Exam #4 (19-22)

Question 1

Threatened Abortion

Answer 1

Findings: slight vaginal bleeding, NO cervical dilation, mild abdominal cramping, closed cervical os, no passage of fetal tissue
TM: conservative supportive treatment; possible reduction in activity w/ diet & hydration

Question 2

Inevitable abortion

Answer 2

Findings: vaginal bleeding, rupture of membranes, cervical dilation, STRONG abdominal cramping, possible passage of products of conception
TM: Vacuum curettage if products of conception are not passed to reduce risk of excessive bleeding and infection,
Prostaglandin analogs such as MISOPROSTOL to empty uterus of retained tissue (if everything has not passed)

Question 3

Incomplete Abortion (passage of SOME of the products of conception)

Answer 3

Findings: Intense abdominal cramping, Heavy vaginal bleeding, Cervical dilation
TM: Client stabilization; Evacuation of uterus via D&C or prostaglandin analog (misoprostol)

Question 4

Complete Abortion (passage of ALL of the products of conception)

Answer 4

Findings: History of vaginal bleeding and abdominal pain, Passage of tissue with subsequent decrease in pain and significant decrease in vaginal bleeding
TM: No medical or surgical intervention necessary; Follow-up appointment to discuss family planning

Question 5

Missed Abortion (nonviable embryo retained in utero for at least 6 WEEKS)

Answer 5

Findings: Absent uterine contractions, Irregular spotting, Possible progression to inevitable abortion
TM: Evacuation of uterus (if inevitable abortion does not occur): suction curettage during FIRST trimester, dilation and evacuation during SECOND trimester
Induction of labor with intravaginal PGE2 suppository to empty uterus without surgical intervention

Question 6

Recurrent Abortion

Answer 6

Findings: History of THREE or more consecutive spontaneous abortions
Not carrying the pregnancy to viability or term
TM: Identification and treatment of underlying cause (possible causes such as genetic or chromosomal abnormalities, reproductive tract abnormalities, chronic diseases or immunologic problems)
Cervical cerclage in SECOND trimester if incompetent cervix is the cause

Question 7

Misoprostol (Cytotec)

Answer 7

Stimulates uterine contractions to TERMINATE a pregnancy and to EVACUATE the uterus after abortion to ensure passage of all the products of conception

Question 8

Mifepristone (RU-486)

Answer 8

Acts as progesterone antagonist, allowing prostaglandins to stimulate uterine contractions; causes the endometrium to slough; may be followed by administration of misoprostol within 48 hours

Question 9

PGE2, DINOPROSTONE (Cervidil, Prepidil Gel, Prostin E2)

Answer 9

Stimulates uterine contractions, causing EXPULSION of uterine contents; expels uterine contents in fetal death or missed abortion during SECOND trimester; EFFACES & DILATES the cervix in pregnancy at term

Question 10

Rh(D) immunoglobulin (Gamulin, HydroRho-D, RhoGAM, MICRhoGAM)

Answer 10

Suppresses immune response of nonsensitized Rh-negative clients who are exposed to Rh-positive blood to prevent isoimmunization in Rh-negative women exposed to Rh-positive blood after abortions, miscarriages, and pregnancies.

Question 11

Ectopic pregnancy

Answer 11

any pregnancy in which the fertilized ovum implants outside the uterine cavity (can lead to hemorrhage, infertility, or death.) (most common site is fallopian tubes)
HALLMARK = abdominal pain with spotting within 6 to 8 weeks after a missed menstrual period. **
- METHORAXADE IS USED TO TREAT IF NO COMPLICATIONS
- Surgery is used if complications occured (ruptured, hemorrhage, high hcg)

Question 12

Gestational Trophoblastic Disease

Answer 12

Two Types:
- disorders of placental development (hydatidiform mole)
- neoplasms of the trophoblast (choriocarcinoma).
Trophoblastic lesions produce hCG (CLINICAL MARKER)
- D&C needed IMMEDIATLY (evacuation of contents)

Question 13

Uterine Insufficiency

Answer 13

Premature dilatation of cervix
- s/s: Pink-tinged vaginal discharge or pelvic pressure
- Cervical shortening via transvaginal ultrasound

Question 14

Placenta Previa (“afterbirth first”)

Answer 14

placental implants over cervical os (bleeding condition that occurs during the last two trimesters of pregnancy)
- S/S: PAINLESS, BRIGHT red vaginal bleeding
possible c-section

Question 15

Classifications of Placenta Previa

Answer 15

Low-lying: placenta NEAR os (less than 2 cm from the internal os)
Placenta previa: placenta COVERS internal os

Question 16

Placental Abruption

Answer 16

early separation of a normally implanted placenta after the 20th week of gestation (leads to hemorrhage)
- S/S: DARK red bleeding, Knife-like pain, contractions.

Question 17

Placental Abruption classifications

Answer 17

A. Partial abruption with concealed hemorrhage.
B. Partial abruption with apparent hemorrhage.
C. Complete abruption with concealed hemorrhage.

Question 18

Hyperemesis Gravidarum

Answer 18

Severe form of nausea and vomiting
- Causes: weight loss of >5% pre-pregnancy weight,Dehydration, metabolic acidosis, alkalosis, and hypokalemia
- peak: 8 to 12 wks, resolves by week 20
- conservation treatment unless severe (parental therapy)

Question 19

Placenta accreta spectrum

Answer 19

• Accreta: placenta attaches itself too deeply into the wall of the uterus (most common)
• Placenta increta: placenta invades the myometrium
• Placenta percreta: extended through the myometrium and uterine serosa and adjacent tissue.

Question 20

Medications used for Hyperemesis Gravidarum:

Answer 20

1. Promethazine (Phenergan): Symptomatic relief of nausea, vomiting, and motion sickness
2. Pyridoxine and doxylamine (Diclegis): Delayed-release medication containing a combination of an antihistamine and vitamin B;
   Symptomatic relief of nausea and vomiting during pregnancy
3. Ondansetron (Zofran): Blocks serotonin release, which stimulates the vagal afferent nerves, thus stimulating the vomiting reflex

Question 21

Gestational Hypertension

Answer 21

hypertension (higher than 140/90 mm Hg) in a previously normotensive woman without proteinuria after 20 weeks’ gestation resolving by 12 weeks’ postpartum.
- Preeclampsia: new-onset hypertension accompanied by PROTEINURIA and/or maternal organ dysfunction that targets the cardiovascular, hepatic, renal, and central nervous systems (CNS). (increasesrisk of placental abruption, preterm birth, intrauterine growth restriction, and fetal distress during childbirth)
- WITH severe features: ≥160/110 mm Hg on two occasions at least 6 hours apart while on bed rest (hyperreflexia)
- Eclampsia: >160/110 mm Hg. (Seizures & hyperreflexia)
MAGNEISUM SULFATE***

Question 22

HELLP

Answer 22

Hemolysis, elevated liver enzymes, low platelets.
- similar to severe preeclampsia

Question 23

Medications used for Preeclampsia & Eclampsia

Answer 23

1. Magnesium sulfate: Prevention and treatment of eclamptic seizures
2. Hydralazine hydrochloride (Apresoline): reduction in blood pressure
3. Labetalol hydrochloride (Normodyne): reduction in blood pressure
4. Nifedipine (Procardia): reduction in blood pressure, stoppage of preterm labor
5. Sodium nitroprusside (Nitropress): used for severe hypertension requiring rapid reduction in blood pressure
6. Furosemide (Lasix): Pulmonary edema

Question 24

ABO incompatibility

Answer 24

type O mothers and fetuses with type A or B blood (less severe than Rh incompatibility)

Question 25

Rh incompatibility

Answer 25

exposure of Rh-negative mother to Rh-positive fetal blood
- imunoimmunization/sensitization
- risk increases with each subsequent pregnancy and fetus with Rh-positive blood

Question 26

Hydramnios (polyhydramnios)

Answer 26

too much amniotic fluid; > 2,000 mL surrounding fetus between 32-36weeks
TM: indomethacin (decreases fluid by decreasing fetal urinary output)

Question 27

Olgiohydramnios

Answer 27

decreased amount of amniotic fluid (less than 500 mL) between 32-36 weeks
TM: serial monitoring; amnioinfusion and birth for fetal compromise

Question 28

Multiple Gestation

Answer 28

Monozygotic: single, fertilized ovum splits (identical twins)
Dizygotic: Two sperm fertilizing two ova (fraternal twins)
TM: serial ultrasounds, operative delivery
-uterus larger than expected for due date

Question 29

Premature rupture of membranes (PROM)

Answer 29

spontaneous rupture of the amniotic sac before true labor begins
PROM: women beyond 37 weeks’ gestation
PPROM: women less than 37 weeks’ gestation