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NURS783 Exam 2 > Placental Pathology and Bleeding > Flashcards

Placental Pathology and Bleeding Flashcards

1
Q

early-term

A

37.0-38.6 GA

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2
Q

full-term

A

39.0-40.6 GA

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3
Q

late-term

A

41.0-41.6 GA

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4
Q

post-term

A

42.0+ GA

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5
Q

What are risk factors of post-term birth?

A

1) primigravida
2) hx post-term pregnancy
3) male fetus
4) obesity

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6
Q

What are complications of post-term birth?

A

1) oligohydraminos –> cord compression, chronic oxygenation problems, growth restriction
2) meconium aspiration
3) macrosomia –> lacerations, tears, hemorrhages

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7
Q

What is the management plan for low-risk, late-term pregnancy?

A

1) @41 weeks: NST and BPP or modified BPP
2) repeat NST in 72h
3) induce by 42 weeks

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8
Q

What is a low-cost, low-risk, vital mode of fetal surveillance?

A

fetal kick counts @ 28-32 weeks

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9
Q

When does ACOG recommend IOL?

A

after 42.0 and by 42.6 GA

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10
Q

placenta circumvallate

A

basal plate smaller than chorionic plate –> membranes doubled back on themselves (white ring)

do not know significance

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11
Q

accessory (succenturiate) lobes

A

vessels from umbilical cord on fetal side travel to separate lobe on placenta

often associated w/ PP hemorrhage!

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12
Q

vasa previa

A

fetal blood vessels over cervical os

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13
Q

management of vasa previa

A

1) @ 28-30 weeks: NST 2x/week
2) hospitalization in 3rd tri – administer antenatal corticosteroids
3) C/S @ 34-36 weeks

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14
Q

placenta accreta

A

abnormal placental attachment d/t absence of decidua basalis and incomplete development of fibrinoid (Nitabuch) layer –> increased trophoblast invasion into decidua

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15
Q

What are the 3 subsets of placenta accreta?

A

1) accreta vera: adherence to myometrium
2) increta: growth into myometrium
3) percreta: through uterine wall w/ placental attachment onto surrounding tissue (e.g. bladder, bowel)

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16
Q

placental abruption

A

separation of placenta from uterine wall before delivery d/t rupture of maternal vessels in decidua basalis

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17
Q

Differentiate b/w the two types of placental abruption

A

1) acute

2) chronic –> subchorionic = early in pregnancy; abruption = late in pregnancy

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18
Q

What is the hallmark symptom of placental abruption?

A

“colicky” abdominal pain that does not go away

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19
Q

When does placental abruption most often occur?

A

24-26 weeks

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20
Q

What are risk factors for placental abruption?

A

1) HTN doubles risk
2) PPROM triples risk
3) C/S inc risk 30-50%
4) smoking; cocaine use
5) polyhydramnios
6) multiple gestation
7) unexplained, abnormally elevated alpha-fetoprotein (AFP)
8) maternal trauma (e.g. MCV, fall, assault)

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21
Q

How is placental abruption managed?

A

OBSTETRIC EMERGENCY

1) varies based on fetal and maternal age/status
2) early abruption associated w/ IUGR in early pregnancy

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22
Q

List the types of placenta previa

A

1) complete = over os
2) partial
3) marginal

23
Q

trophotropism

A

“movement” of low-lying placenta @~20wks

24
Q

What is the hallmark symptom of placenta previa?

A

painless bleeding in 2nd or 3rd trimester

25
Q

What is VITAL to avoid in the assessment of a pt presenting w/ bleeding?

A

NO digital exam if pt never had an U/S to confirm placental position

26
Q

What is appropriate management for acute bleeding and/or contractions?

A

hospitalization

27
Q

When is expectant management appropriate in previa?

A
  • bleeding subsides –> birth can occur closer to EDD

- small abruptions @<34 weeks

28
Q

When should delivery be considered for pts with previa?

A

if near term

  • C/S for asymptomatic previa @ 36-27 weeks
  • immedate C/S for complicated previa
29
Q

small for gestational age

A

<10th percentile

30
Q

appropriate for gestational age

A

10th-90th percentile

31
Q

large for gestational age

A

> 90th percentile

32
Q

intrauterine/fetal growth restriction

A

fetus that has not reached growth potential d/t genetic or environmental factors

33
Q

Besides risk factors, what is the first indication of IUGR?

A

fundal height measuring ≥3cm under expected size for dates in 3rd trimester –> U/S!

34
Q

What are the 4 etiologies of IUGR?

A

1) aneuploidy: abnormal chromosomes - followed by MFM
2) non-aneuploidy syndromes - followed by MFM
3) viral infections
4) placental insufficiency

35
Q

What are maternal risk factors for IUGR?

A

1) cardiac, renal disease
2) lives at high altitude
3) chronic malnutrition
4) Celiac disease
5) substance abuse
6) multiple gestation
7) stress
8) autoimmune disease

36
Q

symmetric IUGR

A

head and body <10th percentile on U/S

  • occurs early in pregnancy
  • R/T aneuploidies, viruses
  • more problematic
37
Q

asymmetric IUGR

A

head circumference&raquo_space;> abdominal circumference

  • occurs after 30 weeks
  • caused by uteroplacental insufficiency
  • elevation in placental blood flow resistance –> shunting of fetal blood to upper body and head (brain)
38
Q

What are benign causes of bleeding in the first trimester?

A

1) implantation spotting
2) cervical polyps
3) vaginal/cervical infection (e.g. GC/CT, HPV)
4) postcoital spotting

39
Q

What are concerning causes of bleeding in the first trimester?

A

1) spontaneous pregnancy loss

2) ectopic pregnancy

40
Q

complete abortion

A
  • complete passage of products of conception
  • closed cervix, small uterus
  • +/- blood in vaginal vault
41
Q

incomplete pregnancy loss

A

AKA threatened abortion AKA inevitable abortion

  • intense cramping
  • +/- heavy bleeding
  • partial passage of products of conception
  • cervix open OR closed
42
Q

delayed pregnancy loss

A

AKA missed abortion AKA blighted ovum

  • closed cervix
  • small or AGA uterus
  • amenorrhea = only s/sx when FHT not heard
43
Q

septic pregnancy loss

A
  • VERY RARE

- loss accompanied by uterine infection and possible sepsis

44
Q

What is the effect of pregnancy on uterine fibroids?

A
  • pregnancy hormones promote growth

- people w/ fibroids have 2x rate of SAB

45
Q

What medications increase risk of SAB?

A

1) isotretinoin (accutane)

2) NSAIDs

46
Q

What are high risk factors for ectopic pregnancy?

A

1) IUD (Mirena)
2) tubal ligation/other tubal surgery
3) hx of ectopic pregnancy

47
Q

What are moderate risk factors for ectopic pregnancy?

A

1) infertility
2) ART
3) hx of genital tract infection
4) multiple sex partners
5) smoking
6) African-American

48
Q

What is the effect of pre-eclampsia on placental development?

A

decreased trophoblastic invasion of decidua –> spiral arteries are less elastic –> increased arterial pressure, lower volume

49
Q

What are fetal risk factors for IUGR?

A

1) teratogenic exposure
2) fetal infection
3) genetic disorder

50
Q

What are placental risk factors for IUGR?

A

1) primary placental disease
2) placental abruption and infarction
3) placenta previa
4) placental mosaicism

51
Q

Which patients need RhoGAM?

A

maternal blood is Rh -

52
Q

How long does one dose of RhoGAM last?

A

12 weeks - needs to be readministered

53
Q

What is RhoGAM management postpartum?

A

If baby is Rh +, administer 300g RhoGAM w/in 72h after birth

NURS783 Exam 2 (6 decks)

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