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NCMN 109A - Maternal Lecture > Gestational Conditions affecting Pregnancy Outcomes Part 2 > Flashcards

Gestational Conditions affecting Pregnancy Outcomes Part 2 Flashcards

1
Q

Spontaneous Abortion

A

Spontaneous Miscarriage

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2
Q

is a medical term for the disruption of a pregnancy before the fetus reaches its viable age of more than 20 to 24
weeks of gestation or weighs at least 500g.

A

Spontaneous Abortion

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3
Q

Spontaneous Abortion is a medical term for the disruption of a pregnancy before the fetus reaches its viable age of more than _______________ of gestation or weighs at least __________.

A

20 to 24 weeks; 500g

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4
Q

Spontaneous miscarriage occurs in _______________ of all pregnancies and arises from natural causes

A

15% to 30%

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5
Q

The most common cause of an abortion is ______________________________, which is either due to a __________________ or a _____________________

A

abnormal fetal development; chromosomal abberation; teratogenic factor

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6
Q

Another common cause is the _____________________________, where there is inadequate endometrial formation or the zygote was implanted on an ___________________. This would cause inadequate development of the placental circulation, leading to poor nutrition of the fetus and eventually, to an abortion.

A

abnormal implantation of the zygote; inappropriate site

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7
Q

Risk Factors of Spontaneous Abortion

A
  • Congenital Structural Defect
  • Low Progesterone
  • Rh Incompatibility
  • Undernutrition
  • Drugs
  • Infection
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8
Q

Signs and Symptoms of Spontaneous Abortion

A

Vaginal Spotting
Vaginal Bleeding
Cramping/sharp/dull pain in the symphysis pubis
Uterine contractions felt by the mother

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9
Q

______________ appears as small brownish to reddish spots of blood coming out of the woman’s vaginal opening.

A

Vaginal spotting

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10
Q

Vaginal spotting appears as _________________________ of blood coming out of the woman’s vaginal opening.

A

small brownish to reddish spots

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11
Q

This usually occurs when the cervix slightly dilates
because the woman may have tried to lift heavy objects or
mild trauma to the abdomen occurred

A

Vaginal spotting

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12
Q

it might indicate that the cervix has opened and products of conception might be expelled

A

Vaginal bleeding

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13
Q

This could occur on both sides and could be caused by trauma or premature contractions that might cause cervical dilation

A

Cramping/sharp/dull pain in the symphysis pubis

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14
Q

Types of Spontaneous Abortion

A

Threatened
Inevitable/Imminent
Incomplete
Complete
Missed
Reccurent/Habitual

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15
Q

The embryo is already viable. The products of
conception are still intact and the cervix is closed, but there is vaginal bleeding present. No sign of fetal demise.

A

Threatened abortion

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16
Q

The embryo is dead with the products of conception intact. The cervix is already dilated and there is presence of vaginal bleeding. Abortion will happen soon and cannot be stopped.

A

Inevitable/Imminent abortion

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17
Q

All products of conception are expelled and the embryo is dead. The cervix is dilated, and there is mild bleeding.

A

Complete abortion

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18
Q

The embryo is dead but some products are somewhat expelled already. The cervix is already dilated and there is severe vaginal bleeding.

A

Incomplete abortion

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19
Q

The embryo is already dead while inside the uterus. The products of conception are still intact and the cervix is closed. There are brown vaginal discharges present.

A

Missed abortion

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20
Q

Abortion becomes recurrent once the woman has had 3 consecutive miscarriages at the same gestational age.

A

Recurrent/Habitual abortion

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21
Q

This is to confirm the pregnancy first if vaginal bleeding occurs.

A

Pregnancy test

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22
Q

The safest and confirmatory test for pregnancy

A

Ultrasound

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23
Q

would be able to confirm if the pregnancy is positive, and also confirm if the products of conception are still intact

A

Ultrasound

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24
Q

This test also confirms the fetal status

A

Ultrasound

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25
This is to make sure that all products of conception would be removed from the uterus.
Dilatation and evacuation
26
before undergoing dilation and evacuation, the physician must be sure that ____________________________ and the ultrasound must show an_________________.
no fetal heart sounds could be heard anymore; empty uterus
27
This is most commonly performed for incomplete abortions to remove the remainder of the products of conception from the uterus.
Dilation and curettage
28
The presenting symptom of an abortion is always ___________________, and once this is noticed by the pregnant woman, she should immediately notify her healthcare provider
vaginal spotting
29
Nursing Management (Assessment) for Spontaneous Abortion
- assess for vaginal spotting - assess for bleeding - ask of the pregnant woman’s actions before the spotting or bleeding and identify the measures she did when she first noticed the bleeding - inquire of the duration and intensity of the bleeding or pain felt - identify the client’s blood type for cases of Rh incompatibility
30
Diagnosis for Spontaneous Abortion
Risk for deficient fluid volume related to bleeding during pregnancy
31
Nursing Management (Intervention) for Spontaneous Abortion
- If bleeding is profuse, place the woman flat in bed on her side and monitor uterine contractions and fetal heart rate - measure intake and output - assess the woman’s vital signs - measure the maternal blood loss by saving and weighing the used pads - Save any tissue found in the pads
32
The aim for evaluation in Spontaneous Abortion is inclined towards
restoring the maternal blood volume and stopping the source of the bleeding.
33
Nursing Management (Evaluation) for Spontaneous Abortion
- restore the maternal blood volume - stop the source of the bleeding - client’s blood pressure must be maintained above 100/60 mmHg - mother’s pulse rate should be below 100 beats per minute - fetal heart rate must be at a normal level of 120-160 beats per minute - client’s urine output should be more than 30 mL/hr - only minimal bleeding should be apparent for not more than 24 hours
34
Placenta Previa
Abnormal Placental Implantation
35
is a condition wherein the placenta of a pregnant woman is implanted abnormally in the uterus.
Placenta previa
36
It accounts for the most incidents of bleeding in the third trimester of pregnancy.
Placenta Previa
37
Placenta Previa accounts for the most incidents of bleeding in the _______________ of pregnancy.
third trimester
38
Etiology/Pathophysiology of Placenta Previa
- The placenta implants on the lower part of the uterus. - The lower uterine segment separates from the upper segment as the cervix starts to dilate. - The placenta is unable to stretch and accommodate the shape of the cervix, resulting in bleeding.
39
Risk Factors for Placenta Previa
- Advanced maternal age - Multiple gestations - Increased parity - Past caesarean births - Past uterine curettage
40
Signs and Symptoms of Placenta Previa
- Bright red bleeding - Painless
41
Types of Placenta Previa
- Low lying placenta - Marginal Placenta Previa - Partial Placenta Previa - Total Placenta Previa
42
The placenta implants in the lower portion instead of the upper portion of the uterus.
Low lying placenta
43
The placenta’s edge is nearing the cervical os
Marginal Placenta Previa
44
A portion of the cervical os is already covered by the placenta
Partial Placenta Previa
45
The placenta occludes the entire cervical os
Total Placenta Previa
46
Diagnostic Tests for Spontaneous Abortion
- Pregnancy Test - Ultrasound
47
Diagnostic Tests for Placenta Previa
Ultrasound
48
Early detection of placenta previa is always possible through
ultrasonography
49
It is the most common and initial diagnostic test that could confirm Placenta Previa
Ultrasound
50
Medical Management for Placenta Previa
- Intravenous therapy - Avoid vaginal examinations - Attach external monitoring equipment - Cesarean delivery
51
if the placenta has obstructed more than 30% of the cervical os it would be hard for the fetus to get past the placenta through normal delivery. ______________________ is then recommended by the physician.
Cesarean birth
52
Nursing Management (Assessment) for Placenta Previa
- Assess baseline vital signs especially the blood pressure. The physician would order monitoring of the blood pressure every 5-15 minutes - Assess fetal heart sounds - Monitor uterine contractions - Weigh perineal pads used during bleeding to calculate the amount of blood lost. - Assist the woman in a side lying position when bleeding occurs.
53
Diagnosis for Placenta Previa
Fear related to outcome of pregnancy due to bleeding
54
Nursing Management (Intervention)
- Assess fetal heart sounds - Allow the mother to vent out her feelings - Assess any bleeding or spotting - Answer the mother’s questions honestly - Include the mother in the planning of the care plan
55
Nursing Management (Evaluation) for Placenta Previa
- Woman is able to discuss her concerns with the health care providers. - States that hearing the fetal heartbeat assures her of the baby’s safety.
56
Abruptio Placenta
Premature Placental Separation
57
is the premature separation of the placenta that occurs late in the pregnancy.
Abruptio placentae
58
It occurs in about 10% of pregnancies and, because it can lead to extensive bleeding
Abruptio placentae
59
is the most frequent cause of perinatal death
Abruptio placentae
60
Etiology/Pathophysiology of Abruptio Placenta
- The placenta has implanted in the correct location. - For some unknown reasons, it suddenly begins to separate, causing bleeding. - This separation would occur late in pregnancy, and accounts for 10% of perinatal deaths.
61
Risk Factors of Abruption Placenta
- High parity - Short umbilical cord - Advanced maternal age - Direct trauma - Chorioamnionitis
62
This is an infection of the fetal membranes and fluid that could predispose the woman to premature placental separation
Chorioamnionitis
63
Signs and Symptoms of Abruptio Placenta
- Sharp, stabbing pain - Heavy bleeding - Uterus is tense and rigid
64
A woman may experience the pain on the ___________________ as initial separation occurs.
upper uterine fundus
65
This usually happens after the separation of the placenta
Heavy bleeding
66
will only occur if the placenta separates first from the edges
External bleeding
67
will occur if placenta separates from the center because blood would pool under it.
Internal bleeding
68
it appears as a board-like, hard uterus without any bleeding
Couvelaire uterus
69
No indication of placental separation and diagnosis of slight separation is made after birth
Grade 0
70
There is minimal separation which causes vaginal bleeding, but no changes in fetal vital signs occur
Grade 1
71
Moderate separation occurs and fetal distress is already evident. The uterus is also hard and painful upon palpation.
Grade 2
72
Extreme separation; maternal shock and fetal death is imminent if no interventions are done
Grade 3
73
Diagnostic Tests for Abruptio Placenta
Hemoglobin level and fibrinogen level
74
These tests are performed to rule out disseminated intravascular coagulation
Hemoglobin level and fibrinogen level
75
Medical Management for Abruptio Placenta
- Intravenous therapy - Oxygen inhalation - Fibrinogen determination - Cesarean delivery - Hysterectomy
76
removal of uterus and other parts of the woman’s reproductive system depending on the severity such as the fallopian, ovaries and cervix
Hysterectomy
77
After Hysterectomy, can a woman get pregnant again?
Sadly, no. With some parts of the reproductive system removed, conception will most likely to occur.
78
Nursing Management (Assessment) for Abruptio Placenta
- Assess for signs of shock - Assess if the bleeding is external or internal - Monitor contractions if separation occurs during labor - Obtain baseline vital signs - Assess for the time the bleeding began, the amount and kind of bleeding, and interventions done when bleeding occurred if it started before admission - Assess for the quality of pain
79
DIAGNOSIS for Abruptio Placenta
Deficient fluid volume related to bleeding during premature placental separation.
80
Nursing Management (Intervention) for Abruptio Placenta
- Place the woman in a lateral, not supine position to avoid pressure in the vena cava. - Monitor fetal heart sounds - Monitor maternal vital signs - Avoid performing any vaginal or abdominal examinations
81
Nursing Management (Evaluation) for Abruptio Placenta
- Maternal vital signs are all within the normal range, especially the blood pressure. - Urine output should be more than 30mL/hr. - No bleeding or minimal amount of bleeding observed. - Uterus is not tense and rigid. - Fetal heart sounds are within the normal range.
82
Premature Rupture of Membrane
Rupture of the Membranes Before Labor Begins
83
is the rupture of membranes anytime after 37 weeks but before the onset of spontaneous uterine activity.
Premature Rupture of the Membrane (PROM)
84
is the rupture of fetal membranes prior to labor in pregnancies between 28 - 37 weeks.
Preterm Premature Rupture of the Membrane (PPROM)
85
PROM complicates approximately ___ of pregnancies. Preterm PROM complicates about ___ of deliveries
8%; 1%
86
Risk Factors for PROM PRE-CONCEPTIONAL CAUSES
Repeated genitourinary infections Cervical incompetence Chronic cervicitis Obesity Smoking/ Illicit drug use Low socioeconomic status Nutritional deficiencies (esp. of copper and ascorbic acid)
87
Risk Factors for PROM PREGNANCY RELATED CAUSES
Intraamniotic infection Polyhydramnios Multiple gestation Fetal abnormalities Previous history of PPROM(21 to 30%)
88
Signs and Symptoms of PROM
Painless leakage of smelly fluid from vagina. Due to loss of fluid fetus can easily be felt through the belly Decrease uterine size Meconium present in the fluid Abdominal pain Fetal heart sound altered Absence of steady labor contraction
89
Diagnostic Tests for PROM
- Thorough History - Sterile Speculum Exam - Microscopic Fern testing - Nitrazine Testing/Litmus Paper Test - Fetal Fibronectin - Ultrasonography - Ultrasound-guided Instillation of Indigo Carmine Dye
90
would show the accumulation of amniotic fluid in the cervix
Sterile Speculum Exam
91
visualization of a characteristic 'fernlike' pattern on a slide viewed under low power on a microscope
Microscopic Fern testing
92
Amniotic fluid typically has a pH of
7.1-7.3
93
normal vaginal secretions have a pH of
4.5-6.0
94
Sensitive but nonspecific protein test
Fetal Fibronectin
95
Protein that's believed to help keep the amniotic sac "glued" to the lining of the uterus.
Fetal Fibronectin
96
Performed to evaluate amniotic fluid index
Ultrasonography
97
If the tampon or pad is stained blue from the dye, rupture of membranes is confirmed
Ultrasound-guided Instillation of Indigo Carmine Dye
98
Management of patients with prelabor rupture of membranes is determined by gestational age: Early term and term patients (37 0/7 weeks of gestation or more):
proceed to delivery and Group B Streptococcus prophylaxis should be administered as indicated
99
Management of patients with prelabor rupture of membranes is determined by gestational age: Late Preterm (34 0/7- 36 6/7 weeks of gestation)
proceed to delivery and Group B Streptococcus prophylaxis should be administered as indicated
100
Management of patients with prelabor rupture of membranes is determined by gestational age: Preterm (24 0/7 – 33 6/7 weeks of gestation):
expectant management, latency antibiotics, single course of corticosteroids, GBS prophylaxis as indicated
101
Management of patients with prelabor rupture of membranes is determined by gestational age: Less than 24 weeks of gestation:
patient counseling, expectant management or induction of labor, antibiotics can be considered as early as 20 0/7 weeks of gestation, GBS prophylaxis/corticosteroids/tocolysis/magnesium sulfate are not recommended before viability
102
Nursing Management for PROM
- Determine maternal and fetal status, including estimated gestational age. Continually assess for signs of infection. - Maintain the client on bed rest if the fetal head is not engaged. This method may prevent cord prolapse if additional rupture and loss of fluid occur. Once the fetal head is engaged, ambulation can be encouraged
103
Studies demonstrate increased risks of neonatal and maternal morbidity due to
sepsis

NCMN 109A - Maternal Lecture (7 decks)

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