Module 06: Abortion, Ectopic Pregnancy, and H-mole Flashcards
What are the different danger signs of pregnancy?
(A) Vaginal bleeding
(B) Persistent vomiting
(C) Chills and fever
(D) Sudden escape of fluid from vagina
(E) Abdominal or chest pain
(E) Absence of fetal heart sounds
(G) Swelling of face and fingers
(H) Flashes of lights
(I) Blurring of vision
(J) Severe headache and dizziness
What are the different nursing considerations for vaginal bleeding?
(A) The degree of bleeding should be evaluated.
(B) It should reported immediately.
(C) May lead to hypovolemic shock.
What are the different nursing considerations for persistent vomiting?
(A) Nausea and vomiting that continues after 12 weeks is extended vomiting.
(B) It depletes the nutritional value of the fetus.
(C) It can cause dehydration and may lead to fetal or maternal death.
What is hyperemesis gravidarum?
Excessive vomiting during pregnancy
What are the different nursing considerations for chills and fever?
(A) May be due to intrauterine infection
(B) Could lead to serious complications to both the mother and the fetus.
(C) The cause should be determined.
Chills and fever is often caused by what?
(A) Infections (i.e UTI)
(B) Dehydration
Infections during pregnancy can lead to what?
(A) Preterm labor
(B) Low birth weight
(C) Sepsis
What medication is given for infections during pregnancy?
CEFUROXIME 800 mg BID 7 DAYS
This condition is characterized as an infection in the membrane that surrounds the fetus and the amniotic fluid (CHORION and AMNION).
Chorionamniotitis
Dehydration during pregnancy can lead to what?
PRETERM LABOR, and IF NOT TREATED, PRETERM DELIVERY
What are the nursing considerations for amniotic fluid leakage?
(A) Membranes are ruptured.
(B) Mother and fetus are threatened because the uterine cavity is no longer sealed against infection
(C) It can cause immaturity of the organs (kidney and lungs)
What is the normal value for amniotic fluid?
1000cc to 2000cc
This condition occurs when the umbilical cord is wrapped around the fetal neck.
Nuchal cord
In one hour, how much of the amniotic fluid is replaced?
1/3 of the amniotic fluid is replaced
What are the nursing considerations for abdominal and chest pain?
(A) May mean tubal pregnancy that have ruptured.
(B) There is already separation of the placenta
(C) Can lead to preterm labor
(D) Chest pain ( pulmonary embolus that follows thrombophlebitis)
How is thrombophlebitis assessed?
HOMAN’S SIGNS
What are the nursing considerations for absence of fetal heart sounds?
IUFD or STILLBIRTH (After they have been initially auscultated on the 4th and 5th month)
What is IUFD?
Intrauterine Fetal Demise
What danger signs of pregnancy can denote pregnancy-induced hypertension and preeclampsia?
(A) Swelling of the face and fingers (edema)
(B) Flashes of lights or dots (scotoma)
(C) Blurring of vision
(D) Severe headache or dizziness
This is known as the excessive nausea and vomiting that persist beyond 12 weeks of gestation.
Hyperemesis Gravidarum (may lead to abortion)
What are the complications of hyperemesis gravidarum?
(A) Dehydration
(B) Weight loss
(C) Starvation
(D) Electrolyte imbalance
The causative agent of hyperemesis gravidarum is cause by bacterial growth in the uterus. True or false?
False: The concrete causative agent is unsure.
What are the possible causes of hyperemesis gravidarum?
HCG and H.pylor
What is the normal HCG?
10,000 to 20,000
What should be assessed in a patient with hyperemesis gravidarum?
(A) Nausea and vomiting
(B) Ketonuria
(C) Elevated hematocrit concentration
(D) Hyponatremia, hypokalemia, and hypochloremia
(E) Hypokalemic alkalosis
(F) Ataxia and confusion
What are the assessment for patients with dehydration?
(A) Thirst
(B) Dry skin
(C) High pulse rate
(D) Weight loss
(E) Concentrated and scanty urine
What is the cause for ataxia and confusion?
Thiamine deficiency
Thiamine deficiency in pregnancy can lead to what
Wenicke Korsakoff Syndrome
What are the possible nursing diagnosis for patients with hyperemesis gravidarum?
(A) Imabalanced nutrition: Less than body requirement
(B) Risk for deficient fluid volume
What are the possible nursing management?
(A) Patient should be NPO for the first 24 hours.
(B) Administer 3L of IV Fluid (Lactated ringer or Vitamin B1)
(C) Metoclopromide (Antiemetic)
(F) Strict monitoring of intake (fluid) and output (urination and vomiting)
(G) If no vomiting after 24 hours of NPO, progress diet to small amounts of clean fluid, dry toast, crackers to soft diet then to regular diet.
What is the priority treatment for hyperemesis gravidarum?
D10NS in 24 hours because it is low in salt concentration and dilates RBC
This condition pertains to the discharge of blood from the vagina. It can happen anytime from conception (when the egg is fertilized) to the end of pregnancy.
VAGINAL BLEEDING
This type of bleeding pertains to a few drops of blood in your underwear.
SPOTTING
This type of condition pertains to heavier flow of blood. With this, a liner or pad is needed to keep the blood from soaking clothes.
BLEEDING
Spotting can be described as what?
(A) Light
(B) Red or brown in color
(C) Not associated with pain
Bleeding can be associated with what?
(A) Amount of blood is less than 500cc
(B) The client would need at least 3 to 4 pads a day.
This pertains to the excessive bleeding within 24 hours after giving birth.
HEMORRHAGE
Hemorrhage is often characterized as what?
The amount of blood loss is more than 500 cc/ml
Bleeding during the first trimester includes what?
(A) Abortion
(B) Ectopic Pregnancy
The fetus is interrupted on the 25th week of pregnancy. Is this considered abortion?
No because abortion only occurs from 20 to 24 weeks.
When the fetus is 20 to 24 weeks, it is viable (it can survive the extrauterine life).
This is known as the expulsion or extraction of embryo or fetus weighing 500g or less from its mother (WHO).
ABORTION (ABORTUS)
An abortion that occurs less than 16 weeks is called what?
EARLY MISCARRIAGE
An abortion that occurs more 16 to 20 weeks is called what?
LATE MISCARRIAGE
What is the risk factor of abortion among women?
(A) Younger than 20 years - 12% of pregnancies
(B) Older than 20 years = 25% of pregnancies
What are the different causes of abortion?
(A) Abnormal fetal development (teratogenic factors like substance abuse that can cause malformations and vasoconstriction of blood vessels)
(B) Implantation abnormalities
(C) Lack of progesterone produced
(D) Infections (STIs)
(E) Ingestion of teratogens
(F) Stress (which can cause vasoconstriction due to the release of cortisol)
Dufa stone is used for patients with early bleeding because?
DUFA STONE HAS PROGESTERONE
What are the different types of bacteria that can cause infections and lead to abortion? (RSUTC)
(A) Rubella
(B) Syphillis
(C) UTI
(D) Toxoplasmosis
(E) Cytomegalovirus
What are the different types of miscarriage?
(A) Threatened
(B) Imminent (inevitable)
(C) Complete
(D) Missed
Describe the cervical OS of threatened miscarriage.
CLOSED
What are the assessment findings for threatened miscarriage?
(A) Scanty and bright red vaginal bleeding
(B) Slight abdominal cramping
(C) No cervical dilatation
What is the therapeutic management for mothers with threatened miscarriage?
(A) Assess FHR and fetal wellbeing
(B) Check what activity caused the event
(C) Avoid strenuous activity for 24 to 48 hours
(D) Need for sympathetic or supportive person
(E) Restrict coitus for 2 weeks after the bleeding episode (if there is sexual intercourse there will be constriction)
(F) Save tissue fragments for examination
(G) If no FHR, dilatation and evacuation is advised (administer oxytocin to prevent bleeding)
Why should HCG testing be done?
To keep track if the HCG has increased 8 hours after the bleeding episode.
If the HCG did not increase, what does that denote?
The placenta is no longer intact
In threatened abortion, can the fetus still be alive?
YES
Under this kind of abortion, the loss of product of conception can not be prevented. The miscarriage occurs when the uterine contracts and when the cervix dilates or opens.
Imminent or inevitable miscarriage
What are the assessment findings of imminent inevitable miscarriage?
(A) Moderate to profuse vaginal bleeding
(B) Moderate to severe uterine cramping
(C) Dilated cervix
(D) Membranes have ruptured
What is the therapeutic management for imminent or inevitable abortion?
(A) Save the tissue fragments for examination.
(B) Assess the FHR and fetal well being, if none dilatation and evacuation is advised.
(C) Administer oxytocin after D&C
(D) Inform that the pregnancy is lost
(E) Restrict sexual contact for about 2 weeks to prevent infection
Why should dilatation and evacuation be done?
To clean the uterus and prevent further infection.
What is the nursing responsibility in D&E after the procedure?
(A) Assess for vaginal bleeding
(B) Count the number of pads used.
Under this type of abortion, the entire products of conception are expelled spontaneously without any assistance.
COMPLETE MISCARRIAGE
What are the signs and symptoms of complete abortion?
(A) Lower abdominal cramping
(B) Vaginal bleeding
(C) Passage of products of conception
(After conception, it will all go away)
What is the management for complete abortion?
(A) Dilatation and curettage (D&C) or suction curettage is performed.
(B) Inform the patient that pregnancy is lost.
Under this type of abortion, the products of conception is expelled but the membrane or placenta is retained in the uterus.
INCOMPLETE ABORTION
What are the signs and symptoms of incomplete abortion?
(A) Abdominal cramping
(B) Vaginal bleeding
What is the management for incomplete abortion?
(A) Dilatation and curettage (D&C) or suction curettage is performed.
(B) Inform the patient that pregnancy is lost.
Under this type of abortion, the fetus dies in utero but is not expelled.
MISSED ABORTION OR EARLY PREGNANCY FAILURE
What are the signs and symptoms of missed abortion?
(A) Fundic height remains to be the same.
(B) Previously heard FHR is no longer heard.
(C) Painless vaginal bleeding
(D) UTZ (ultrasound) confirmation that the fetus is dead
What are the management for missed abortion?
(A) Dilatation and evacuation is commonly done.
(B) If over 4 weeks, labor is induced by prostaglandin suppository or misoprostol (CYTOTEC); oxytocin stimulation
(C) Provide emotional support and accepting attitude.
(D) Refer the patient to counseling.
This is a miscarriage pattern wherein women who had three spontaneous miscarriage occurred at the same gestational age.
RECURRENT PREGNANCY LOSS OR HABITUAL MISCARRIAGE
What are women who have recurrent pregnancy lost called?
HABITUAL ABORTERS
What are the possible causes for recurrent pregnancy loss? DEADI
(A) Defective spermatozoa or ova
(B) Endocrine factors
(C) Deviation of uterus (septate or bicornuate)
(D) Uterine infection or chorioamniotitis
(E) Autoimmune disorder 9lupus)
What are the endocrine factors in recurrent pregnancy loss?
There would be an increase in protein bound iodine leading to poor thyroid factors and a defect in the luteal phase.
What occurs in a septate uterus
There is a septum in the uterus that divides it into two.
What occurs in the bicornuate uterus?
Uterus has difficulty expanding due to its shape.
Is bicornuate symptomatic or asymptomatic?
ASYMPTOMATIC
What are the possible complications of miscarriage?
(A) Hemorrhage
(B) Powerlessness and Anxiety
(C) Infection
(D) Isoimmunization
What should be done in hemorrhage after miscarriage?
(A) Assess the cause
(B) Check the extent of bleeding, color or odor of blood
(C) Monitor vital signs
(D) Demonstrate a supportive attitude
(E) Prepare D&C if possible
(F) Administer blood components and oral medications (methergine) as prescribed
How should the patient be positioned when she experienced hemorrhage after miscarriage?
SUPINE
What are the nursing responsibilities for infections?
(A) Check for fever (38), abdominal pain or tenderness and foul vaginal discharged.
(B) Instruct the client to practice proper perineal cleaning
(C) Avoid using tampons
(D) Demonstrate aseptic technique
What is the nursing responsibility of isoimmunization?
Administer RhIG as prescribed
What are the nursing responsibilities in powerlessness and anxiety?
(A) Deal with the patient with understanding and supportive attitude.
(B) Encourage verbalization of feelings.
(C) Refer to counseling (if necessary)
This type of abortion is complicated by infection.
SEPTIC ABORTION
What are the signs and symptoms of septic abortion?
(A) Fever
(B) Uterine cramping
(C) Foul smelling vaginal discharge
What is the management for septic abortion?
(A) Check for infection
(B) Assist patient during intensive treatment
(C) Insert indwelling catheter
(D) Initiate IV insertion and monitor
(E) Administer antibacterial medication
(F) Assist in D&E procedure
(G) Inform the patient of possible risk if this is present (bacteremia or sepsis)
(H) Refer patient to counseling
This complication arises when the implantation occurs outside the uterine cavity. This is known as the second leading cause of bleeding in early pregnancy.
ECTOPIC PREGNANCY
Where does ectopic pregnancy usually occur? FCO
(A) Fallopian Tube
(B) Cervix
(C) Ovaries
Ectopic pregnancy is the first leading cause of bleeding in early pregnancy. TRUE OR FALSE?
FALSE (SECOND LEADING)
What are the possible causes of ectopic pregnancy?
(A) Previous ectopic pregnancy
(B) Tubal surgery
(C) Previous genital infection
(D) Smoking (endometrial scarring, which results to a problem in the cilia, the egg then doesn’t move)
(E) Previous pelvic and abdominal surgery
(F) Sexual intercourse early before 18 years
What are the different signs and symptoms of ectopic pregnancy?
(A) Vaginal spotting or bleeding
(B) Cul de sac mass
(C) Absence of amniotic sac
(D) Amenorrhea or abnormal menstruation followed by slight uterine bleeding
(E) Sharp stabbing pain (lower abdominal quadrants)
(F) Ultrasound shows ruptured fallopian tubing and blood at the peritoneum and gestational sac outside the uterus
(E) Quantitative B-hCG is usually less
What are the different signs and symptoms of tubal rupture?
(A) Severe sharp knife like pain in the lower quadrant
(B) Abdominal rigidity
(C) Nausea and vomiting
(D) Low HgB and HcT
(E) Sharp localized pain in the cervix on internal examination
(F) Cullen’s signs
(G) Shoulder Pain
(H) Signs of hypovolemic shock
Where will the blood go after tubal rupture?
PERITONEUM
How does ectopic pregnancy affect shoulder pain?
It can disrupt the phrenic nerve.
What are the different signs of hemorrhage?
(A) Cullen’s sign
(B) Abdominal Rigidity - due to peritoneal irritation
This pertains to the bluish discoloration of the umbilicus due to the presence of blood in the peritoneal cavity.
Cullen’s signs
What are the different signs of shock in ectopic pregnancy?
(A) Falling bP
(B) Rapid pulse
(C) Lightheadedness
(D) Pallor
(E) Cold clammy skin and cyanotic nail beds
What are the late signs or complications of ectopic pregnancy?
(A) Lightheadedness
(B) Tachycardia
(C) Tachypnea
(D) Hypotension
What are the two (2) diagnostic tests for ectopic pregnancy?
(A) Culdocentesis (aspiration of bloody fluid from the cul de sac)
(B) Ultrasound which reveals the presence of a gestational sac outside the uterine cavity
What is the therapeutic management of ectopic pregnancy?
Conservative Therapy
What is the goal of conservative therapy?
(A) Remove ectopic pregnancy
(B) Preserve reproductive function through a single does of methotrexate
A single does of this has been shown to be safe, effective, and associated with minimals costs when used in carefully selected patients.
METHOTREXATE
What is the criteria for methotrexate therapy?
(A) Hemodynamically stable
(B) Reliable and compliant patient
(C) Ectopic pregnancy smaller than 4cm in diameter or 3.5cm with NO CARDIAC ACTIVITY
(D) Absence of fetal cardiac activity
(E) No evidence of tubal rupture
(F) B-hCG less than 5000mlIU/mL
(G) Eliminate side effects of multiple dosing (gastritis, stomatitis, leukopenia, and thrombocytopenia)
What are the surgical interventions for ectopic pregnancy?
(A) Salpingostomy
(B) Salpingectomy
(C) Salpingo-oophorectomy
(D) Administration of RhIG
This pertains to the removal of the ovaries.
Salpingostomy
This pertains to the removal of the fallopian tube.
Salpingectomy
This pertains to the removal of the fallopian tubes and ovaries.
Salpingo-oophorectomy
This pertains to the removal of a conceptus less than 2 cm located at the distal portion of the fallopian tube by performing a linear
incision over the ectopic pregnancy. The conceptus will extrude from the incision and be removed manually.
Salpingostomy
This occurs when a longitudinal incision is made over the ectopic pregnancy and the conceptus is removed using forceps or gentle suction.
Salpingotomy
This pertains to the removal of the conceptus by milking and suctioning of the fallopian tube.
Fimbrial evacuation
This pertains to the removal of the ruptured tube because the presence of a scar if tube is repaired and left can lead to another tubal pregnancy.
Salpingo-oophorectomy or Salpingectomy
What is the nursing management for ruptured ectopic pregnancy?
(A) Maintain fluid volume
(B) Initiate IV line with a large bore catheter
(C) Assist in obtaining blood sample
(D) Monitor vital signs and intake and output
(E) Prevent and treat hemorrhage
(F) Blood transfusion
(G) Place patient flat in bed with legs elevated (TRENDELENBURG)
(H) Monitor amount of blood loss
(I) Provide comfort
(J) Provide support
How do you provide comfort to patients with ectopic pregnancy?
Administer analgesics and relaxation techniques
When does ovulation begin in patients who had ectopic pregnancy?
Ovulation begins as early as 19 days or 3 weeks after resection of ectopic pregnancy
Hydatidiform mole is also known as what?
GESTATIONAL TROPHOBLASTIC DISEASE OR MOLAR PREGNANCY
This condition is known as the abnormal proliferation and degeneration of trophoblastic villi. This is a mass of abnormally growing trophoblastic tissue in which avascular vesicles hang in like grape-like clusters
H-MOLE
What are the two (2) types of h.mole?
(A) Complete h.mole
(B) Partial h.mole
Describe complete h.mole.
(A) The trophoblastic villi swells and becomes cystic.
(B) Embryo is dead (1 to 2 mm)
(C) No fetal blood is present
(D) 46XX or 46XY
Describe partial h.mole.
(A) Some villi are formed
(B) Villi are swollen and misshapen
(C) 69 chromosomes (69XXX or 69XXY)
Complete h.mole is at risk for what?
CHLORIOCARCINOMA
What are the different predisposing factors of h.mole?
(A) Below 17 years old and above 35 old
(B) Low socioeconomic status
(C) Low protein intake
(D) Previous mole
(E) Higher incidence in Asian women
What are the signs and symptoms of h.mole?
(A) Amenorrhea
(B) Positive pregnancy test
(C) HCG 1 to 2 m IU
(D) Uterine size increases faster than usual
(E) Nausea and vomiting (hyperemesis gravidarum)
(F) HTN
(G) Proteinuria
(H) Vaginal bleeding
(I) Discharge of clear fluid filled vesicles
(J) Ultrasound reveal
Describe the vaginal discharge in h.mole,
SPOTTING (DARK BROWN BLODD) - Profuse fresh flow
When is vaginal bleeding present in h.mole?
16th week
What is the therapeutic management for h.mole?
(A) Suction curettage to evacuate the abnormal trophoblast cells
(B) Baseline pelvic exam
(C) hCG serum test is monitored every 2 weeks until it reaches normal count (must be negative)
(D) Chest x ray every 3 months for 6 months
(E) Chemotherapy (if HCG titers are increased for 3 consecutive weeks or remain elevated 3 to 4 months after delivery)
In H.mole, if there is a sudden shoot up of Hcg level or plateau indicates what?
CHLORIOCARCINOMA
In h.mole, where are the common sites of metastatis of chloriocarcinoma?
LUNGS
What is the therapeutic management for chloriocarcinoma?
HYSTERECTOMY (THABSO)
THABSO is usually done to patients above 40 years old. TRUE OR FALSE?
TRUE
What is the nursing management after h.mole treatment?
(A) Maintain fluid and electrolyte imbalance
(B) Emphasize that pregnancy should be avoided for 1 year
(C) Administer blood replacement
(D) Emotional support
Favorable if HCG titers do not recur after evacuation of the mole
This complication of h mole is characterized as the persistent trophoblastic proliferation after h mole.
Gestational Trophoblastic Tumors
This complication is known as the severe malignant complication that involve the
transformation of chorion into cancer cells that invade and erode blood vessels and uterine muscles.
Choriocarcinoma
