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OB - NCM109 Care of Mother and Child at Risk or with Problems (Acute and Chronic) > Gestational Conditions - Part 1 > Flashcards

Gestational Conditions - Part 1 Flashcards

1
Q

Most severe form of nausea and vomiting in pregnancy

A

Hyperemesis Gravidarum

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2
Q

Hyperemesis Gravidarum usually begins by _____ of gestation

A

9-10 weeks

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3
Q

Hyperemesis Gravidarum peaks at _____?

A

11-13 weeks

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4
Q

Hyperemesis Gravidarum resolves in most cases by _____?

A

12-14 weeks

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5
Q

Characterized by persistent nausea and vomiting associated with ketosis and weight loss

A

Hyperemesis Gravidarum

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6
Q

Hyperemesis Gravidarum can cause:

A
  • Volume depletion
  • Electrolytes and acid-base imbalances
  • Nutritional deficiencies
  • Death
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7
Q

Hyperemesis Gravidarum: Symptoms

A
  • Nausea and Vomiting
  • Ptyalism
  • Fatigue, Weakness, Dizziness
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8
Q

Hyperemesis Gravidarum: History

A
  • Timing, onset, severity, pattern, and alleviating and exacerbating factors
  • Past medical conditions, surgeries, medications, allergies, adverse drug reactions, family history, social history (including support system), employment, habits, and diet
  • Gynecologic history of symptoms
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9
Q

Hyperemesis Gravidarum: Risk Factors

A
  • Previous pregnancies with hyperemesis gravidarum
  • Greater body weight
  • Multiple gestations
  • Trophoblastic disease
  • Nulliparity
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10
Q

Hyperemesis Gravidarum: Medical Care

A
  • Reassurance
  • dietary recommendations
  • support
  • Alternative therapies
    • acupressure
    • hypnosis
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11
Q

Hyperemesis Gravidarum: Medical Care (Medication)

A
  • Vitamin B-6 10-25 mg 3-4 times daily
  • doxylamine 12.5 mg 3-4 times daily (only FDA- approved drug)
  • Ginger capsules 250 mg 4 times daily
  • Metoclopramide 5-10 mg orally every 8 hours
    -widely used
  • Promethazine 12.5 mg orally or rectally q4h or dimenhydrinate 50-100 mg orally q4-6h
  • Ondansetron 4-8 mg orally or IV q8h
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12
Q

Hyperemesis Gravidarum: Medical Care (Nutritional Supplement)

A
  • parenteral or enteral route
  • The standard method has been via total parenteral nutrition (TPN)
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13
Q

Hyperemesis Gravidarum: Diet

A
  • Eat when hungry, regardless of normal meal times
  • Eat frequent small meals
  • Avoid fatty and spicy foods and emetogenic foods or smells
    • Increase intake of bland or dry foods
  • Eliminate pills with iron
  • High-protein snacks are helpful
  • Crackers in the morning
  • Increase intake of carbonated beverages
  • Herbal teas containing peppermint or ginger, other ginger-containing beverages, broth, crackers, unbuttered toast, gelatin, or frozen desserts
  • Preconception use of prenatal vitamins may decrease nausea and vomiting associated with pregnancy
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14
Q

Hyperemesis Gravidarum: Activity

A
  • decreased activity
  • increased rest
  • fresh outdoor air
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15
Q

Ectopic Pregnancy (other name)

A

Tubal pregnancy;
Cervical pregnancy;
Tubal ligation-ectopic pregnancy

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16
Q

Pregnancy that occurs outside the womb

A

Ectopic Pregnancy

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17
Q

Ectopic Pregnancy: _____ weeks after missed menstrual period, site ruptures

A

2-8 weeks

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18
Q

___ trimester bleeding
- Usually occurs _____ of the fallopian tube (_____)
- Ampullar 80%
- Isthmus 12%
- Interstitial/fimbrial 8%
- _____ pregnancy

A

1st trimester

distal third; Pilliteri

Abdominal

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19
Q

Ectopic Pregnancy: Causes and Risk Factors

A
  • Anything that blocks or slows the movement of the egg through the fallopian tubes
  • Birth defect in the fallopian tubes
  • Scarring after a ruptured appendix
  • Having an ectopic pregnancy before
  • Scarring from past infections or surgery of the female organ
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20
Q

Ectopic Pregnancy: Increased Risk Factors

A
  • Age over 35
  • Pregnancy with IUD
  • Removal of tubal sterilization
  • Multiple sexual partners
  • Infertility treatment
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21
Q

Ectopic Pregnancy: Symptoms

A
  • breast tenderness
  • nausea
  • Abnormal vaginal bleeding
  • Low back pain
  • Mild cramping on one side of the pelvis
  • No periods
  • Pain in the lower belly or pelvic area (sharp and stabbing)
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22
Q

Ectopic Pregnancy: If the area around the abnormal pregnancy ruptures and bleeds:

A
  • Fainting or feeling faint
  • Intense pressure in the rectum
  • Low blood pressure
  • Pain in the shoulder area
  • Severe, sharp, and sudden pain in the lower abdomen
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23
Q

Ectopic Pregnancy: Diagnostic Exams

A
  • Pelvic Exam
  • Pregnancy Test
  • Vaginal ultrasound
  • Blood level HCG
24
Q

Ectopic Pregnancy: Treatment

A
  • The developing cells must be removed to save the mother’s life
  • Treatment for shock may include:
    -Blood transfusion
    • Fluids given through a vein
    • Keeping warm
    • Oxygen
    • Raising the legs
  • Surgery
    • stop blood loss
    • remove the pregnancy
    • removal of the fallopian tube (some cases)
  • If the ectopic pregnancy has not ruptured:
    • Surgery
    • Medicine that ends the pregnancy
25
Q

Ectopic Pregnancy: Prevention

A

Not really preventable but may reduce risks:
- Practicing safer sex by taking steps
before and during sex
- Getting early diagnosis and treatment of all infections caused by sexual relations (STDs)
- Stop smoking

26
Q

Loss of pregnancy before 20 weeks of gestation without outside intervention

First trimester bleeding

Viable fetus
- more than 20-24 weeks
- Or weighs at least 500 g

A

Spontaneous Abortion

27
Q

Types of Abortion

A
  1. Threatened abortion
  2. Inevitable abortion
  3. Complete abortion
  4. Incomplete
  5. Missed abortion
  6. Recurrent abortion

Mnemonic: TICIM R

28
Q
  • -bright red and scant vaginal bleeding
  • there is the presence of a viable pregnancy with a closed cervix
  • Early under 16 weeks
  • Late 16-24 weeks
  • Avoid sexual intercourse 2 weeks after
A

Threatened Abortion

29
Q
  • Imminent
  • Cervix has dilated
  • Membranes have ruptured
  • The products of conception remain in utero
  • There is uterine contractions
  • Bleeding within 2 hours and ceases within 2 days
A

Inevitable Abortion

30
Q
  • Refers to the spontaneous passage of all the products (fetus, membrane, placenta) of conception
  • does not require medical treatment
A

Complete Abortion

31
Q

Part expelled usually the fetus and membranes and placenta retained

A

Incomplete Abortion

32
Q
  • Early pregnancy failure
  • Characterized by intrauterine fetal death (IUFD) and retention of the products of conception
  • Fetus died 4-6 weeks before symptoms
A

Missed Abortion

33
Q
  • Habitual aborters
  • A history of 3 or more spontaneous pregnancy losses at the same gestational age
A

Recurrent Abortion

34
Q

Recurrent Abortion: Causes

A
  • Defective ova or spermatozoa
  • Endocrine factors
    • Decrease Protein-bound iodine (PBI)
    • Decrease globulin iodine (GBI)
    • Poor thyroid function
    • just Luteal phase defect
  • Deviations of the uterus
    • Septate
    • Bicornuate uterus
  • Resistance to uterine artery blood flow
  • Chorioamnionitis (uterine infections)
  • Auto immune disorders
    • Lupus anticoagulants
    • Anti phospholipid antibodies
35
Q

Maternal Conditions Associated with Increased Risk

A

MEDICAL CONDITIONS
a. Hypothyroidism
b. Diabetes mellitus (DM)
c. Polycystic ovary syndrome
d. Thrombophilia
e. Antiphospholipid antibodies
f. Systemic lupus erythematosus (SLE)

SURGICAL EMERGENCIES
a. Septicabortion
b. Appendicitis

INTRAUTERINE CAUSES
a. Ashermansyndrome
b. Fibroids
c. Uterine malformations

36
Q
  • occurs following curettage of the uterus
  • Severe degrees of intrauterine adhesions
    • leads to obstruction of the uterine cavity and subsequent infertility
A

Asherman Syndrome

37
Q

Asherman syndrome: Mild degrees of adhesions are associated with:

A
  • pregnancy loss
  • insufficient amount of normal endometrial tissue
    for implantation and placental development
  • defective vascularization of the remaining endometrial tissue caused by fibrosis
38
Q
  • Women with submucosal fibroids (1.8% risk of miscarriage)
  • involves a projection of the submucosal fibroids into the uterine cavity
    • distortion of the blood supply in the endometrium
    • interferes with embryonic implantation
A

Fibroids

39
Q

Is the most common malformation of the uterus

A

Bicornuate Uterus

40
Q

Maternal Infections

A

a. Bacterial vaginosis
b. Listeria monocytogenes infection
c. Measles
d. Mumps
e. Coxsackie virus infection
f. Toxoplasma gondii infection (toxoplasmosis)
g. Ureaplasma and Mycoplasma infection

41
Q

Maternal Conditions Associated with Increased Risk: Obstetric history

A

a. Maternal age at the time of conception
b. Previous spontaneous abortion

42
Q

Maternal Conditions Associated with Increased Risk: Diet and lifestyle

A

a. Caffeine consumption
b. Obesity
c. Smoking
d. Substance abuse

43
Q

Maternal Conditions Associated with Increased Risk: Medications

A

a. Selective serotonin reuptake inhibitor (SSRIs) (fluoxetine, citalopram, fluvoxamine, sertraline, and paroxetine)
b. Angiotensin-Converting Enzyme (ACE) inhibitors

44
Q

Diagnostics

A
  • A detailed history
  • Pelvic examination
  • Imaging with ultrasound
45
Q

Treatment

A
  • Expectant management
  • Medical evacuation
  • Surgical uterine evacuation
46
Q

Uterine Malformations: Complications

A
  • Hemorrhage
  • Intrauterine infection
  • Increased risk for depression and anxiety
47
Q

Hydatid mole
Molar pregnancy

A

Hydatidiform Mole

48
Q
  • A rare mass or growth that forms inside the womb (uterus) at the beginning of a pregnancy
  • A type gestational trophoblastic disease (GTD)
  • A cancerous form of GTD (Choriocarcinoma)
A

Hydatidiform Mole

49
Q

Hydatidiform Mole: Risk Factors

A
  • Women with low protein intake
  • Older than 35
  • Asian heritage
  • Blood Group A woman married to Group O man
50
Q

Hydatidiform Mole: Causes

A
  • Over-production of the tissue that is supposed to develop into the placenta
  • Due to problems during fertilization
  • The exact cause of fertilization problems is unknown
    • A diet low in protein, animal fat, and vitamin A may play a role
51
Q

Hydatidiform Mole: Types

A

Partial Molar pregnancy
Complete Molar pregnancy

52
Q

Hydatidiform Mole: Symptoms

A
  1. Abnormal growth of the womb
    • Excessive growth in about half of cases
    • Smaller-than-expected growth in about a third of cases
  2. Nausea and vomiting that may be severe enough to require a hospital stay
  3. Vaginal bleeding in pregnancy during the first 3 months of pregnancy
  4. Symptoms of hyperthyroidism
    - Heat intolerance
    - Loose stools
    - Rapid heart rate
    - Restlessness, nervousness
    - Skin warmer and more moist than usual
    - Trembling hands
    - Unexplained weight loss
  5. Symptoms similar to preeclampsia that occur in the 1st trimester or early 2nd trimester
    - High blood pressure
    - Swelling in feet, ankles, legs
53
Q

Hydatidiform Mole: Diagnostics

A
  1. Pelvic Examination
  2. Pregnancy Ultrasound
  3. Tests
    - HCG blood test
    - Chest x-ray
    - CT or MRI of the abdomen
    - Complete blood count
    - Blood clotting tests
    - Kidney and liver function tests
54
Q

Hydatidiform Mole: Interventions

A

Dilatation and Curettage (D & C)
Hysterectomy

55
Q

Hydatidiform Mole: Possible Complications

A

Lung problems may occur after a Dilatation and Curettage if the mother’s uterus is larger than 16 weeks gestational size

Complications of molar pregnancy include:
- Preeclampsia
- Thyroid problems
- Molar pregnancy that continues or comes back

Complications related to the surgery to remove a molar pregnancy include:
- Excessive bleeding
- Side effects of anesthesia

OB - NCM109 Care of Mother and Child at Risk or with Problems (Acute and Chronic) (3 decks)

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