exam 3! Flashcards
can be secondary arrest of labor occurring during active phase.
labor dystocia
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
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
Characterized by proliferation and edema of the chorionic villi
hydatidiform molar
whos at risk for hydatidiform molar
common in older women and asian
dark brown discharge
higher levels of hcg
extreme n/v
larger uterus than normal for gestational age
hydatidiform molar
cause of uterine rupture
previous c/s or uterine surgery
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
member of herpes group – through sex
Cytomegalovirus
congenital is very severe consequences for fetus.
- Prevention – not during pregnancy
- DO NOT get pregnant for 28 days after vaccination
rubella
- Baby born with spots and nerve damage
varicella zoster
greatest congenital risk for varicella zoster
13-20 weeks
what trimester is the baby most at risk for varicella zoster
2nd
detect with bright light – active lesions – c-section
herpes simplex
fifth disease, fetal death can occur if contracted in 1st trimester They get at daycare.
parvovirus b19
If mom +, baby gets HBIG + hep B vaccine within 12 hrs. of life
hep b
hiv
Keep viral load <1000, no breastfeeding
what viruses do we worry about most
TORCH
Toxoplasmosis, rubella, cytomegalovirus, herpes
Total separation of implanted placenta before fetus is born
abruption
Implantation of the placenta in the lower uterus
placental previa
lower border of the placenta is within 3cm of the internal cervical os but dies not completely cover the os
partial previa
placenta completely covers internal cervical os
total previa
Sudden onset of painless uterine bleeding in the last half of the pregnancy
placental previa
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
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
no
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
pt
10-14 seconds
INR
1.0
ptt
20-30 seconds
tt
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)