Pregnancy complications Flashcards
1
Q
What is an ectopic pregnancy
A
fertilized egg implants outside of the uterine cavity - usually fallopian tube
2
Q
what are some of the treatments for ectopic pregnancy
A
laproscopy, salpingostomy (removal of fallopian tube), partial salpingostomy, or methotrexate
3
Q
what does methotrexate do
A
stops fetal growth
4
Q
what is another name for gestational trophoblastic disease
A
molar disease
5
Q
what is molar disease
A
fluid filled grape like clusters rather then fetus
6
Q
who is a risk for having a molar pregnancy
A
high maternal age, previous molar pregnancy
7
Q
what are the ss of a molar pregnancy
A
absence of FHR, high hcg, low maternal alpha- fetoprotein, looking further along, higher BP before 24 weeks
8
Q
what is an inevitable SAB
A
no expulsion of contents but bleeding and dialation of cervix cants stop it
9
Q
what is the treatment for SAB if they dont pass it on their own
A
DNC (dilation and curettage - scraping contents out), DNE (dilation an evaluation - sucks it out)
10
Q
what is a missed SAB
A
death of fetus but contents retained
11
Q
what is cervical insufficiency
A
structural inability of cervix to remain closed in absence of preterm labor
12
Q
who is at risk for cervical insufficiency
A
cervical trauma, hx of LEEP, family hx DES
13
Q
what is a recurrent SAB
A
3 or more SAB could be because of genetics, anatomical, chromosomal
14
Q
who is at risk for a ectopic pregnancy
A
hx of STI, past ectopic pregnancy, use of IUD, endometriosis, assisted reproduction
15
Q
what are the ss of a ectopic pregnancy
A
Unilateral stabbing abdominal pain, lower quadrant pain, vaginal bleeding, could have shoulder pain from referred bleeding
16
Q
what is a complete SAB
A
complete expulsion of contents
17
Q
what is an incomplete SAB
A
partial expulsion of contents
18
Q
what is the treatment for a molar pregnancy
A
removal of uterine contents
19
Q
why is there lots of follow up for a molar pregnancy
A
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
20
Q
what is a SAB
A
Miscarriage less then 20 weeks
21
Q
what is a potential cause for 1st trimester SAB
A
chromosomal abnormalities, infection, maternal anatomical defects, immunological, endocrine factors
22
Q
what is a threatening SAB
A
signs of SAB without dilation- fetus is still alive and attached
23
Q
what are the ss of SAB
A
vaginal bleeding, cramping, decrease ss of pregnancy
24
Q
what is a potential cause for 2nd trimester SAB
A
chronic infection, maternal uterine/cervical defects, exposure to fetotoxic substance, drug use, trauma/shock
25
what is a septic SAB
Content and/or uterus becomes infected during abortion process
26
what can be done for cervical insufficiency
placement of clerclage at cervical/vaginal opening
27
when would a clerclage be removed
at 37 weeks to give birth
28
what could be some adverse effects for hyperemesis
alkalosis, ketouria, decreased weight, potential fetal growth restrictions, dehydration
29
who is at risk for hyperemesis
increase placental mass, molar pregnancies, thimaine and vitamin D deficiency, increase hormones
30
what is placental previa
implantation of placenta in lower uterine segment
31
what is a complete placenta previa
covers entire opening of cervix
32
what is a partial placenta previa
covers part of cervix opening
33
what is a marginal placenta previa
placenta is approaching cervical opening but not covering it
34
what is a low lying placenta previa
in between normal level and marginal level (aka not covering but not where its suppose to be)
35
what are the ss of placenta previa
painless, can have bright red bleeding
36
what is a placental abruption
premature seperation of placenta from uterine lining
37
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)
38
what is the treatment for placental abruption
depends on degree, hospitalization, continuous monitoring, if severe may need immediate c -section
39
what are some ss of DIC
bleeding from gums, mouthm nose, decrease platelets, decrease fibrogen
40
who is a risk for placental previa
multiple pregnancies, previous scaring of uterus, smoking, drug use, hx of SAB, maternal age
41
why could complete/partial not be vaginally birthed
because the placenta would come out first and cut off o2 supply to the baby
42
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
43
who is at risk for placental abruption
maternal hypertension, smoking, SAB, short umbilical cord, domestic violence
44
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
45
what are some interventions for DIC
strict I/O, side laying to increase blood flow to baby,
46
when does preterm labor happen
between 20-37 weeks
47
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"
48
what are some late term complications of preterm labor
cerebral palsy, intellectual & developmental issues, retinopathy
49
what is the goal of preterm labor
inhibit/reduce contractions, stop dilation, optimize fetal status
50
what does the tocolytic: BIfedipine/procardia do
calcium channel blocker, watch for decrease BP from vasodialation
51
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
52
what are some causes for PROM
infection in genital tract, smoking, multibaby
53
what increases risk for preterm labor
could be unknown, abruption, uterine over distension, hormonal changes, , bacterial infection
54
what are some short term complications of preterm labor
respiratory distress, intraventricular hemorrhage, necrotizing enterocolitis, patent ductus arterioles
55
what does tocolytic: magnesium sulfate do
decreases BP and seizures in pre eclampsia
56
what do you need to monitor for magnesium sulfate
urine output, BP, deep tendon reflexes, magnesium levels
57
what do you need to keep on you when your patient is taking magnesium sulfate
calcium gluconate to reverse adverse effects
58
what is PROM
premature rupture of membrane before labor
59
what are the ss of PROM
vaginal leaking of fluid
60
how do you confirm PROM
ferning (microcope looking at fluid), Nirogene (cotton color changing thing), aminosure kit
61
what teaching is involved for PROM
no baths, no sex, nothing in the vagina
62
what does SPASM stand for (pre eclampsia)
significant Bp changes, protienuria, arterioles, significant lab changes, multi organ systems, before 24 weeks
63
what is eclampsia
progression from pre-elcampsia involves CNS aka seizures
64
what increases the risk for hypertensive disorders
smoking, obesity, diabetes, family hx,
65
what are the ss of severe hypertensive disorders
HELLP (hemolysis, elevated liver enzymes, low platelet count)
66
when does postpartum pre eclampsia
usually develops 48hrs to 6 weeks after delivery
67
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
68
what can hypertensive disorders cause
abruption, preterm labor, low birth weight, poor fetal growth, hepatic failure
69
what is chronic hypertension and when does it show up
before pregnancy or before 20 weeks - over 140/over 90
70
what is gestational hypertension
new onset hypertension after 20 weeks without proteinuria
71
what is gestaional pre - elampsia
>140/>90 x2 4 hours apart, with proteinuria
72
what position can help gestational hypertension
left side laying
73
what is the only cure for pre-elcampsia/ eclamspia
delivery
74
what are the ss of HELLP syndrome
pre- eclampsia, n/v, hepatic dysfunction, acute renal failure
75
how many calories do you need to increase for 2 babies
600-900cal/day
76
what does TORCH stand for
toxoplasmosis, other, rubella, cytomegalovirus, herpes simplex virus
77
what does toxoplasmosis do to a developing fetus
ventricularomegaly, intracranial calcifications, IUGR, hepatosplenomegaly
78
what does cytomegalovirus do to a developing fetus
deafness, blindness, intellectual/ developmental disabilities, jaundice
79
what does cytomegalovirus do to a mom (ss)
asymptomatic
80
what is antepartal HIV vertical transmission
virus crosses placenta
81
what is intrpartal HIV vertical transmission
travels from vagina up into uterus during labor or after rupture of membrane
82
what are some potential complications of multibaby
preterm labor, diabetes, increase risk for UTI, umbilical prolapse
83
what group beta strept (GBS)
normal flora for many women
84
what do you treat group beta strept (GBS) with
penicillin antibiotics
85
what can group beta strept (GBS) affect
labor/ birth
86
when is screening done for group beta strept (GBS)
36-37 weeks
87
what is toxoplasmosis
spread via cat feces or undercooked meats
88
what are some maternal ss for toxoplasmosis
fatigue, muscle pains, myocarditis, lymphadenopathy
89
what does rubella do to a developing fetus
deafness, eye defects, CNS abnormalities, cardiac malfunction
90
what are some maternal ss of rubella
rash on face/neck/arms/legs lasting 3 days
91
what is isoimmunization
development of maternal antibodies destorying fetal RH+ blood
92
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
93
when do you give Rhogam
RH - mom at 28 weeks and within 72 hours after delivery to RH+ baby
94
what is pregestational diabetes
hyperglycemia resulting from limited or absent insulin production, deficent insulin or combo of both
95
what are the risks for getting gestational diabetes
ovre 25 years old, obesity, insulin resistance,
96
if a women has gestational diabetes what are the more likely to get as awell
pre eclampsia/ eclampsia
97
what kind of diet should someone with gestational diabetes be on
low carb diet
98
what kind of diagnostic procedures can confirm embolism
doppler US, MRI, CT
99
is the 1st RH+ baby affected
rarely affected
100
is RH+ dominant or recessive
dominant
101
who doesnt need RHogam
mom with RH+ blood, Mom with RH- and baby with Rh-
102
what is gestational diabetes
Impairment in carbohydrate metabolism
103
how does glucose work during preganancy
glucose levels decrease in mom during 1st trimester, during 2nd and 3rd trimester insulin requirements slowly increase
104
what is the 1st half of pregnancy for gestational diabetes called
anabolic phase= maternal hyperinulinemia
105
what is the 2nd half of pregnancy for gestational diabetes called
catabolic phase= fetal hyperinsulinemia
106
does glucose and insulin cross the placenta
insulin doesnt glucose does
107
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
108
what are some ss of thromboembolism
pain, tenderness, warmth, swelling color change
109
what are some ss of pulmonary embolism
tachypnea, dyspnea, pleurtic chest pain, anxious
110
what meds do you give someone with a emoblism
anticoagulant
111
what is a doppler ultrasound blood flow studies
study of blood vessels in umbilical vessels
112
what is a contraction stress test
evaluates FHR reasponse to uterine contractions
113
what is a negative contraction stress test
desired - no significant decels in FHR
114
what is a positive contraction stress test
late decels with 50% on contractions
115
what is a reactive non stress test
15x15 in 20 mins
116
what is a non reactive non stress test
absence of accels or less then 2 accels. in 20 minutes
