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
