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NCMN 109A - Maternal Lecture > Gestational Conditions affecting Pregnancy Outcomes Part 1 > Flashcards

Gestational Conditions affecting Pregnancy Outcomes Part 1 Flashcards

1
Q

Hyperemesis Gravidarum

A

Pernicious or Persistent Vomiting

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2
Q

is a medical term for SEVERE nausea and vomiting of pregnancy prolonged past week 16 of pregnancy or that is so severe that dehydration, ketonuria, and significant weight loss occur within the first 12 weeks of pregnancy

A

Hyperemesis Gravidarum

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3
Q

Hyperemesis Gravidarum is a medical term for _____________________________________ of pregnancy prolonged past week __ of pregnancy or that is so severe that ________________________________________ occur within the first ____ weeks of pregnancy

A

SEVERE nausea and vomiting; 16; dehydration, ketonuria, and significant weight loss; 12

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4
Q

Risk Factors of Hyperemesis Gravidarum

A

Increase Pregnancy Hormones
Trophoblastic Disease
Having a multiple pregnancy
Primigravida
Previous History

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5
Q

Etiology/Pathophysiology of Hyperemesis Gravidarum
Etiology : __________________

  • May be related to ________________________________________________________
  • May be associated with ______________________
A

unknown; increased thyroid function because of the thyroid-stimulating properties of human chorionic gonadotropin; Helicobacter pylori

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6
Q

Signs and Symptoms of Hyperemesis Gravidarum

A

Significant Weight Loss
Ketonuria
Elevated Haematocrit Concentration
Reduced Concentration of Na+, K+, Cl-
Hypokalemic alkalosis
Ataxia and Confusion
Weight loss
Intrauterine Growth Restriction
Preterm Birth

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7
Q

Loss of hydrochloric acid from the stomach

A

Hypokalemic alkalosis

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8
Q

Deficiency of vitamin B1 (thiamine)

A

Ataxia and Confusion

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9
Q

Diagnostic Tests for Hyperemesis Gravidarum

A

Complete Blood Count
Urine Ketones
Urine Specific Gravity
Liver Enzymes. Elevation of AST and ALT
BUN
Serum Electrolytes
Ultrasound

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10
Q

Medical Management for Hyperemesis Gravidarum

A
  • Hospitalization for about 24 hours
  • NPO for the first 24 hours
  • Intravenous fluids
  • Antiemetic
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11
Q

Intravenous fluids e.g. for Hyperemesis Gravidarum

A

3000 mL Ringer’s Lactate with added vitamin B1

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12
Q

may be prescribed to control vomiting

A

metoclopramide

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13
Q

DIAGNOSIS for Hyperemesis Gravidarum

A

Imbalanced nutrition: less than body requirements related to prolonged vomiting

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14
Q

INTERVENTIONS for Hyperemesis Gravidarum

A

Decrease Stimuli
Provide Emesis Basin
Do Not Urge a Woman to Eat
If on TPN: 1. Check blood glucose twice daily 2. Check urine ketones

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15
Q

Ectopic pregnancy

A

Extrauterine Implantation

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16
Q

happens when the implantation of the fertilized egg occurs outside the uterine cavity

A

Ectopic pregnancy

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17
Q

In Ectopic Pregnancy, the implantation can either occur on the surface of the __________________________________________________________________________

A

ovary, in the cervix, in the abdomen and most commonly in the fallopian tube (95%).

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18
Q

Approximately ___ of pregnancies are ectopic.

A

2%

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19
Q

Hyperemesis Gravidarum occurs at an incidence of ___ pregnant women.

A

2%

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20
Q

TYPES OF ECTOPIC PREGNANCY

A

Tubal pregnancy
Non tubal pregnancy

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21
Q

it occurs when the egg has implanted in the fallopian tube

A

Tubal pregnancy

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22
Q

This is the most common type of ectopic pregnancy and the majority of ectopic pregnancies are of this type

A

Tubal pregnancy

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23
Q

comprise pregnancies implanted at sites other than the fallopian tube

A

Non tubal pregnancy

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24
Q

These ectopic pregnancies may implant in the cervix, cesarean section scar, cornua of the uterus, ovary, or abdominal cavity.

A

Non tubal pregnancy

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25
Q

Risk Factors of Ectopic Pregnancy

A
  • Previous infection such as salpingitis or pelvic inflammatory disease
  • Scars from a tubal surgery
  • Congenital malformations
  • Uterine tumors
  • Use of intrauterine device
  • Smoking
  • A recent in vitro fertilization
  • Previous ectopic pregnancy
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26
Q

Signs and Symptoms of Ectopic Pregnancy

A
  • Vaginal spotting
  • Sharp abdominal pain
  • Sharp, stabbing pain at the lower quadrant
  • Vaginal bleeding
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27
Q

This would rarely occur in conjunction with the pain, but this may be a sign that the ectopic pregnancy is nearing its rupture

A

Vaginal spotting

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28
Q

This is one of the symptoms which tell that the ectopic pregnancy has already ruptured.

A

Sharp, stabbing pain at the lower quadrant

29
Q

occurs after the ectopic pregnancy has ruptured

30
Q

Diagnostic Tests for Ectopic Pregnancy

A

Culdoscopy
Pelvic Ultrasound
Magnetic Resonance Imaging

31
Q

Medical Management for Ectopic Pregnancy

A
  • Administration of methotrexate
  • Administration of mifepristone
  • Intravenous therapy
  • Withdrawing of blood sample
  • Laparoscopy
  • Salpingectomy
32
Q

is a chemo-therapeutic agent that is a folic acid antagonist.

A

methotrexate

33
Q

It destroys rapidly growing cells such as the trophoblast and the zygote.

A

methotrexate

34
Q

This would be administered until a negative hCg titer results have been produced.

A

methotrexate

35
Q

An abortifacient that causes sloughing off of the tubal implantation site.

A

mifepristone

36
Q

This will be performed to ligate the bleeding blood vessels and repair or remove the damaged fallopian tube

A

Laparoscopy

37
Q

This intervention would be performed if the fallopian tube is completely damaged. The affected tube would be removed and what would be left would be sutured appropriately

A

Salpingectomy

38
Q

At __________ weeks of pregnancy, the trophoblast would be large enough to rupture the fallopian tube.

39
Q

Sharp, stabbing pain in the lower quadrant is likely to be felt by the woman once a rupture has occurred, followed by _______________________________.

A

scant vaginal bleeding

40
Q

Diagnosis for Ectopic Pregnancy

A
  • Risk for Deficient Fluid Volume related to bleeding from a ruptured ectopic pregnancy.
  • Powerlessness related to early loss of pregnancy secondary to ectopic pregnancy.
41
Q

EVALUATION
Ectopic Pregnancy
The patient must maintain adequate fluid volume at a functional level as evidenced by normal urine output at _______________________ and a normal specific gravity between the ranges of ______________________

A

30-60mL/hr; 1.010 to 1.021.

42
Q

1 in every 1,000 pregnancies

A

Gestational Trophoblastic Disease Hyatidiform Moles (H-mole)

43
Q

Due to low dietary intake of animal fats

A

Gestational Trophoblastic Disease Hyatidiform Moles (H-mole)

44
Q

Common to women >35 y.o. and <15 y.o.

A

Gestational Trophoblastic Disease Hyatidiform Moles (H-mole)

45
Q

3H

A

history of H-mole, history of miscarriages, hyperthyroidism

46
Q

Risk Factors for Gestational Trophoblastic Disease Hyatidiform Moles (H-mole)

A
  • Low protein intake
  • Women older than 35 years old
  • Asian women
  • Women with a blood group of A who marry men with blood group O.
47
Q

Signs and Symptoms of Gestational Trophoblastic Disease Hyatidiform Moles (H-mole)

A
  • Uterus expands faster than normal.
  • A very high serum or urine test for hCg
  • Vaginal bleeding
48
Q

When the H-mole is still not identified at the ___th week of pregnancy, it will identify itself through vaginal bleeding accompanied by clear fluid filled vesicles

49
Q

Diagnostic Tests for Gestational Trophoblastic Disease Hyatidiform Moles (H-mole)

A

Pregnancy test
Urine test or serum for hCG
Ultrasound

50
Q

In H-mole, an ultrasound will show a _____________________________ with a _________________ pattern, filled with clear fluid instead of an embryo.

A

dense growth of grape-like vesicles; snowflake

51
Q

Gestational Trophoblastic Disease Hyatidiform Moles (H-mole)
Medical and Nursing Management
PHARMACOLOGIC

A
  • Methotrexate
  • Dactinomycin
52
Q

This is ordered by the physician once metastasis occurs

A

Dactinomycin

53
Q

Gestational Trophoblastic Disease Hyatidiform Moles (H-mole)
Medical Management
SURGICAL

A

Suction curettage

54
Q

This is the ideal management of gestational trophoblastic disease, to evacuate the mole inside the woman’s uterus and avoid any further complications if it stays longer inside the reproductive system.

A

Suction curettage

55
Q

Gestational Trophoblastic Disease Hyatidiform Moles (H-mole)
ASSESSMENT
Assess for signs and symptoms of pregnancy-induced hypertension, because for a woman with H-mole, they occur earlier than the ___________ week of pregnancy

56
Q

Gestational Trophoblastic Disease Hyatidiform Moles (H-mole)
Nursing Management
DIAGNOSIS

A

Grieving related to loss of pregnancy as evidenced by anger and social detachment

57
Q

Incompetent cervix

A

Cervical Insufficiency

58
Q

is a condition that refers to the inability of the cervix to hold the fetus any longer until term because it has dilated prematurely.

A

Incompetent cervix

59
Q

When the fetus reaches its ___th week, it starts to become heavy and gain fats.

60
Q

Risk Factors of Incompetent Cervix

A

Increased maternal age
Congenital structural defects
Trauma to the cervix

61
Q

Signs and Symptoms of Incompetent Cervix

A
  • Show
  • Increased pelvic pressure
  • Cervical dilation
62
Q

Diagnostic Test for Incompetent Cervix

A

Ultrasound

63
Q

This is the only test that the physician could order if an incompetent cervix is already suspected.

A

Ultrasound

64
Q

This is a pink-tinged vaginal fluid that is discharged from the vaginal opening as a sign that the cervix has dilated.

65
Q

Medical and Nursing Management for Incompetent Cervix

A

McDonald’s Cervical Cerclage
Shirodkar Cervical Cerclage

66
Q

Nylon sutures are placed horizontally and vertically across the cervix. They are pulled back together until the cervical canal is only a few millimeters in diameter.

A

McDonald’s Cervical Cerclage

67
Q

Sterile tape is used for this technique, where
it is threaded in a purse-string manner under the submucous layer of the cervix. Then, it is sutured in place so it would close the cervix (1)

These sutures are removed on the _______________ week of pregnancy for the fetus to be born vaginally. (2)

A

Shirodkar Cervical Cerclage

;

37th or 38th

68
Q

Nursing Management for Incompetent Cerviz
DIAGNOSIS

A

Anxiety related to impending loss of pregnancy as evidenced by premature dilation of the cervix.

NCMN 109A - Maternal Lecture (6 decks)

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