ob chapter 21+22 Flashcards
Is vaginal bleeding during pregnancy normal?
No, it is always a deviation from the normal and potentially serious.
When can vaginal bleeding occur during pregnancy?
At any point during pregnancy.
What is the most common cause of miscarriage in the first trimester?
Abnormal fetal development due to a teratogenic factor or chromosomal aberration.
Why is any degree of bleeding during pregnancy a potential emergency?
It may indicate that the placenta has loosened, cutting off nourishment to the fetus.
Why might the amount of visualized blood not reflect total blood loss?
An undilated cervix and intact membranes can contain blood within the uterus.
What serious condition should be assessed in a pregnant patient with bleeding?
Significant blood loss or developing hypovolemic shock.
What is isoimmunization in pregnancy?
The production of antibodies against Rh-positive blood when an Rh-negative patient is exposed to Rh-positive fetal blood.
How can isoimmunization occur during pregnancy?
If the placenta is dislodged during birth, miscarriage, or procedures like D&C/D&E, fetal blood may enter the pregnant patient’s circulation.
Why is isoimmunization dangerous for future pregnancies?
If the next fetus is Rh-positive, maternal antibodies could destroy fetal red blood cells in utero.
What medication is given to prevent isoimmunization?
Rh (D antigen) immunoglobulin (RhIG).
When should Rh-negative patients receive RhIG?
After a miscarriage or any event where fetal blood may enter maternal circulation.
Why is RhIG given even if the fetal blood type is unknown?
To prevent antibody formation in case the conceptus was Rh-positive.
What are the symptoms of a threatened miscarriage?
Scant, bright red vaginal bleeding with slight cramping but no cervical dilation.
What happens in an imminent (inevitable) miscarriage?
Vaginal bleeding, uterine contractions, and cervical dilation occur, making pregnancy loss unavoidable.
What characterizes a complete miscarriage?
The entire products of conception (fetus, membranes, and placenta) are expelled spontaneously without assistance.
What happens in an incomplete miscarriage?
Part of the conceptus (usually the fetus) is expelled, but the membranes or placenta remain in the uterus.
What is typically required for an incomplete miscarriage?
A dilation and curettage (D&C) procedure to remove retained tissue.
What defines a missed miscarriage?
The fetus dies in utero but is not expelled.
How is a missed miscarriage usually discovered?
By absence of fundal growth at a prenatal exam or loss of previously heard fetal heart sounds.
What is placenta previa?
A condition where the placenta implants abnormally in the lower part of the uterus.
What is the most common cause of painless bleeding in the third trimester?
Placenta previa.
How is placenta previa often detected?
Through a routine sonogram during pregnancy.
What is the management for placenta previa?
Immediate bed rest in a side-lying position.
Can a patient with placenta previa have a vaginal birth?
No, a C-section is required.
What are the signs of abruptio placentae?
Sharp, stabbing pain high in the uterine fundus, uterine tenderness on palpation, and heavy vaginal bleeding.
Why is abruptio placentae an emergency?
The placenta separates from the uterus, threatening both the patient and the fetus.
What immediate interventions are needed for abruptio placentae?
Insert a large-gauge IV catheter for fluid replacement and administer oxygen by mask to limit fetal anoxia.
What is preterm labor?
Labor that occurs before the end of week 37 of gestation.
Why is preterm labor serious?
It may lead to the birth of an immature infant.
What drug is used off-label to halt labor?
Terbutaline (a tocolytic agent).
What medication is given to accelerate fetal lung maturity?
Betamethasone.
Why is betamethasone administered in preterm labor?
It helps accelerate lung surfactant formation and reduces the risk of respiratory distress syndrome.
What defines gestational hypertension?
Blood pressure of 140/90 mm Hg or higher after 20 weeks of gestation, without proteinuria or edema.
What medications are used to manage gestational hypertension?
Hydralazine (Apresoline), labetalol (Normodyne), or nifedipine.
Why are antihypertensive drugs prescribed in gestational hypertension?
To reduce high blood pressure and prevent complication
What conditions have an increased incidence in adolescent pregnancy?
Iron-deficiency anemia, preterm labor, postpartum hemorrhage, preeclampsia, cephalopelvic disproportion, inability to adapt postpartally, and lack of knowledge about infant care.
What is considered advanced maternal age?
Pregnancy at 35 years or older at birth.
Why might a patient over 40 have increased pregnancy risks?
They are more likely to have pre-existing conditions such as hypertension, varicosities, or hemorrhoids.
What additional genetic screening is offered to pregnant patients over 35?
Chromosomal assessment due to the increased risk of Down syndrome.
What is the risk of Down syndrome for pregnancies over age 35?
About 1 in 100.
What early genetic test can be offered for chromosomal screening?
Circulating free DNA (cfDNA) testing as early as 10 weeks.
