Obstetrics Part 1 Vega edition Flashcards
What is the placenta and what does it do?
A disk-shaped organ that provides fetal nourishment and waste removal.
Do women always have a placenta?
No, it is a temporary organ of pregnancy.
What happens to the placenta after birth?
It separates from the uterus after delivery and is expelled.
What is true about the blood of the mother and the fetus?
They do not mix; unless during birth or miscarriage.
What is the umbilical cord?
The unborn infant’s lifeline. It attaches the fetus to the placenta.
What does the umbilical cord do?
Delivers the nutrients/nourishment and oxygen to the fetus. The umbilical vein carries oxygen and nutrients to the fetus. 2 umbilical arteries carry deoxygenated blood from the fetus to the placenta.
Physiology changes to the vascular system/circulatory/cardiovascular?
Cardiac output increases
Maternal blood volume increases by 45%
There is also an increase in red blood cell (RBC) content and plasma; however, the plasma volume increase is greater than the RBCs, causing a relative anemia. The pregnant patient is given iron supplements to increase oxygen binding on the RBC.
The blood volume delays the signs and symptoms of shock in the patient
Maternal HR increases by 10-15 BPM
BP decreases slightly in the first and second trimesters and returns to normal in the third trimester
What is spontaneous abortion?
Delivery of the fetus and placenta before the fetus is viable (20 weeks of gestation) (miscarriage) (most often before 12 weeks of gestation)
When does spontaneous abortion most often occur?
before 12 weeks of gestation.
What causes spontaneous abortion?
Genetics (50% of all cases), uterine abnormality, infection, drugs, or maternal disease.
With spontaneous abortion what is normally present at 8-12 weeks?
Cramping and vaginal bleeding.
What is ectopic pregnancy?
A fertilized ovum is implanted outside the uterus, usually in a fallopian tube.
What happens to the tissue surrounding the embryo during ectopic pregnancy?
It ruptures.
What causes ectopic pregnancy?
Previous ectopic pregnancies, pelvic inflammatory disease, adhesions from surgery, tubal surgery including elective tubal ligation, or intrauterine device (IUD).
Locations of ectopic pregnancy? (include %’s)
Fallopian tubes (90%), Abdomen (6%), ovary, cervix and outside wall of uterus
Emergency care for ectopic pregnancy?
The primary treatment is to administer a high concentration of oxygen, regardless of the SpO2 reading and oxygenation status of the pregnant patient, via a nonrebreather mask at 15 lpm to maximize oxygenation of the fetus. Transport the patient to a facility that can manage a surgical emergency.
What is placenta previa?
A misplaced placenta near or over the cervix.
Where is the placenta normally placed?
Normally implanted in the fundus (top).
Why does the placenta prematurely tear?
When the fetus changes position in the uterus, or the cervix begins to efface and dilate.
What are the three types of placenta previa?
Total: the placenta completely covers the opening of the cervix
Partial: the placenta partially covers the opening of the cervix
Marginal: the placenta is near the opening of the cervix
What causes placenta previa?
Multiparity (more than 2 deliveries), greater than 35 yrs old, bleeding after intercourse during pregnancy, and history of early vaginal bleeding.
Major concerns for placenta previa and what should you do?
blood loss for the mother and hypoxia and distress for the fetus. This is a situation in which, regardless of the SpO2 reading and oxygenation status of the pregnant woman, a high concentration of oxygen is administered via a nonrebreather mask at 15 lpm to maximize oxygenation of the fetus.
What is abruptio placentae?
Abnormal separation of the placenta from the uterine walls.
Patho of abruptio placentae?
Small arteries located in the lining between placenta and uterus are prone to rupture. When this happens, the accumulating blood begins to separate the placenta from the uterus in till it tears away disrupting the function of the placenta.
what does fetal abruptio placentae cause?
A reduction in fetal blood flow causes fetal hypoxia, inadequate nutrient delivery, and poor elimination of carbon dioxide and other waste products
What does maternal abruptio placentae cause?
Severe hemorrhage and hypovolemic shock.
predispositions for abruptio placentae?
Hypertension, use of cocaine, preeclampsia, multiparity, previous abruption, smoking, short umbilical cord, premature rupture of the amniotic sac, diabetes, and trauma involving the abdomen during pregnancy.
The two types of abruptio placentae? (also what is the morality rate)
Complete: the placenta completely separates from the uterine wall. 100% mortality rate.
Partial: the placenta is torn from the uterine wall and it has a 30-60% mortality rate.
Emergency medical care for abruptio placentae?
Administer the same care as the placenta previa
Administer high concentrations of oxygen regardless of the mother’s SpO2
Treat for hypovolemic shock
Patho of a ruptured uterus?
As the uterus enlarges during pregnancy, the uterine wall becomes extremely thin, especially around the cervix.
Where can the fetus possibly go in the case of a ruptured uterus?
The abdomen.
Emergency medical care for ruptured uterus?
-The primary treatment is to administer a high concentration of oxygen, regardless of the SpO2 reading and oxygenation status of the pregnant patient, via a nonrebreather mask at 15 lpm to maximize oxygenation of the fetus.
-Transport the patient to a facility that can manage a surgical obstetric emergency
What does gravida and para mean?
Gravida is each pregnancy and para is each birth of a fetus after 20 weeks of gestation; dead or alive. twins count for one para because it was only one delivery emergency.
