later ; UTI burns immediately

magnesium

1.5-2.5

meds to accelerate lung maturity

corticosteriods - betamethasone - dexamethasone

what to do for a prolapsed cord

trendelenburg | c/s

low backache, pelvic pressure/pain, balling up

preterm labor

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

placenta previa

abruption we are worried about

DIC

tx for preeclamp

platelets or fibrinogen | fluids

severe preeclamp

``` >160/110 pulmonary edema ogliguria thrombocytopenia proteinuria ```

antihypertensive meds

Apresoline (Hyralyzine), Labetalol, Nifedapine (Procardia)