Pregnancy complications Flashcards
What is an ectopic pregnancy
fertilized egg implants outside of the uterine cavity - usually fallopian tube
what are some of the treatments for ectopic pregnancy
laproscopy, salpingostomy (removal of fallopian tube), partial salpingostomy, or methotrexate
what does methotrexate do
stops fetal growth
what is another name for gestational trophoblastic disease
molar disease
what is molar disease
fluid filled grape like clusters rather then fetus
who is a risk for having a molar pregnancy
high maternal age, previous molar pregnancy
what are the ss of a molar pregnancy
absence of FHR, high hcg, low maternal alpha- fetoprotein, looking further along, higher BP before 24 weeks
what is an inevitable SAB
no expulsion of contents but bleeding and dialation of cervix cants stop it
what is the treatment for SAB if they dont pass it on their own
DNC (dilation and curettage - scraping contents out), DNE (dilation an evaluation - sucks it out)
what is a missed SAB
death of fetus but contents retained
what is cervical insufficiency
structural inability of cervix to remain closed in absence of preterm labor
who is at risk for cervical insufficiency
cervical trauma, hx of LEEP, family hx DES
what is a recurrent SAB
3 or more SAB could be because of genetics, anatomical, chromosomal
who is at risk for a ectopic pregnancy
hx of STI, past ectopic pregnancy, use of IUD, endometriosis, assisted reproduction
what are the ss of a ectopic pregnancy
Unilateral stabbing abdominal pain, lower quadrant pain, vaginal bleeding, could have shoulder pain from referred bleeding
what is a complete SAB
complete expulsion of contents
what is an incomplete SAB
partial expulsion of contents
what is the treatment for a molar pregnancy
removal of uterine contents
why is there lots of follow up for a molar pregnancy
because of the high hcg levels if they dont go down they may need chemo - bc of that dont get pregnant again for a year
what is a SAB
Miscarriage less then 20 weeks
what is a potential cause for 1st trimester SAB
chromosomal abnormalities, infection, maternal anatomical defects, immunological, endocrine factors
what is a threatening SAB
signs of SAB without dilation- fetus is still alive and attached
what are the ss of SAB
vaginal bleeding, cramping, decrease ss of pregnancy
what is a potential cause for 2nd trimester SAB
chronic infection, maternal uterine/cervical defects, exposure to fetotoxic substance, drug use, trauma/shock
what is a septic SAB
Content and/or uterus becomes infected during abortion process
what can be done for cervical insufficiency
placement of clerclage at cervical/vaginal opening
when would a clerclage be removed
at 37 weeks to give birth
what could be some adverse effects for hyperemesis
alkalosis, ketouria, decreased weight, potential fetal growth restrictions, dehydration
who is at risk for hyperemesis
increase placental mass, molar pregnancies, thimaine and vitamin D deficiency, increase hormones
what is placental previa
implantation of placenta in lower uterine segment
what is a complete placenta previa
covers entire opening of cervix
what is a partial placenta previa
covers part of cervix opening
what is a marginal placenta previa
placenta is approaching cervical opening but not covering it
what is a low lying placenta previa
in between normal level and marginal level (aka not covering but not where its suppose to be)
what are the ss of placenta previa
painless, can have bright red bleeding
what is a placental abruption
premature seperation of placenta from uterine lining
what are the ss of placental abruption
3rd trimester bleeding with sudden severe abdomen pain, uterine tenderness, may or may not have bleeding (concealed or revealed)
what is the treatment for placental abruption
depends on degree, hospitalization, continuous monitoring, if severe may need immediate c -section
what are some ss of DIC
bleeding from gums, mouthm nose, decrease platelets, decrease fibrogen
who is a risk for placental previa
multiple pregnancies, previous scaring of uterus, smoking, drug use, hx of SAB, maternal age
why could complete/partial not be vaginally birthed
because the placenta would come out first and cut off o2 supply to the baby
what are the interventions for placenta previa
VS Q 15min, iV fluids, 02 given, no vaginal exams because it could irritate it more and cause more bleeding
who is at risk for placental abruption
maternal hypertension, smoking, SAB, short umbilical cord, domestic violence
what is disseminated intravascular coagulopathy (DIC)
bleeding disorder (caused by something else) but all the clotting factors go to placenta leaving rest of mom defenseless
what are some interventions for DIC
strict I/O, side laying to increase blood flow to baby,
when does preterm labor happen
between 20-37 weeks
what are some ss of preterm labor
can be painful/painless contractions, pelvic pressure, vaginal discharge (could have blood), water may break, “i just dont feel right”
what are some late term complications of preterm labor
cerebral palsy, intellectual & developmental issues, retinopathy
what is the goal of preterm labor
inhibit/reduce contractions, stop dilation, optimize fetal status
what does the tocolytic: BIfedipine/procardia do
calcium channel blocker, watch for decrease BP from vasodialation
what does Bethamethasone do
IM if fetus is 24-34 weeks, it increases fetal lung maturity series of 2 shots 24 hours apart it works for 48hrs -7 days after 7 days if another preterm labor risk you can give the shots again
what are some causes for PROM
infection in genital tract, smoking, multibaby
what increases risk for preterm labor
could be unknown, abruption, uterine over distension, hormonal changes, , bacterial infection
what are some short term complications of preterm labor
respiratory distress, intraventricular hemorrhage, necrotizing enterocolitis, patent ductus arterioles
what does tocolytic: magnesium sulfate do
decreases BP and seizures in pre eclampsia
what do you need to monitor for magnesium sulfate
urine output, BP, deep tendon reflexes, magnesium levels
what do you need to keep on you when your patient is taking magnesium sulfate
calcium gluconate to reverse adverse effects
what is PROM
premature rupture of membrane before labor
what are the ss of PROM
vaginal leaking of fluid
how do you confirm PROM
ferning (microcope looking at fluid), Nirogene (cotton color changing thing), aminosure kit
what teaching is involved for PROM
no baths, no sex, nothing in the vagina
what does SPASM stand for (pre eclampsia)
significant Bp changes, protienuria, arterioles, significant lab changes, multi organ systems, before 24 weeks
what is eclampsia
progression from pre-elcampsia involves CNS aka seizures
what increases the risk for hypertensive disorders
smoking, obesity, diabetes, family hx,
what are the ss of severe hypertensive disorders
HELLP (hemolysis, elevated liver enzymes, low platelet count)
when does postpartum pre eclampsia
usually develops 48hrs to 6 weeks after delivery
how much proteinuria needs to exist to fall into hypertensive disorders
excretion of 300mg ever 24 hours, or 1+ in 2 random urine samples 4-6 hours apart
what can hypertensive disorders cause
abruption, preterm labor, low birth weight, poor fetal growth, hepatic failure
what is chronic hypertension and when does it show up
before pregnancy or before 20 weeks - over 140/over 90
what is gestational hypertension
new onset hypertension after 20 weeks without proteinuria
what is gestaional pre - elampsia
> 140/>90 x2 4 hours apart, with proteinuria
what position can help gestational hypertension
left side laying
what is the only cure for pre-elcampsia/ eclamspia
delivery
what are the ss of HELLP syndrome
pre- eclampsia, n/v, hepatic dysfunction, acute renal failure
how many calories do you need to increase for 2 babies
600-900cal/day
what does TORCH stand for
toxoplasmosis, other, rubella, cytomegalovirus, herpes simplex virus
what does toxoplasmosis do to a developing fetus
ventricularomegaly, intracranial calcifications, IUGR, hepatosplenomegaly
what does cytomegalovirus do to a developing fetus
deafness, blindness, intellectual/ developmental disabilities, jaundice
what does cytomegalovirus do to a mom (ss)
asymptomatic
what is antepartal HIV vertical transmission
virus crosses placenta
what is intrpartal HIV vertical transmission
travels from vagina up into uterus during labor or after rupture of membrane
what are some potential complications of multibaby
preterm labor, diabetes, increase risk for UTI, umbilical prolapse
what group beta strept (GBS)
normal flora for many women
what do you treat group beta strept (GBS) with
penicillin antibiotics
what can group beta strept (GBS) affect
labor/ birth
when is screening done for group beta strept (GBS)
36-37 weeks
what is toxoplasmosis
spread via cat feces or undercooked meats
what are some maternal ss for toxoplasmosis
fatigue, muscle pains, myocarditis, lymphadenopathy
what does rubella do to a developing fetus
deafness, eye defects, CNS abnormalities, cardiac malfunction
what are some maternal ss of rubella
rash on face/neck/arms/legs lasting 3 days
what is isoimmunization
development of maternal antibodies destorying fetal RH+ blood
what 3 things need to happen for isoimmunization
fetus must have RH+ and mom Rh-, significant amount of fetal blood entering maternal blood (0.1), mom has capacity to produce antibodies
when do you give Rhogam
RH - mom at 28 weeks and within 72 hours after delivery to RH+ baby
what is pregestational diabetes
hyperglycemia resulting from limited or absent insulin production, deficent insulin or combo of both
what are the risks for getting gestational diabetes
ovre 25 years old, obesity, insulin resistance,
if a women has gestational diabetes what are the more likely to get as awell
pre eclampsia/ eclampsia
what kind of diet should someone with gestational diabetes be on
low carb diet
what kind of diagnostic procedures can confirm embolism
doppler US, MRI, CT
is the 1st RH+ baby affected
rarely affected
is RH+ dominant or recessive
dominant
who doesnt need RHogam
mom with RH+ blood, Mom with RH- and baby with Rh-
what is gestational diabetes
Impairment in carbohydrate metabolism
how does glucose work during preganancy
glucose levels decrease in mom during 1st trimester, during 2nd and 3rd trimester insulin requirements slowly increase
what is the 1st half of pregnancy for gestational diabetes called
anabolic phase= maternal hyperinulinemia
what is the 2nd half of pregnancy for gestational diabetes called
catabolic phase= fetal hyperinsulinemia
does glucose and insulin cross the placenta
insulin doesnt glucose does
what are the fetal effects of gestational diabetes
5x more likely of perinatal death, 2x more likely in congential malformations, sudden intrauterine death, respiratory distress
what are some ss of thromboembolism
pain, tenderness, warmth, swelling color change
what are some ss of pulmonary embolism
tachypnea, dyspnea, pleurtic chest pain, anxious
what meds do you give someone with a emoblism
anticoagulant
what is a doppler ultrasound blood flow studies
study of blood vessels in umbilical vessels
what is a contraction stress test
evaluates FHR reasponse to uterine contractions
what is a negative contraction stress test
desired - no significant decels in FHR
what is a positive contraction stress test
late decels with 50% on contractions
what is a reactive non stress test
15x15 in 20 mins
what is a non reactive non stress test
absence of accels or less then 2 accels. in 20 minutes
