Gestational Conditions - Part 2 Flashcards
Other names for Incompetent Cervix
insufficient cervix, premature cervical dilatation
A condition that occurs when weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy
Incompetent Cervix
- 2nd trimester bleeding
- Painless dilatation
- Cervix might begin to open too soon
Incompetent Cervix
A/An ______ can be difficult to diagnose
- preventive medication during pregnancy
- frequent ultrasounds
- a procedure that closes the cervix with strong sutures (cervical cerclage)
Incompetent Cervix
Incompetent Cervix starts at week ___ to week ___ of pregnancy
15 to week 20
Incompetent Cervix: Symptoms
- Sensation of pelvic pressure
- Backache
- Mild abdominal cramps
- Change in vaginal discharge
- Light vaginal bleeding (pink-stained)
- Uterine contraction follows
Incompetent Cervix: Risk Factors
- Congenital conditions
- Uterine abnormalities
- genetic disorders affecting a fibrous type of protein
- Exposure to diethylstilbestrol (DES)
- Increased maternal age
- Obstetric trauma
- If you experienced a cervical tear during a previous labor and delivery
- Certain cervical procedures
Incompetent Cervix: Complications
- Premature birth
- low birth weight
- breathing difficulties
- underdeveloped organs
- higher risk of learning disabilities and behavioral problems
- Pregnancy loss
Incompetent Cervix: Treatment and Drugs
- Progesterone supplementation
- Serial ultrasounds
- Cervical cerclage
- McDonald
- Shirodkar
- Pessary
Incompetent Cervix: Prevention
- Regular prenatal care
- Eat a healthy diet
- Gain weight wisely
- Avoid risky substances
Types of Placenta Previa
- Marginal
- Partial
- Complete
The placenta is next to cervix but does not cover the opening
Marginal
The placenta covers part of the cervical opening
Partial
The placenta covers all of the cervical opening
Complete
Placenta Previa: Causes
- Abnormally shaped uterus
- Many previous pregnancies
- Multiple pregnancy (twins, triplets, etc.)
- Scarring on the lining of the uterus, due to history of surgery, CS previous pregnancy
Placenta Previa: Symptoms
- Sudden painless bleeding from the vagina
- Some women have cramps
- Labor sometimes starts within several days of heavy bleeding
- Sometimes, bleeding may not occur until after labor starts
Placenta Previa: Diagnostics
Ultrasound
Placenta Previa: Treatment
- After 36 weeks
- delivery of the baby - C-section
- if placenta covers all or part of the cervix - Blood transfusions
- Medicines to prevent early labor
- Medicines to help pregnancy continue to at least 36 weeks
- Shot of special medicine called Rhogam if your blood type is Rh-negative
- Steroid shots to help the baby’s lungs mature
Placenta Previa: Treatment (If the placenta is near or covering a part of the cervix)
- Reducing your activities
- Bed rest
- Pelvic rest (no sex, no tampons, and no douching)
Other names for Placenta Abruptio
Premature separation of placenta
Ablatio placentae
Abruptio placentae
Placental abruption
- Separation of the placenta before the baby is delivered
- Occurs in about 1 out of 150 deliveries
- third trimester bleeding
Placenta Abruptio
Placenta Abruptio: Causes
- Short umbilical cord
- chorioamnionitis
- Direct causes are rare, but include:
- Injury to the belly area
- Sudden loss of uterine volume
Placenta Abruptio: Risk factors
- Blood clotting disorders (thrombophilias)
- Cigarette smoking
- Cocaine use
- Diabetes
- Drinking more than 14 alcoholic drinks per week during pregnancy
- High blood pressure during pregnancy History of placenta abruptio
- Increased uterine distention
- Large number of past deliveries
- Older mother
- Premature rupture of membranes
- Uterine fibroids
Blood clotting disorders
Thrombophilias
Placenta Abruptio: Symptoms
- Abdominal pain
- Back pain
- Frequent uterine contractions
- Uterine contractions with no relaxation in between
- Vaginal bleeding
- Couvelaire uterus (Uteroplacental apoplexy)
Couvelaire uterus
Uteroplacental apoplexy
No symptoms of separation were apparent from maternal or fetal signs
Diagnosis that slight separation did occur is made after birth (examination of placenta showed a recent adherent clot on the maternal surface)
Degree of Separation: Zero (0)
Minimal separation but enough to cause vaginal bleeding and changes in maternal signs
No fetal distress or hemorrhagic shock occurs
Degree of Separation: One (1)
Moderate separation
There is evidence of fetal distress
Uterus is tensed and painful on palpation
Degree of Separation: Two (2)
Extreme separation
Without immediate intervention, maternal shock and fetal death will result
Degree of Separation: Three (3)
Placenta Abruptio: Diagnostics
- Abdominal ultrasound
- Complete blood count
- Fetal monitoring
- Fibrinogen level
- Partial thromboplastin time
- Pelvic exam
- Platelet count
- Prothrombin time
- Vaginal ultrasound
Placenta Abruptio: Treatment
- IV fluids blood transfusions
- An emergency cesarean section may be needed
- (only a small placental separation) the mother may be kept in the hospital for close observation
- If the fetus is developed enough, vaginal delivery may be done
Placenta Abruptio: Prognosis
- The mother does not usually die of this condition
- But any of the following increases the risk of death for both the mother and baby:
- Closed cervix
- Delayed diagnosis and treatment of placental abruption
- Excessive blood loss, leading to shock
- Hidden (concealed) uterine bleeding in pregnancy
- No labor
- Fetal distress occurs early in the condition in about half of all cases
- Infants who live have a 40-50% chance of complications, which range from mild to severe
Placenta Abruptio: Fetal distress occurs early in the condition in about _____ of all cases
Half
Placenta Abruptio: Infants who live have a _____% chance of complications, which range from mild to severe
40-50%
Placenta Abruptio: Possible Complications
- shock
- possible death of the mother or baby
- hysterectomy
- If bleeding occurs after the delivery
- blood loss cannot be controlled
Placenta Abruptio: Prevention
- Do not drink any alcohol, such as beer and wine
- Do not smoke or use recreational drugs during pregnancy
- Get early and regular prenatal care.
Toxemia
Pregnancy-induced Hypertension (PIH)
Preeclampsia
- A pregnant woman develops high blood pressure and protein in the urine after the 20th week (late 2nd or 3rd trimester) of pregnancy
- Vasospasm occurs
Preeclampsia
Preeclampsia: A pregnant woman develops high blood pressure and protein in the urine after the _____ of pregnancy
20th week (late 2nd or 3rd trimester)
The exact cause of preeclampsia is ___?
Unkown
Preeclampsia: Causes
- Autoimmune disorders
- Blood vessel problems
- diet
- genes
Preeclampsia: Risk Factors
- First pregnancy under 20 years
- Multiple pregnancy (twins or more)
- Obesity
- Being older than age 35
- Low socio-economic backgrounds
- History of diabetes, high blood pressure, or kidney disease
- polyhydramnios
Preeclampsia: Symptoms
- Hypertension
- 140/90 mmHg on 2 occasions (6 hours apart) - Proteinuria
- 1+ or 2+ on a reagent test strip - Swelling of the hands and face/eyes (edema)
- Sudden weight gain over 1-2 days, more than 2 pounds a week - Headache
- Belly pain on the right side, below the ribs
- Irritability
- Decreased urine output, not urinating very often
- Nausea and vomiting
- Vision changes
Severe Preeclampsia: Symptoms
- BP above 160/110 mmHg (2 occasions 6 hours apart)
- Extreme edema
- 1+ pitting edema (slight indentation)
- 2+ pitting edema (moderate indentation)
- 3+ pitting edema (deep indentation)
- 4+ pitting edema (indentation remains after removal of finger) - Severe epigastric pain, nausea and vomiting
- Spots before the eyes
- Severe headache
- Marked hyperreflexia
- Ankle clonus
- Continued motion of the foot - Most severe
- Acute Cerebral edema
- Grand mal seizures (tonic-clonic)
- coma
Preeclampsia: Diagnostics
- A physical exam
- Blood and urine tests will be done
Preeclampsia: Treatment in the Hospital
Treatment in the hospital may include:
- Close monitoring of the mother and baby
- Medicines to control blood pressure
- Steroid injections
Preeclampsia: Treatment (Medication)
Magnesium Sulfate (MgSO4)
- Smooth muscle relaxant
- Used for severe preeclampsia
- Piggyback
- Loading dose 4 -6 grams IV over 20 minutes
- Maintenance 0 – 2 grams/hr IV
Preeclampsia: Nursing Responsibilities (Magnesium Sulfate)
- Loading Dose
- blood pressure every 15 minutes for the first hour
- if stable then every 30 minutes X 2 - Calcium gluconate - antidote o
- Post-loading dose VS are stable monitor the following at a minimum
- Every Hour
- Strict I & O
- BP, pulse, RR
- Level of Consciousness (LOC)
- Symptom changes - Every 2 hours
- Temp if membrane ruptured
- Auscultation of lung sounds
- Deep tendon reflexes
- Symptom changes - Every 4 hours
- Temp if membranes intact
Preeclampsia: Prognosis
Sign and symptoms of preeclampsia usually go away within ___ weeks after delivery
6 weeks
Note: However, the high blood pressure sometimes gets worse the first few days after delivery
Preeclampsia: Complications
- Bleeding problems
- Premature separation of the placenta from the uterus before the baby is born
- Rupture of the liver
- Stroke
- Death (rarely)
PROM
Premature Rupture of Membranes
Bag of Water break before a woman goes into labor
Premature Rupture of Membranes
Note: Most women will go into labor on their own
within 24 hours
If the water breaks before the 37th week of pregnancy
Preterm premature rupture of membranes (PPROM)
Premature Rupture of Membranes: Risk Factors
- Infections of the uterus, cervix, or vagina
- Poor eating or drinking
- Too much stretching of the amniotic sac
- Smoking
- Previous surgery or biopsies of the cervix
- History of PROM or PPROM
Premature Rupture of Membranes: Symptoms
- Fluid leaking from the vagina
- Look at it and smell it (what?”)
- Amniotic fluid usually has no color and does not smell like urine
Premature Rupture of Membranes: Diagnostics
Cervix will be checked (softened or dilated)
Premature Rupture of Membranes: Treatment
After 37 Weeks
Wait for a while or Induced labor
Premature Rupture of Membranes: Treatment
Between 34 and 36 Weeks
Induced labor
Premature Rupture of Membranes: Treatment
Before 34 Weeks
If no signs of infection
- bed rest
- Steroid
Antibiotics
