Obstetrics Flashcards
ROM
Rupture of Membrane
PROM
Premature Rupture of Membrane
Embryo
First 8 weeks of pregnancy
PARA
How many times a woman has had a baby
G T P A L
G-gravida
T-term
P-preterm
A-abortions
L-living
Fetus
Anything 8 weeks and up.
Chadwicks sign
The softening and bluish discoloration of the Cervix
Hyperemesis Gravidarum
➢Severe nausea, vomiting, weight loss, and electrolyte disturbance
➢Sometimes referred to as “a severe case of morning sickness.”
➢Symptoms usually between 2 and 5 weeks’ post conception.
Preeclampsia
gestational hypertension with proteinuria.
Can be mild or severe. (treat if severe)
The pathophysiology of preeclampsia, which does not reverse until after delivery, is characterized by vasospasm, endothelial cell injury, increased capillary permeability, and activation of the clotting cascade.
Pre-eclampsia is most commonly seen in the last 10 weeks of gestation, during labour, or in the first 48 hours post-partum. Rarely seen before 20 weeks gestation.
Medical Conditions and Disease Processes that can Complicate Pregnancy Preeclampsia Factors associated with preeclampsia include: •advanced maternal age •chronic hypertension •chronic renal disease •vascular diseases •multiple gestation
Signs and Symptoms of Preeclampsia Cerebrum •Headache Hyperreflexia Retina •Blurred vision Diplopia Gastrointestinal System •Right upper quadrant or epigastric pain and tenderness Renal System •Proteinuria Azotemia Oliguria Anuria Vasculature or Endothelium •Hypertension Edema Activation of the clotting cascade Placenta •Abruptio placentae Fetal distress
Mild preeclampsia S&S
Mild- characterized by hypertension, edema, and proteinurea
Severe preeclampsia S&S
Severe- characterized by blood pressures of 160/100 or higher, generalized edema, HA, visual disturbances, SOB, hyperactive reflexes, confusion, URQ pain and pulmonary edema “
Hypertension criteria in pregnancy
Acute rise of 30 mmHg in systolic pressure and/or a 15 mmHg rise in diastolic pressure over prepregnancy levels that occurs at least two times, taken 6 hours apart
If no baseline then a Blood pressure >140/90 mm Hg is used
5 functions of placenta
- gas exchange
- protection
- nutrient transport
- waste removal
- hormone production
Spontaneous Abortion
the nontherapeutic termination of pregnancy from any cause before 20 weeks’ gestation (Later is known as preterm birth)
Most common causes of third trimester bleeding
Most often due to:
- Abruptio placenta
- Placenta previa
- Uterine rupture
Abrupto placentae
•Partial or complete detachment of normally implanted placenta at more than 20 weeks’ gestation. USUALLY MINIMAL BLEEDING.
Sudden dark red vaginal bleeding in 3rd trimester
PAIN
- Abdomen may be tender or rigid
- May be minimal bleeding with shock
- Bleeding dependant on severity of separation also
- Contractions may be present
•If fetal heart tones absent, fetal death is likely
- Predisposing factors
- Trauma
- Maternal hypertension
- Preeclampsia
- Multiparity
- Previous abruption
- Cocaine use
Placenta Previa
- Placental implantation in lower uterine segment, encroaching on or completey covering cervical opening
- 5 in 1000 deliveries
- More common in preterm birth
•Bleeding is described as “PAINLESS BLEEDING”
•Increases if labor begins •Fetal compromise More common with: •Increased maternal age •Multiparity •Previous cesarean section •Previous placenta previa
Uterine Rupture
Uterine muscle tears. Sudden “tearing” abdominal pain
•Active labor •Early signs of shock •Vaginal bleeding •May be hidden Fetal parts may be felt easily through the abdominal wall
Events That Occur from Complex Physiological Changes Associated with Pregnancy
BEAU-CHOPS
-Bleeding/DIC
•Embolism: coronary/pulmonary/amniotic fluid embolism
•Anesthetic complications
•Uterine atony
•Cardiac disease (MI/ischemia/aortic dissection/cardiomyopathy
•Hypertension/preeclampsia/eclampsia
•Other: differential diagnosis of standard ACLS guidelines
•Placenta abruptio/previa
•Sepsis
Gestation
Period during which intrauterine fetal development takes place
•Average 40 wks from fertilization to delivery
•90-day periods (trimesters)
GI changes in pregnancy
Morning sickness and nausea may occur at any time, usually between the sixth and fourteenth week of pregnancy.
▪ The enlarging uterus displaces the mother’s stomach and intestines upward and laterally. This may cause GERD
▪ The liver is displaced backward, upward, and to the right.
▪ prolonged gastric emptying and relaxation of the pyloric sphincter occurs. Heartburn and constipation are common.
Cardiac changes during pregnancy
▪ Elevation of the diaphragm displaces the heart to the left and upward. Flat or inverted T waves may be present in lead III on the electrocardiogram.
▪ Cardiac output increases by 30% by the thirty-fourth week of pregnancy.
▪ The pulse rate may increase 15 to 20 beats/min above baseline late in the third trimester.
Circulatory changes during pregnancy
Circulation
▪ Total blood volume increases by 30%. Plasma volume increases by 50%.
▪ Blood pressure decreases 10 to 15 mm Hg during the second trimester.
▪ Peripheral edema in the ankles, hemorrhoids and varicose veins may be present.
▪ Supine hypotension syndrome
Blood
▪ The leukocyte count increases.
▪ Fibrinogen levels increase by 50%
Respiratory changes during pregnancy
Respiratory System
▪ Tidal volume and minute ventilation increase by 30% to 40% in late pregnancy.
▪ Functional residual capacity decreases by about 25%.
▪ The respiratory rate may be normal or may increase
▪ Pco2 changes from 40 to 30 torr (is this beneficial?)
This may cause dizziness and a sensation of shortness of breath for the pregnant woman.
Metabolic changes during pregnancy
Metabolism
▪ weight gain of 15 to 30 pounds.
▪ Increased water retention produces an increase in hydrostatic pressure within the capillaries.
▪ The metabolic rate and caloric demand (especially for protein) increase.
▪ Glucose escapes into the urine
▪ Maternal gestational diabetes mellitus (GDM) may result from an impaired ability to metabolize carbohydrates.
▪ Fetal demands for calcium and iron may deplete maternal stores
PIH
Pregnancy Induced Hypertension
- Gestational hypertension
- Preeclampsia
- Eclampsia
Eclampsia
Becomes eclampsia when SEIZURES are present.
The risk of fetal mortality increases by 10% with each maternal seizure
