OB TEST 2 shunk Flashcards
Types of miscarriages (abortions)
- Threatened- cervical os is CLOSED. Bleeding (not heavy) and cramping.
- Inevitable- cant be prevented. cervical os is OPEN. heavy bleeding and cramping
- Incomplete-retained parts
- Complete- everything is expelled
- Missed abortion- fetus dies and remains in the uterus. requires D&C / D&E
- Habitual- three or more.
- Induced- not spontaeous (chosen)
Treatment for miscarriages
Threatened- bed rest and supportive care
Missed- monitor for up to 4 weeks, then evacuate
Incomplete/Inevitable- d&C/ d&e
Late incomplete/inevitable- prostaglandins and/or oxytocin may be ordered
Incompetent Cervix
CANT HOLD PREGNANCY IN.
- painless dilation (no contractions but cervix opens)
short cervical length and composition of cervix are factors.
TX: cerclage
(cercage is rarely done after25 weeks. risks are ROM, chorioamnionitis, PTL)
What is an ectopic pregnancy?
-fertilized egg outside the uterus.
95% occur in tubes
s/s and tx 4 intact ectopic pregnancy
s/s: missed period, vag bleeding, abdominal pain
exam will show+ preg test, +champaign sign
tx: give METHOTREXATE (chemo drug to stop cells from growing)
s/s and tx of ruptured ectopic pregnancy
s/s: increased abdominal pain and referred shoulder pain
tx: they have to have surgery (sometimes tube is removed)
Molar pregnancy
Complete- fertilized egg w/ no nucleus
male sperm cells keep multiplying; looks like white grapes
Incomplete: egg fertilized, often contains embryonic or fetal parts
<6% progress to chorocarcinoma
s/s and tx of molar pregnancy
s/s: later vag bleeding in 95%of cases (prunish color)
bigger quicker, and high levels of HCG (excessive nausea and vomiting)
TX: d&c
moms need ultrasound and b-hcg for one year and do not get preggo for at least a year
what is placenta previa? s/s?
-implantation near the os
(total-completely covers os- scheduled c section, partial-< 3cm of os- possible vag birth, low-lying- lower uterine segment)
s/s: PAINLESS, BRIGHT-RED BLEEDING
**do not do cervical exam b/c placenta is there. do speculum exam.
-may have PTL. if 37 weeks and lungs developed, immediate delivery
Abruption? s/s?
-premature separation of the placenta
TRAUMA is #1 risk factor.
s/s: PAINFUL, DARK RED BLEEDING, CONTRACTIONS.
u/s does NOT dx.
must have fast c-section
pph
>500cc w/ vag birth, >1000cc w/ c-section
causes: UTERINE ATONY, retained placenta, accreta, lacerations, uterine rupture or inversion, hematomas
****s/s: lightheaded, tachycardia
***tx: massage fundus, give METHERGINE- helps contract.
hypovolemic shock
EMERGENCY- can lose 30-40% of circulating blood volume b4 becoming symptomatic
TX: head down (trenelenburg lol) IV access, O2, BP cuff on, massage uterus, get help
Gestational HTN
BP is elevated after 20 weeks and is over 140/90.
No proteinuria.
Preeclampsia
HTN bp over 140/90 after 20 weeks.
Proteinuria***
(IF PREECLAMPSIA OCCURS BEFORE 20 WEEKS THEN TROPHOBLASTIC DISEASE IS PRESENT!)
Chronic HTN
HTN over 140/90 all the time not just during pregnancy.
anyone w/ chronic htn is at risk for preeclampsia.
Mild vs. Severe Preeclampsia
BP- mild 140/90 severe 160/110
Proteinuria- mild 1+/2+ severe 3+/4+
Edema- mild- dependent eyes, face, fingers, severe- generalized with pumonary edema**
Reflexes- mild-normal, severe- hyperreflexia >3+
Urine output- mild 30ml/hr, severe- <20ml/hr
SEVEREwill also have headache, blurred vision, and irritability
Tx for preeclampsia
patho: poor perfusion due to vasospasms.***
give MG sulfate to prevent seizures (not for bp) causes cns depression and uterine relaxations.
watch for signs of toxicity: loss of dtrs, resp depression <12bpm, oliguria, cardiac arrest
CALCIUM GLUCONATE IS THE ANTIDOTE!!!
HELLP syndrome
H- hemolytic
EL- elevated liver enzymes (ALT/AST)
LP- low platelets (<100,000)
Iron Deficiency Anemia
Hgb less than 10.5
tx: ferrous sulfate take with orange juice.
diet: green, leafy veggies
Hyperemesis Gravidarum
- loss more than 5% of pre-pregnancy weight
s/s: N/V, DEHYDRATION**, metabolic acidosis, liver dysfunction.
Tx: NPO,IV fluids, anitemetics, maybe TPN
Lacerations
1st degree laceration- skin tear
2nd degree- skin and muscle
3rd degree- skin, muscle, anal sphinter
4th degree- skin, muscle, sphinter, rectal wall
Hematoma tx
ICE then removal of clot
Cardiac Problems
- hard for pts with heart problems- may result in CHF and Cardiomyopathy.
tx: class 1&2- physical activity, weight gain, anemia, infection
class 3&4- prevent <3 decompensation, same as 1 and 2 +bedrest, thrombus prevention (heparin)
Pt with cardiac problems should they be pushing while delivering?
NO! labor and delivery puts additional stress on the heart.
They should also get an early epidural and usually have .forceps or vacuum delivery
Herpes (HSV)
If mom is + for herpes at the time of birth she should have a C SECTION!
GBS
screening at 35-38 weeks
tx: PCN when in labor
How to identify preterm labor
Fetal Fibronectin- protein present in beginning and end of pregnancy- swab and see if shes not ready to deliver
s/s: contractions longer, stronger, and closer together.
PPROM- preterm premature rupture of membranes
Never give mom steroids after how long into pregnancy
34 weeks!
NEVER give mom steroid after how long into pregnancy
34 weeks because
Shoulder Dystocia
-shoulders are stuck!
2 manuevers: Mc Roberts and suprapubic pressure
Prolapsed cord
cord comes out before presenting part.
occult- hidden frank-visible
tx: lift head to keep pressure off the cord. DO NOT TOUCH CORD. c-section is now needed!
Hypertonic uterine dysfunction
Too many contractions but not dilating.
nsg interventions- slow down contractions- therapeutic rest. give MORPHINE, sometimes go to sleep and wake up in active labor
Hypotonic Uterine dysfunction
dilated to 4 or 5 but not enough contractions.
give PITOCIN
What is bishops score?
-used to predict inducibility of the cervix.
measures cx dilation, effacement,fetal station, cx consistency, cx position
*****A score of 8+ , they can successfully be induced!
What has to happen before forceps and vacuum delivery?
- cervix completly dilated
- bladder emptied
- presenting part engaged
- ROM before application
- big baby
Endometritis// mastitis// uti tx
antibiotics, fluids, analgesics
to be able to have a vaginal birth after c-section
-incision has be transverse (horizontal)
How to tx back labor
-have mom change position to hands and knees or side lying
For a women carrying multiple babies, what has to happen to deliever vaginally?
-the first baby must be in vertex position.
Amnioinfusion
-lactated ringers to dilute the amnotic fluid with meconium,
also done to float the cord with prolapsed cord.
Betamethasone
used to mature the lungs but not after 34 weeks.
Physical Abuse
-sites are face, breast, and abdomen
Cycle: tension building, battering, honeymoon
Mother with DM (diabetes) what is baby at risk for?
hypoglycemia
Glucose changes in relation to pregnancy trimesters as well as insulin requirements
1st trimester BS goes down so decease inulin req. 2nd and 3rd trimester BS goes up so more insulin will be needed due to increased insulin resistance. At term (delivery) insulin needs double or triple
Moms with DM and peripheral vascular disease #1 risk to baby
IUGR
moms with DM what fetal/materal risks occur during delivery?
Macrosomia; insulin acts as a growth hormome, so increased risk of CPD, C-section, forcep, vaccuum deliveries, shoulder dystocia, polyhydramnios, inc risk of PIH & Preeclampsia also infections and ketoacidosis
s/s of hypoglycemia in a newborn?
Jitteriness and High pitched cry, enourage breast feeding, check BS often (40-60)
after delivery in a Diabetic mom what happens so insulin req. and what is this mom at great risk for?
Insulin needs significantly decrease and PPH is common, usually an IV of D5W is given
How is Gestational DM diagnosed?
usually tested @ 24-28 weeks w/ a one hour GCT or glucola test, if BS is over 140 mg/dl then a 3 hour GCT is done and if 2 of the 4 BS readings are above 140 mg/dl it is Gestational DM. they may/may not req insulin
Risks of a newborn in a gestational DM mom
macrosomia (Big babe) hypoglycemia, hypocalcemia***
Risks of baby w/ IDDM (insulin dep diabetes Mellitus)
obesity and DM later in life!!!!***
What to give Hypotonic Uteine Ctx
oxytocin or ptocin
what to give for hypertonic uterine ctx
Morphine, mom will usually sleep 4-6 h then wake up in active labor
Mastitis or endometritis or any infec what to give?
Analgesics, Antibx, IV
why is an amnioinfusion done?
to float the cord for Variable decels or to dilute Meconium
most common areas on mom of abuse
face, breasts, abdomen
risk w/ forcep delivery
lacerations, PPH
cycle of abuse
- Tension Bldg,
- Battering,
- Honeymoon stage
then repeats!
Prostaglandin gel is used to soften cervix, if bishop score is 5-7, bishop score must be what in order to induce labor
8+
teen pregnancy what effects on baby can happen?
PTL, IUGR, low birth weigh
Teenage pregnancy has what effect on the teen?
nutrional problems, drug and alc abuse, phantom dads, impaired parenting skills
Drug use & effects on baby
Tobacco-↓O2, LBW vasoconstriction******
****Marijuana-Tremors, ↑Moro Reflex
Cocaine-Abruptio placenta , low birth weight
Advantage and disadvantage of delaying pregnancy
+ more mature
-longer recovery
Violence increases or decreases during pregnancy
increases, risk of child abuse too
Inability to conceive after one year of unprotected, regular intercourse
Infertility
Primary Vs. Secondary Infertility
*****Primary infertility -woman has never been pregnant
****Secondary-woman has been pregnant
1 cause of Infertility
Delayed pregnancy
Managing Infertility
The overall management involves treating the underlying cause and correcting underlying problems (increase sperm count & motility, reduce infection, hormone therapy, surgery)***********
In preeclampsia seizures are treated by? and the BP is treated by?
seizures: seizur precautions (dark room, little stimulation, pad side rails, side lying) DRUG: MgSo4
BP: Hydralizne or if that doesnt work the -olol’s or Nifedipine etc. etc.
tx for hematoma
ICE**
Nsg Dx for teen pregnancies
Risk for disturbed Body Image
Risk for Impaired Parenting
Knowledge deficit r/t pregnancy, contraceptive use, infant care,parenting
Inadequate nutrition
Risk for ineffective health maintenance
Impaired self-esteem
factors that contribute to teenage preg.
Low self esteem, low SES, lack of role models,
ethical dilemma r/t abortions in nursing
when you are employed you have to say because of my religious restrictions I can not participate In abortions******
