Module 9 Flashcards
implantation spotting cervicitis fibroids subchorionic hemorrhage 1st trimester pregnancy loss (abortion) ectopic pregnancy Post-coital spotting Polyps Vaginal Infection STI Cervical friability
common causes of 1st trimester bleeding
fever? how heavy is bleeding? cramping/pain? severity of pain? location of pain? LMP? positive pregnancy test? passing any clots? Past history (ectopic pregnancies, SABs, medical disorders, risk factors, fibroids)
subjective data for woman reports 1st trimester vaginal pain
Light spotting lasting one or two days that occurs approximately 7 to 11 days after conception.
implantation spotting
two tests to confirm ectopic pregnancy
beta hCG + ultrasound
S/S of \_\_\_\_\_\_\_\_\_\_\_\_\_\_: •Abdominal – generalized or localized •Amenorrhea, positive pregnancy test •Bleeding often brownish in color •May have breast tenderness, nausea, and other pregnancy signs •PE: adnexal mass, acute pain or CMT
ectopic pregnancy
Signs of \_\_\_\_\_\_\_\_\_\_\_\_\_\_: Hypotension nausea pallor shoulder pain urge to defecate
ectopic pregnancy rupture
(Woman @ 8w5d pregnancy) Tests to complete with: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_: Ultrasound Serum Beta hCG Blood type Rh factor Antibody screen Speculum exam
bright red bleeding
BPP Movement Score 2
≥ 3 gross body movements in 30 minutes
BPP Movement Score 0
< 3 gross body movements in 30 minutes
BPP Tone Score 2
≥ 1 movement of limb from flexion to extension and back to flexion
BPP Tone Score 0
Limb extension with no return to flexion
BPP Breathing Score 2
≥ 30 seconds of sustained fetal breathing movements in 30 minutes
BPP Breathing Score 0
< 30 seconds of sustained fetal breathing movements in 30 minutes
BPP Fluid Score 2
≥ 1 AF pocket measuring ≥ 2 x 2 cm in two perpendicular planes
BPP Fluid Score 0
No AF pocket measuring ≥ 2 x 2 cm in two perpendicular planes
BPP FHR Score 2
≥ 2 accelerations of > 15 bpm lasting ≥ 15 seconds in a 40 minute period
BPP FHR Score 0
< 2 accelerations of > 15 bpm lasting ≥ 15 seconds in a 40 minute period
The risk of fetal asphyxia is very low (1/1000 risk of perinatal death within 1 week if not intervention) with these BPP results:
10/10
8/10 with normal fluid
8/8 (without NST)
BPP test result that means potential chronic fetal hypoxia
8/10 with ABnormal fluid
this is an equivocal BPP test result
6/10 with normal fluid
BPP test result that means possible fetal asphyxia
6/10 with ABnormal fluid
BPP test results that mean risks of fetal asphyxia is increased
4/10
2/10
0/10
If membranes intact and there is no renal malfunction/abnormality, delivery is indicated if fetus is term/ If < 34 weeks, increased surveillance may be preferred d/t risks of prematurity
with this BPP result:
8/10 with ABnormal fluid
Repeat test within 24 hours if BPP results are:
6/10 with normal fluid
Deliver if term/ If < 34 weeks consider clinical picture and whether increased ANFS to prolong pregnancy is preferred
with this BPP result
6/10 with ABnormal fluid
Deliver no matter what with these BPP results:
4/10
2/10
0/10
the best time to iniate kick counts is ___-___ weeks
34-36
routine use of __________ has not improved perinatal outcomes
ultrasound
the best practice of fundal height measurement:
same midwife each time
using acoustic stimulator and waiting longer on NST increases:
reactivity
risk factor for \_\_\_\_\_\_\_\_\_\_\_\_\_: Hx pelvic inflammatory disease IVF gynecological surgery current IUD tubal ligation previous ectopic pregnancy Infertility Hx of STIs History of multiple partners at a young age Smoking Douching
ectopic pregnancy
Objective Data for \_\_\_\_\_\_\_\_\_\_: Vital Signs Abdominal Exam Speculum Exam Bimanual exam
bleeding/spotting
Differential Dx for \_\_\_\_\_\_\_\_\_\_\_\_: Spontaneous Abortion (miscarriage) Ectopic Pregnancy Hydatidiform Mole Subchorionic Hemorrhage Trauma
first trimester bleeding
medication used to terminate ectopic pregnancy
methotrexate
labs to collect with spontaneous pregnancy loss
beta hCG
cervical os is open, there is increased bleeding with cramping/contractions, products of conception may be visible at the cervical os.
inevitable abortion
products of conception have been expelled. The uterus is small and contracted, the cervix is generally closed (it closes quickly after the products of conception are expelled), there is scant bleeding or cramping.
complete abortion
Placental tissue or products of conception remain in the uterus or cervix. Bleeding and cramping are present. The uterus is smaller than expected, but not contracted well.
incomplete abortion
In utero fetal death before 20 weeks with a retained fetus and closed cervix.
missed abortion
Diagnosis of____________:
Ultrasound may have an abnormal yolk sac, the fetal heartbeat may be slow or absent.
spontaneous abortion
presence of vaginal bleeding, but the cervical os is generally closed and the uterus is appropriately sized.
threatened abortion
Signs that indicate an ectopic pregnancy is a _______________:
Abdominal rigidity
Abdominal guarding
Severe tenderness
Evidence of hypovolemic shock (hypotension, tachycardia)
surgical emergency
Differential Dx for \_\_\_\_\_\_\_\_\_\_\_\_\_: Ectopic pregnancy Upper genital tract infections Ovarian issues (cysts, torsion) Fibroids Abnormal uterine bleeding Endometriosis Appendicitis UTI Kidney stones Diverticulitis or other bowel diseases
abdominal pain in early pregnancy
tests to order when you suspect ectopic pregnancy
Pregnancy test
Serum beta HCG test (if pregnancy test was negative and yet you suspect ectopic)
Transvaginal ultrasound
hCG will ____________ or _____________ with ectopic pregnancy
plateau or increase slowly
ectopic pregnancy sx typically appear at ___-___ weeks gestation
6-8
calculated by adding the depth of the largest vertical pocket in each of the 4 uterine quadrants. (normal= 8 cm - 24 cm)
AFI
