OB test 2 Flashcards
Spontaneous abortion
pregnancy that ends before 20 weeks.
ends by natural causes.
most occur with in the first 12 weeks.
Possible causes of spontaneous abort
- chromos abnormalities
- endocrine disorder- hypothyrodism
- infections- syhphillis. G/C
- implantation disorders
- structural factors (incompetent uterus)
- immunologic factors
s/s of abortion
Bleeding, uterine cramping/pain/ctx
complications of an abortion
- risk for infection
- risk for hemorrhage
- tissue/organ damage with instrumental procedures
- potential RH sensitization
Threatened abortion
typically just bleeding
days or weeks
may have cramping, back and pelvic pressure which indicates increased risk for inevtiable abortion
management for threatend abortion
speculum rxam w/ gentle SVE
ultrasound
type and screen, beta hCG and progesterone (maintains preg, develops lining)
pelvic rest
pad count
inevitable abortion s/s
SROM
dilation
ctx’s
active bleeding
incomplete abortion s/s
partial expulsion of parts of conception (the parts will leave uterus but remain in vagina due to being so small)
severe abd cramping
uterine bleeding
dilation
tissue passed
managment of incomplete
stablize mom= Vs O2 and IV
Labs: t&s, antibody screen
once stable: sedation, vaccum curettage or D&C, oxytocin or methergine after, PhoGAM PRN
complete abortion
All POC passed, incomplete becomes complete onces all parts pass
cramping and bleeding subside
cervix closes
loss of preg symptoms
management of complete
Beta hCG tracked (will go down), pad count, monitor for infection, No intercouse until check, RhoGAM PRN
Missed abortion
Dead fetus is retained in uterus
s/s- loss of preg symptoms @
size < date
possible brownish-red vag bleeding
managemen of misses
U/S - will be no FHR
beta hCG - decreased
evacuation procedure or labor initiation
RhoGAM PRN
A D&C will be done in 1st trimester
Cytotec or methylitrexate - used to expell fetus
reccurrent abortion
2 or morse losses in 1st trimester
causes:
genetic or chromosomal
reproductive tract anomalies
systemic conditions
STDS
DM, Lupus
incompetent cervix
reproductive tract abdnormality that cause painless dilation of cervix in 2nd trimester
cannot hold preg to term
possible causes of incompetent cx
scarring
lacerations/trauma hx
over-stretching
excessive cx dilation in previous D&C
shorten cx
infections
LEEp or cone procedure - takes part of uterus
Cerclage
A small stitch put on the cervix to help it stay closed
done between 13-14 wks, rarely done after 25 wks, took out at 37 wks, and some will go right into labor, some dont .
Risks- Rupture of members, chorioaminoitist (infection), Pre term labor from stimulating the uterus.
nursing care post cerclage
montior for contractions, SROM, signs of infection
medical termination of pregnancy < 7 wks
RU-486 & cytotec
methotrexate
medical termination of pregnancy >7 wks
thru 12th week - vacuum aspiration
after 12th wk- dilation and evacuation.
s/s of ectopic preg
missed period, vag bleeding, abd pain, + preg test, shock s/s possible if full on rupture
unrupture - dull/ intermittent to colicky pain
rupture- acute pain
management of ectopic preg
check labs- hcG will be down and progeterone will be done, get CBC, type & cross match, RH
Transvaginal U/S done
salpingostomy - open and scrap out tube
methotrexate - folic acid antagonist - stops pregnancy
complete mole
hydatidiform mole
results from fertilized egg with no nucleus
looks like a bunch of white grapes on u/s
-no fetus, placenta, membranes or fluid
20% progess to choriocarnioma later on
vag bleeding/hemorrage are common
hcG goes up
incomplete mole
hydatidiform mole
often contrains embryonic or fetal parts and amniotic sac
congential anomolies common
rarely develop cancer later
symptoms may mimic an imcomplete or missed AB
s/s of molar pregnancy
absense of F<3R
vag bleeding
n/v- casued by increase hcG levels
preg induced hypertension before 20 wks
management of molar preg
dx by u/s and b-hcG
tc for HEG or preeclampsia
follow-up care
- serial b-hcG for 1 year
- delay another preg
risk for placenta previa
previous c/s
increase risk with multiple gestations- more babies more chance a placenta will implant near OS
cocaine use
smoking
mulitpara
Assessment of previa pt.. s/s
sudden onset of Paibless birght red bleeding after 20 wks, scant to profuse amount, may cease, may recur
VS-normal,FHT- reassuring
abd- soft, relaxed, non-tender, with normal tone, fetus often unengaged due to placental location
management of previa pt
get hx- bleeding hx?, amt of bleeding
general status and VS - usually no chagne till late
external fetal monitoring - fetal status, ctx’s
labs: CBC, T&S, coags
US
spec exam, NO SVE
if 36 wks and lung maturity documented or is in labor is active significant bleedin - immediate labor !
Assessment of abruptio pt
may have vag bleeding (dark red) or it may be concealed
abd or low back pain =dull or ache
uterine tenderness- localized - slight to ridgid/board-like
uterine activity = irritability with hypertoncity common or hyerstimulation
elevated uterine resting tone
risk factors for abruptio placentae (premature seperation of placenta prior to delivery
maternal HTN
advanced maternal age
trauma
cocaine use
PROM
managment of abruptio
determine by amount of blood loss, fetal maturity, and maternal/fetal status
evaluate bleeding
monitor labs - H&H decreases, decrease in clotting factors
Kleihauer-betke (fetal blood cells in mothers system) - to see if theres been a bleed- exchange of fetal and maternal blood.
S/S of uterine atony (most common cause of Early PPH)
uterine fundus difficult to locate
boggy uterus
fundus firms w/ massage then becomes soft again
elevated fundal height
excessive bleeding often more bright red
excessive clots
meds for atony
oxytocin, methergine, carboprost, hemabate or prostin, cytotec.
subinvolution
-most common cause of late hemorrhage
uterus will be larger than normal and its often soft or boggy
causes- retained placental frags, pelvic infection
TX
retained placental frags - D&C
infections - ABX
methergine
nursing care for PPH
montior closey
assist with care to stablize hemodynamic status
emotional support
Teaching - fatigue/exhaustion potential, high iron foods, vit C, protein, nutrition, activity guidelines, support systems.
mngt hemorrhagic shock
promote tissue oxygenation
-lateral postition w/ HOB flat
-limit activity
reduce anxiety & fear
-02 tx
Restore circulation/address blood volume
- large bore IV access
- fluids
- PRBCs, fresh frozen plasma
- monitor output
hemodynamic monitoring
monitor for signs of coagulopathy
-labs: T&S, CBC, coags
DIC (disorcer of clotting)
consumes large amounts of clotting factors
causes: abruptio, amniotic fluid emboli, dead fetus syndrome, PIH, infection, cardiopulmonary arrest, and hemorrhage
managment-correct underlying cause, volume replacement, blood component therapy, increase oxygenation, and montior labs and pt status
nursing care: ongoing assess of bleeding, admin fluids and blood products, strict I&O montoring.
Classifications of Gest HTN
>140 systolic or >90 diastolic afer 20 eks, in previously normotensive women, neg or trace protenruia, BP to normal within 6 weeks PP
Classifications or preeclampsia
>140 S or >90 D and > 1+ proteinuria
seen after 20 wks
Classifcations of chronic HTN
>140 S or >90 D
dx prior to preg or before 20
neg or trace protenuria
puts pt at greater risk of becoming preeclamptic
Risk factors or developing preeclampsia
primipara (first baby), age >35, anemia, family hx of it, obesity, multifetal pregnancy, DM, renal disease, HTN, antiphospholipid syndrome, angiotensin gene T 235
Patho of preeclampsia
vasospasm and hypoperfusion
-Arteriolar vasospasm injures endothelial cells so platelets aggregate, fibrin deposits are laid down, and blood vessels decrease in diameter which lyses RBCs and decrease blood flow to all organs and increases BP
sensitive to angiotensin II (vasoconstrictor)
s/s of mild preeclampsia of mom
>140/90 BP, 1+ 2+ proteinuria, dependent edema-eyes, face, fingeres, no pulmonary
s/s of severe preeclampsia in mom
>160/110 BP
> or = 3+ proteinuria
generalized edema with possible pulmonary
<30 ml/hr urine output
headache usually
visual problems
Fetal symptoms of mild preeclampsia
placental perfusion reduced
fetal symptoms of severe preeclampsia
Placental perfusion = IUGR, abruptio placenta, FHT late decels
premature placental aging = small size, signs of aging (white and red infants)
preeclampsia managment
early detection is key
mild- home mangement - assessed every 2-3 wks - NST, BPP, freq U/S
Lacerations
1st degree- no repair needed
2nd degree- muscle, repair needed
3rd degree - muscle and anal sphincter, repair
4th degree- muscle, anal sphincter, and anus, repair
Hematomas (early PPH)
location: vulvar, vag, retroperitoneal
appearance: discolored, bulging mass
common with SVD or assister deliveries
hematomas s/s
cause deep unrelived pain and pressure; sensative to touch
firm fundus, may not be visible, systemic signs of concealed blood loss
care for hematomas
O2, IV fluid, stabilize if s/s of shock, anesthesia, OR - incisie and drain, incise and cauterize vessel
HELLP syndrome
H- hemodylasis (burr cells, increase bilirubin)
EL-elevated liver enzymes (AST, ALT)
LP= low plateletes (<100,000 mm3 )
prominent symptom = epigastric pain
-n/v, generalized edema
sign that preeclampsia is getting worse
Care for HELLP
cont close monitoring
cont mgSo4
-24 hrs after delievery minimally
monitor lochia - increase PPH risl, oxytocin or prostaglandins for increase bldg ,not ERGOT preps they increase BP
if dia BP remains above 105 then put on antihypertensive
Iron deficiency anemia
hgb 10.5 -11
maternal - causes decrease O2 carrying capacity of blodd, pallor, fatigue, pica (non-food craving), increase risk of infection
fetal - iron supp-325 mg - 1-3/day, take with vit C (OJ)
hyperemesis s/s
severe n/v, dehydration, decrease BP, increase P, poor skin tugor
weight loss <5% of pre-preg weight
acidosis from starvation
ketosis (elevated blood and urine ketones)
liver dysfunction
alkalosis from loss of hydrocholoride acid in gastric fluids
hypokalemia
hyperemesis managment
NPO - 24-36 hts
IV fluids
Monitor: wt, I&O, VS’s, fetal status, U/S, labs-liver, electrolytes, H&H
dark, quiet enviornment
meds- zofran, phenergan, benadryl
diet-progress slowly
Insulin needs with DM in preg
first half- decrease in maternal glucose levels
second half - increase in insulin resistance
by term - insulin needs double or triple
after deliver- need goes down, baby stops taking sugar
DM mom complications
ketoacidosis (can lead to death)
increase preeclampsia incidence - type 1 greater risk then GDM
polyhydramnios- baby has increase sugar, pees a lot more
infections- uti, vaginitis
PTL
birth trauma - big babies
C/S delivery
PPH
intrapartum pre-existing DM care
IV therapy - two lines - reg insulin and glucose solution
BS q 1-2 hr goal is 80-110
antepartum pre-existing DM care
goal = euglycemia
hosp prn for glucose sontrol
delievery time - >39wks
Preterm Labor (PTL)
before end of the 37th
leading cause of infant death w/in 1 mo
common- RDS, infections, congential heart defects, IVH, acidosis
PTL risk factors
UTI, drug use, mulitples, smoking, anemia, violence, STDs, hydramnios, infections, short cervix
PTL drugs
tocolytics therapy - goal to delay delivery - gen gain 2-7 days, allows fro steriod admin fro fetal lung maturity
mag sulfate - decreases uterine contractility
beta-adrengergic agonists (ritrodrine and terbutaline) - not used often - serious M//F s.e - tachycardia
Calcium channel blocker - Nifedipine - inhibits calcium from enter smooth muscle and decrease ctx given PO
Indomethacin (NSAID) blocks prostaglandins - short term use only (not after 32 wks) has potential to close ductus arteriosus
hypotonic uterine dysfunction
ctx weaken, shorten and less frquent
1st assess fetal size and pelvis, if ok then,,
ambulate, IV hydrate, position change, AROM, nip atim, pain manage, decrease anxiety, OXYTOCIN
if abnormal - c/s
hypertonic uterine dysfunction
frequent, painful ctxs that do not dialte the cx, encourage decent or effacement
ctx is uncoordinated,may not completely relax between ctx, usually in latent and nulliparous
TX= rest-warm bath/shower and analgesics - morphine
goal- sedation, usually after 4-6 hrs of rest they wake up in active labor
shoulder dystocia TX
mcroberts maneuver ( mom flat, knees to chest)
suprapubic pressure- abd pressure over pubic area
episiostomy gives more room
prolapse cord variations
occult - hidden so it isnt seen and cannot be felt by SVE
complete - visible protruding from vag
prolapse cord risk facotrs
fetus remains in high station, SGA, breech, transverse, hydramnios, AROM/ROM
TX for prolapse cord
carefully assess during and after ROM
PRIORITY- relieve pressure on cord
mom in knee chest, trendelenburg or modified sims
SVE till delivery - to lift presenting part off cord - do not touch cord
-nurse doing SVE stays in bed with mom, to hold baby in until c/s
vaginal birth after having had c/s (VBAC)
Trial of Labor
attemp lab when:
mothers pelvis right size
fetus right position
if had classic incision for a previous c/s cant have trial of labor
Induction
labor started artificially
needs to be present before induction:
- benefit of delivery outweighs continuing preg
- fetus is longitudinal lie
- cervix is ripe
- no CPD
- fetus is mature
dont do if:
previa, prolapse, abnormla presentation, scarred upper uterus
augmentation
assisting labor that started spontaneiously that has slowed or stopped
nip stim, cervix softening
bishop score
Predicts inducibility of cervix
Score includes - dilation, effacement, fetal station, cervix consistency, cervix position
a score over 8 means a successful induction is likely
5-6 prostaglandin gel used
8-10 pitocin can be used
Infertility
inability to conceive after ONE YER of unprotected, regular intercourse.
primary - never had a baby
secondary- had a child, now cant have another
fetal implications of adolescent pregnancy
higher risk for:
prematurity
low birth weight
IUGR
delayed pregnancy
women >35 yrs
these are good moms to teach - suport
fetal px with tobacco use
decrease O2, LBW
fetal px with alcohol use
IUGR, CNS dysfunction
fetal px with marijuana use
increased moro reflex and tremors
px with cocaine use
abruption, LBW
px with amphetamines use
vasoconstriction
cycle of violence
1st phase: Tension building - anger, blaming, arguing occur
2nd phase: Acute battering= battering incident occurs
3rd phase: honeymoon stage - batterer asks for forgiveness, promises never will happen again.
then repeats itself
