High risk antepartum Flashcards
Trichomoniasis
Cause
Anaerobic protozoan T. vaginalis
thrives in alkaline environment
affects skenes glands
Trich male S&S
asymptomatic
dysuria
burning on urination
Trich female S&S
asymptomatic
fishy smell
yellow-green, brownish grey discharge
Strawberry cervix
Dx of trich
wet mount (N.s and K) whiff test KOH added: fishy smell
Tx of trich
metronidazole (Flagyl)
Trich teaching
Avoid intercourse till infection is clear
Continue tx thru menses
treat partner
if pregn, cut in half and give BID for 7 days
Can be given during the first trimester
If untreated: ROM–premature delivery
Lactating: take the dose and avoid breastfeeding for 24 hours. Pump and discard and resume after 24 hrs
No alcohol—Antabuse like effect
Take med with food (GI distress)
Metallic taste in mouth (chew gum)
Changes urine to dark brown-red
puts woman at risk for yeast infection (treat with Diflucan or monistat/terasol cream)
Chlamydia cause
c.trachoatis
S&S of chlamydia in women
vaginal discharge spotting after sex lower abdominal pain dysuria coexists with gonorrhea
S&S of gonorrhea in men
discharge from penis
burning in urination
swollen or painful testicles
Dx of chlamydia
culture
urine test
all women <25 receive culture with pap smear.
Tx of Chlamydia
Doxycycline if not preg.
Zithromax if preg.
Teaching of Doxycycline
not given to preg. women.
It can causes fetal tooth staining
Baby born to woman with chlamydial infection
chlamydia pneumonia opthalmia neonatorum (erythromycin)
Untreated Chlamydia or Gonorrhea during pregnancy can lead to
PROM
Chorioamnionitis
Untreated chlamydia in non pregnant
Scarring of fallopian tubes: infertility and ectopic pregnancy
PID
Gonorrhea
Clap cause
gram - aerobic bacterium: Neisseria Gonorrhea
Bathrolins cyst
In cervix, skenes glands, lower Urinary tract, pharynx and rectum
Gonorrhea S&S men
asymptomatic
dysuria and penile discharge
Gonorrhea S&S women
Greenish yellow discharge dysuria pelvic pain Painful intercourse Irreg. vaginal bleeding red, tender, swollen vulva
Dx of gonorreha
culture
Tx of gonorrhea
Rocephin
treat chlamydia as well with doxycycline (nonpreg) and zithromax (preg)
Syphilis cause
spirochete Treptonema pallidum
Syphilis untreated leads to
Multiple Organ disease
Syphilis acquired
utero, sexually, touching infected wound
Primary stage syphilis
Highly contagious
Chancre: red, swollen, pea sized ulcerations on penis, vagina cervix or mouth. Painless. Heals in 5-6 weeks
Secondary stage syphilis
6 weeks to 5 months after chancre healed Macular rash on hands and feet that doest itch. Resembles measles. Hepatoslpenomegaly Flulike S&S Hair sparse: loss of hair in patches lasts 2-6 weeks
Tertiary Stage syphilis
Involves multiple organs
1-50 years after first symptoms
General psychosis, paralysis and death
Dx of syphilis
VDRL blood test (1st prenatal visit and 36 weeks). If +: do RPR
once active inflammation, VDRL always has low titer
RPR: verifies if low titer is prior exposure or active disease
Tx of syphilis
Penicillin
If syphilis while pregnant
Spontaneous abortion
Stillborn
congenital syphilis (blindness, deafness and mental retardation)
HPV/ Condyloma Acuminata
types
6 &11: genital warts
16&18: cervical cancer
HPV transmission
sexual contact and contact with warts themselves. Anal and genital areas
S&S HPV
asymptomatic
warts anywhere in perineal area
Dx of HPV
visual inspection and detailed pt Hx
Tx of HPV
most go away Only relieving symptoms Trichloric acid prilotherapy paladine Aldara cream
NO NEED FOR C-SECTION
Complications of HPV if had it during pregnancy
Laryngeal Papillomas in baby (warts in throat)
Prevention of HPV
Gardasil Vaccine: 3 doses: 1st age 9-12, 2nd one month after and 3rd 6 mod after 2nd. Parental consent neded Contraindicated if yeast allergies Defferred during pregnancy
Herpes Simplex Virus
Chronic, never goes away
Herpes type 1
Cold sores and blisters (face, lips, nose and chin) they come and go
Pruritic and itchy
Tx: Valtrex
Herpes type 2
Tx
teach
worst
Genital Herpes (can gave type 1 here too)
Valtrex for rest of their lives
extremely painful
pt may not drink and get dehydrated due to painful urination. Teach them to urinate while sitting in a tub of warm water or squirt warm water on genital area during urination.
1st episode is the worst (low F, painful vesicles, lymphadenopathy)
Dx of Herpes
Visualization of lesions
viral culture of fluid
blood for antibody titer
Tx of Herpes
No cure
Acyclovir (32-3 weeks too) or Valtrex to slow down shedding
comfort care, cleansing area is crucial to avoid inf.
IF herpes present at time of delivery: C-section
Placenta Previa predisposing factors
C-sections Hx
Multiparity
Increased maternal age
smoke and cocaine use
Complete placenta previa tx
need a c-section
Marginal Placenta previa/low lying
tx
within 3 cm of os
Vaginal birth is possible
Partial placenta previa tx
need a c-section
S&S of placenta previa
painless vaginal bleeding
Uterus is soft, relaxed, nontender
usually toward end of 2nd trimester and beginning of 3rd trimester.
Dx of Placenta previa
sonogram (14 weeks) may indicate low lying placenta but is normal and as it grows it is brought up. Come back for sonogram
Tx of placenta previa
Needs to know the possibility of C-section
Teach S&S of labor to woman because she needs to come right away
very conservative
VAGINAL EXAMS NOT DONE
go home and rest
put legs up, do pad counts, FHR monitor
HELLP Syndrome
what do the words stand for?
What is it?
Hemolysis Elevated Liver enzymes Low Platelets -Extension of severe preeclampsia
Etiology or HELLP
white
multipara
Preeclampsia
<36th week (90%)
S&S of HELLP
misdiagnosed as gall bladder or flu N/V Flu like symptoms Malaise RUQ gastric pain (due to high liver enzymes and hemolysis) HTN RISK FOR IMPENDING SEIZURE
Labs for HELLP
CBC
platelet count
Liver enzyme studies
Tx for HELLP
Prompt delivery no matter what age
Fresh frozen plasma
Packed RBC
Maternal risks of HELLP
Increased intraocular pressure: detached retina and blindness, cerebral hemorrhage and, stroke out and die
Fetal risks of HELLP
small baby SGA (vasospasm, vasoconstriction, poor perfusion
Hypermagnesemia (if given mg sulfate): decreased reflex, oliguria
Preeclampsia
what is it?
High BP and protein in urine that develops after 20 weeks of pregnancy.
Mild preeclampsia BP
<140/90
protein urine: 1 or +2
elevated liver enzymes
lived edema
Tx of Mild preeclampsia
manage at home if compliant: frequent rest periods no watching over children No strict bed rest, she can get up and walk to the br, kitchen Left side position Weigh daily Monitor protein in urine (if >2 call doc) BP daily Fetal kick counts NST and BPP High protein diet/ avoid salty food.
Signs that mild preeclampsia is getting worse
visual disturbances
severe headache
GI pain, epigastric pain. liver enlargement
Severe preeclampsia BP
BP 160/110 or higher
Protein: 2 or 4+
S&S of severe preeclampsia
blurred vision r/t cerebral edema
decreased urinary output
facial and sacral edema
Tx of severe preeclampsia
Hospitalized Low stimulus environment Private room at end of hall Lights out Assess for CLONUS (jerking movement on foot) bed rest BP meds (antihypertensive: Apresoline : if diastolic > 110. increases CO and placental blood flow) Mg. Sulfate GET BABY OUT
Epigastric pain with severe preeclampsia
sign that she is going not eclampsia!!
Mg Sulfate
Normal levels
toxicity
4-8 mg
Given in severe preeclampsia to prevent seizures
CNS depr. anticonvulsant/ smott muscle relaxant/decreases vasoconstriction
Used to stop preterm labor
IV as a secondary line
TOx: Absence of DTR, skin flush, warm feelings, oliguria, N/V, reap. depression, drooling
Ca gluconate (antidote)
NI: BP/RR/DTR/Ur.Output/Pulseox/resuscitation equip.
Risk factors for high BP while pregn
primipara existing DM Multigestations Young and old Hx of preeclampsia
Eclampsia can cause
Pt to go into labor and have precipitous birth
Poor placental perfusion and oxygenation
Complications of eclampsia
Cerebral hemorrhage: blurry vision/spots in eyes/hyperactive reflexes
Decreased placental blood circulation: IUGR, Hypoxia
Tx of eclampsia
airway, oxygen, side position (aspiration), suction PRN, no restraint. Is fluid urine or ROM Nitrazine test vaginal exam after seizure (to see if she is going into labor) uterine contractions? FHR Auscultate lungs (aspiration) Mg sulfate or Hydralazine Board like abdmen??---Abruptio placentae
HIV NI
proper hand washing to avoid inf 32 weeks NST sonograms 3rd trimester Internal monitoring and episiotomies AVOIDED ZVD (AZT) during labor NO breastfeeding Birth control education standard precautions
Baby born to HIV mother
Bactrim for 6 weeks to prevent pneumocystits pneumonia
r/o inf: 4 polymerase chain reaction test over 4 months (negative tests: no infection)
Yeast infection/monilia factors that increase it
pregnancy abxs Oral contraceptives douching diabetes Diabetes
monilia S&S
thick, curd like cottage cheese discharge
painful intercourse
dyrsuria
red and painful labia and vulva
Dx of monilia
vaginal secretions wet mount
presence of hyphaed yeast buds
Tx monilia
terazol cream
OTC monistat
Diflucan (not for preg. 24 hrs to work)
Bacterial Vaginosis S&S
thin, grey discharge with fishy odor
Dx of bacterial vaginosis
wet mount: epithelial cells with edges all around due to bacteria sticking to them
Add KOH to elecit + amine test: fishy odor
Tx of B.V
Flagyl BID per week
BV can cause
PROM and preterm
all women should be test and treated
Retrograde menstruation
blood retracts into fallopian tubes and peritoneal cavity. Endom tissue can go up the brain and cause bleeding
S&S of endometriosis
pelvic pain dyspaeruni Painful menses and bowel movements short menstrual cycles can lead to infertitily
Dx of endometriosis
laparoscopic exam
if cervix is in retroverted position (facing the back) and not movable (fixed) is a sing
Tx of endometriosis
NSAIDS (decrease prostaglandin)
Danasol (supresses ovulation)
oral contraceptives: depoprovera (inhibits growth of endometrial tissue)
surgery to remove adhesions
Advise them to get preen right after surgery
Hysterectomy
PID causative agents
Douching
gonorrhea
chlamydia
strep
S&S of PID
pelvic pain fever chills vaginal discharge CMT( cervical motion tenderness)
Dx of PID
Adnexal tendernes (tubes and ovaries) Positive Chandelier sign (pain when cervix is moved) Culture for chlamydia and gonorrhea
tx of PID
Abx
Rocephin and doxycycline
erythromycin and zithromax
TEach PID
risk for infertility tubal scarring risk for ectopic pregnancy IUDs are contraindicated Change tampons q 4 hrs Proper perineal care
follicular ovarian cysts
when ovarian follicle fails to rupture during ovulation. next menstruation it regresses and hurts
Luteal ovarian cyst
when corpus luteum fails to regress and it hurts a lot
Tx for ovarian cysts
nothing
>6 cm surgery
oral contraceptives (suppress ovulation)
S&S of ovarian cyst
Fullness of adnexal area
painful intercourse
irregular
Dx of ovarian cyst
palpation or transvaginal sonogram
Uterine fibroids S&S
menstrual cramping
menorrhagia (bleeding)
Painful
Uterine fibroids etiology
r/t estrogen and progesterone >35 Black women menarche before 12 nulipparity Obesity
Dx of Uter. fib
Bimanual exam
transabdominal/vagnal sonogram
Tx uterine fibroids
NSAIDS CAM Oral contraceptives RU486 hysterectomy uterine artery embolization (not letting it grow) they shrink in menopause
if uterine fibroid and has baby
HEMORRHAGE AFTER BIRTH
Factors that impair number and function of sperm
infection
varicocele
exposure to toxins
alcohol, marijuana and cocaine use
Hystosalpingogram
dye injected into uterine cavity to determine latency of fallopian tubes
Rubin technique
carbon dioxide is injected up the uterus.
if woman feels referred shoulder pain: GOOD SIGN. tubes are patent.
done after menses bc wanna make sure you aren’t pregnant
Clomid
tx of infertility
used when woman is anovulatory
1st drug used. to induce ovulation. Stimulates release of FSH and LH
-risk for multiple births, ovarian enlargement (severe and pain)—must notify doctor
given for 3 months. if not working—-Pergonal
Pergonal
IM injection
teach injection in buttocks
induces ovlation
hyperstimulation syndrome and multiple births risk
Medical abortion
up to 8 weeks
pill or suppository
sonogram a week later to make sure products out
Suction abortion
up to 12 wees
Dilation abortion/D&C/curettage
after 12 weeks
cervix dilated. content scraped out and suctioned
Incomplete abortion
need to do D&C
threatened abortion
bleeding
backache
pelvic pressure
-instruct woman to get rest and take it easy.
NO COMPLETE BED REST. the abortion is inevitable.
Cervix is closed
Inevitable abortion
bleeding and cramping
cervix dilated
sonogram to make sure no FHR
D&C done
Management of abortions
r/o other causes for bleeding
sonogram
support groups
tell mother she didn’t dean abortion on herself
Monitor for infection, Hct and Hgb, hemorrhage,
give Rhogam
Symmetrical IUGR
cause
proportionally small in all parts
-long term maternal or fetal genetic abnormality
chronic disease of mother: High BP (preeclampsia, eclampsia) malnutrition, poor diet, anemia, drugs.
Dx of symmetrical IUGR
2nd trimester via sonogram/ultrasound
worse outcome than asymmetrical
Asymmetrical IUGR
cause
disproportionally small
uteroplacental insufficiency (acute, short-term prob)
HBP, Preeclampsia in 3rd trimester.
grow to normal proportions by 1 year old
Dx of asymmetrical IUGR
3rd trimester
Associated problems with preterm neonate
ROP-retinopathy of prematurity RDS BPD- bronchopulmonary dysplasia NEC-Necrotizing entecolitis Cold stress hyperbilirubinemia apnea
Risk factors for necrotizing enterocolitis
LBW SGA preterm/premature formula fed decreased gestational age
S&S of necrotizing enterocolitis
Abd distention Vomiting decreased BS stool has occult blood gastric residual food left in stomach poor color bowel looks dilated in Xray resp difficulty
Tx of necrotizing enterocolitis
surgery ostomy NPO IV fluids and abxs NG tube for suction Maintaining good thermal environment
Effects of DM on pregnancy
Hydramnios (leads to preterm, cord prolapse) due to fetal diuresis inc. Gestational HTN ketoacidosis Stillborn Hypoglycemia (1st trimester) UTI monilia Dystocia
Fetal neonatal effects of DM
Congenital malformation (cardiac, neural tube, sacral a genesis) Macro somos Preterm birth Birth trauma Perinatal death Fetal asphyxia RDS Polythycemia IUGR hyperbilirubinemia Hypoglycemia Hypocalcemia
Fetal surveillance in diabetes
Sonograms AFP fetal echocardiogram NST-Bpp Amnio
Hypoglycemia S&S
Shakiness Sweating Pallor, cold and clammy Disoriented Hunger Headache Blurred vision
Hyperglycemia S&S
Fatigue Flushed skin Dry mouth, thirsty Frequent urination Rapid deep respirations Drowsiness Depressed reflexes
NI for cardiac disease pregn antepartum
High iron, protein and low fat diet
Avoid anemia and infections
Adequate sleep 8-10 hrs
Seen every 2 weeks first half of preg. Seen every week second half of preg.
Week 28-30 WATCH CLOSET FOR HIGHEST BLOOD VOLUME
NI for cardiac intrapartum
Lung sounds for rhales Abxs I&O Side lying position O2 Epidural recommended (pain ⬆️ CO) Encourage short pushes No valsalva maneuver Forceps or vacuum
NI for cardiac postpartum
First 48 hrs critical (4 days hospitalization) because of rapid fluid shift
Gradual progression of activity
Breast feed it not on 3rd or 4th
Cause of infertility
STI
postponing pregnancy
Endocrine disorders
Semen analysis
Sperm count (400 million)
Sperm motility
Sperm morphology
Sims huhner test
Postcoital test
Tell pt to have sex right before ovulation
Then examine vaginal secretions to see if sperm can swim
Threatened abortion management
Monitor other causes of bleeding, infection, hypovolemic shock, sonogram, blood levels
Causes of ectopic pregnancy
PID STI previous surgery there Low estrogen Hormone imbalance IUD
Etiology of Hyperemesis gravidarum
HCG
Emotional factors
Diet- poor eater; vit B6
Partial hydatiform mole
Small uterus
2 sperm 1 ovum: too many chromosome
Not viable fetus
Spontaneous abortion
Complete hydatiform mole
Prune juice like bleeding Chorionic vili will grow Large uterus Sonogram 14-16 weeks: thick brown prune discharge like bleeding
