pregnancy at risk: gestational conditions Flashcards
What is hyperemesis gravidarium and what its the cause?
Excessive vomiting accompanied by dehydration, electrolyte imbalance, ketonuria,
cause: unknown- first trimester
Clinical manifestations of hyperemesis gravidarium?
Weight loss, dehydration, increased pulse, unable to keep liquids down, electrolyte imbalance.
Care for hyperemesis gravidarium?
- IV hydration electrolyte imbalance
- Smaller meals
- Ginger tea
- Dry foods, protein snack before bed time.
What does maternal blood loss do to the mom?
vs fetus
mom: Increased risk for hypovolemia, anemia, infection, preterm labor, and preterm birth
fetal risks: blood loss or anemia, hypoxemia, hypoxia, anoxia, and preterm birth.
What is the cause for recurrent premature dilation of the cervix?
anatomical
cervical surgery or procedures
Management for recurrent premature dilation of the cervix? [including meds]
bed rest progesterone anti-inflammatory antibiotics shirodkar or Mcdonald procedure Cerclage placed at 12-15 weeks.
What is Ectopic pregnancy and where does it take place?
Fertilized ovum implanted outside uterine cavity.
95% occurs on ampullar
other places: ovary, abdominal cavity, cervix
Clinical manifestations for Ectopic pregnancy?
Management?
Missed period
Adnexal fullness
Dark red or brown vaginal bleeding
HCG levels >1500 mid with no IUP noted
Hector was MAD and did METH with SAL
H- HCG levels >1500 M- missed period Anexal fullness Dark red or brown vaginal bleeding METH: methotrexate SAL: salpingectomy
What is gestational trophoblastic disease? [hydatidiform mole - molar pregnancy]
Benign growth of placental trophoblast- the chronic villi develop edematous, cystic clusters
what are the two types of gestational trophoblastic disease?
- complete or classic: mole results from fertilization of egg with lost or inactivated nucleus
- partial mole: result of two sperm fertilizing a normal ovum
Clinical manifestations of gestational trophoblastic disease?
vaginal bleeding, uterus is larger than dates
Management of gestational trophoblastic disease?
- most pass spontaneously
- suction curettage is safe and rapid
- induction of labor with oxytocin or prostaglandins not recommended !!!!
What is placenta previa?
classes?
placenta is implanted in lower uterine segment near or over internal cervical os
classes:
complete placenta previa
partial placenta previa
menial placenta previa
What are the risks for placenta previa?
- previous C section
- AMA
- history of D&C or suction curettage
- smoking
What is the clinical manifestation of placenta previa?
bright red vaginal bleeding
What are the maternal and fetal outcomes for placenta previa?
-maternal morbidity and mortality
complications
-fetal risks , malpresentation and congenital abnormalities
-preterm birth
How do you diagnose placenta previa?
Management ?
transabdominal ultrasound exam
observation and rest
cesarean birth
hospital/home care
What is placental abruption?
premature separation of placenta
What are the risks for placental abruption?
MVA Trauma Battering Smoking Thrombophillas Twins Previous abruptio Cocaine
Clinical manifestations of placental abruption?
Boardlike abdomen
contractions
vaginal bleed with uterine pain [ usually darker and less than previa]
What is Velamentous cord?
cord vessels branch at membranes and course onto placenta. its exposed and not protected by whartons jelly.
rupture of membranes or traction on cord may tear one or more fetal vessels. so then fetus may rapidly bleed to death
What is battledore cord?
Cord is inserted at or near the placental margin. it increases risk of hemorrhage.
What does normal clotting do?
stops flow of blood from injured vessels through formation of insoluble fibrin, which acts as a hemostatic platelet plug.
What is the coagulation process in normal clotting?
coagulation processes involves interaction of coagulation factors, in which each factor sequentially activates factor next in line
THE CASCADE EFFECT SEQUENCE
What is the fibrinolytic system process?
- fibrin splits into fibrinolytic degradation products
- circulation restored
What is DIC?
Disseminated intravascular coagulation
- pathological form of diffuse clotting causing widespread external and internal bleeding.
google :Disseminated intravascular coagulation (ko-ag-u-LA-shun), or DIC, is a condition in which blood clots form throughout the body’s small blood vessels. These blood clots can reduce or block blood flow through the blood vessels, which can damage the body’s organs.
What is von willebrand’s disease?
type of hemophilia that can affect women.
The effect of trauma on pregnancy is influenced by —?
- length of gestation
- type and severity of the trauma
- degree of disruption of uterine and fetal physiologic features
Maternal physiologic characteristics in trauma?
- uterus and bladder positioning
- elevated levels of progesterone
- decreased tolerance for hypoxia and apnea
- cardiac output
- circulating blood volume
Fetal physiological characteristics in trauma?
- careful monitoring of fetal status assists greatly in maternal assessment
- fetal monitor tracing works as oximeter of internal maternal well being.
Nursing care management for fetus following a trauma?
immediate stablization primary survey secondary survey electronic fetal monitoring perimortem caesarean delivery discharge planning
Abruption placentae VS Placenta previa?
placenta previa
clinical manifestations: bright red vaginal bleeding
risks: previos c/s, AMA, hx of D&C or suction curettage, smoking
abruption placentae
clinical manifestations: birdlike abdomen, contractions, vaginal bleed with uterine pain. blood is darker and less than previa.
RISKS: mva, trauma, battering, smoking, thrombophilia, twins, previous abruption, cocaine
Do physiological adaptations of pregnancy mask warning signs and changes in vital signs during early shock states?
YES
What does fetal survival depend on?
maternal survival. after trauma, first priority is mom before consideration of baby.
What are some major complications to minor traumas in pregnancy?
abruption placentae, fetomaternal hemorrhage , preterm labor and birth, fetal death.
