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NU314 OB > Pregnancy Complications > Flashcards

Pregnancy Complications Flashcards

1
Q

High risk pregnancy

A

one in which a condition exists that jeopardizes the health of the mother, her baby, or both

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2
Q

When do risk assessments begin and how long do they last?

A

Begin at the first antepartal visit and continue w/ each subsequent visit

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3
Q

Why are risk assessments continued through out the pregnancy?

A

Because risk factors may be identified in later visits that were not apparent during earlier visits

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4
Q

What is the biggest killer of mom and baby during pregnancy?

A

obstetric hemorrhage

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5
Q

What conditions are associated with early bleeding during pregnancy?

A
  • Spontaneous abortion
  • Ectopic pregnancy
  • Gestational trophoblastic disease
  • Cervical insufficiency
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6
Q

What conditions are associated with late bleeding during pregnancy?

A

Placenta previa
Abruptio placentae
After 20th week of gestation

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7
Q

What is the most common complication of early pregnancy?

A

Spontaneous abortion

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8
Q

Miscarriage

A

loss of a pregnancy before 20 weeks gestation

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9
Q

Stillbirth

A

loss of a fetus after 20 weeks gestation

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10
Q

What is the most common cause of spontaneous abortion in the first trimester?

A

fetal genetic/chromosomal abnormalities

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11
Q

What are common causes of spontaneous abortion in the second trimester?

A

Maternal conditions: cervical insufficiencies, congenital or acquired anomaly of the uterine cavity (fibroids), hypothyroidism, diabetes mellitus, chronic nephritis, cocaine use, PCOS, HSV, hypertension, etc…

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12
Q

If the mother is Rh- how long after the completion of the abortion will she need Rhogam?

A

within 72 hours after completion

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13
Q

Threatened Abortion

A
  • slight bleeding
  • NO cervical dilation
  • mild cramping
  • NO passage of fetal tissue
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14
Q

Inevitable Abortion

A
  • vaginal bleeding
  • ROM
  • cervical dilation
  • strong cramping
  • possible passage of tissue
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15
Q

Incomplete Abortion

A
  • intense abdominal cramping
  • heavy vaginal bleeding
  • cervical dilation
  • passage of some tissue
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16
Q

Complete Abortion

A
  • passage of ALL tissue
  • history of vaginal bleeding and abdominal pain
  • passing of tissue w/ subsequent decrease in pain and significant decrease in vaginal bleeding
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17
Q

Missed Abortion

A
  • nonviable embryo retained in utero for at least 6 weeks
  • absent uterine contractions
  • irregular spotting
  • possible progression to inevitable abortion
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18
Q

Habitual Abortion

A

history of three of more consecutive spontaneous abortions

not carrying the pregnancy to viability or term

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19
Q

How long after an abortion will mom need Rhogam?

A

within 72 hours

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20
Q

Cytotec (Misoprostol)

A

stimulates uterine contractions to terminate a pregnancy; evacuate the uterus after an abortion to ensure passage of all the products of conception

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21
Q

Mifepristone

A

acts as progesterone antagonist, allowing prostaglandins to stimulate uterine contractions; causes the endometrium to slough; may be followed by administration of misoprostol within 48 hours

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22
Q

Cervidil

A

stimulates uterine contractions, causing expulsion of uterine contents; to expel uterine contents in fetal death or missed abortion during second trimester, or to efface and dilate cervix at term

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23
Q

Rhogam

A

suppresses immune response of non-sensitized Rh-clients who are exposed to Rh+ blood after abortions, miscarriages, or pregnancies

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24
Q

ectopic pregnancy

A

any pregnancy in which the fertilized ovum implants outside the uterine cavity

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25
Q

where can ectopic pregnancies occur

A

fallopian tubes, cervix, ovaries, and the abdominal cavity

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26
Q

where is the most common place of an ectopic pregnancy

A

fallopian tubes

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27
Q

what is the most common cause of maternal death

A

ectopic pregnancy

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28
Q

ectopic pregnancy can lead to what?

A

massive hemorrhage, infertility, or death

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29
Q

ectopic pregnancies usually result from what conditions?

A

conditions that obstruct or slow the passage of the fertilized ovum through the fallopian tube to the uterus

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30
Q

most common cause of ectopic pregnancy

A

pelvic inflammatory disease (PID)

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31
Q

risk factors for ectopic pregnancy

A 
STI's - chlamydia and gonorrhea
PID 
previous tubal surgery
previous pregnancy loss
oral contraceptives
previous ectopic pregnancy
fibroids
sterilization
smoking
multiple sex partners 
douching
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32
Q

Why is the diagnosis of ectopic pregnancy sometimes challenging?

A

Because many women are asymptomatic until rupture

33
Q

What is the classic triad of ectopic pregnancy?

A

abdominal pain
amenorrhea
vaginal bleeding

34
Q

What diagnostic procedures are used for ectopic pregnancy?

A

Uterine pregnancy test to confirm pregnancy
Beta-hCG to rule out false negative
Transvaginal ultrasound to visualize misplaced pregnancy

35
Q

What medication is often used to treat ectopic pregnancies with an early diagnosis?

A

Methotrexate

36
Q

What are contraindications for medical intervention of ectopic pregnancies?

A 
unstable patient
severe abdominal cramps 
pulmonary, renal, or liver disease
peptic ulcer
suspected intrauterine pregnancy
immunodeficiency 
poor client compliance
37
Q

Methotrexate

A

folic acid antagonist that inhibits cell division in a developing embryo

38
Q

What other medications may be used for ectopic pregnancy?

A

prostaglandins, misoprostol, and actinomycin

39
Q

What are adverse effects of methotrexate?

A

nausea, vomiting, stomatitis, diarrhea, gastric upset, increased abdominal pain, and dizziness

40
Q

What surgical intervention might be performed for unruptured fallopian tube with ectopic pregnancy?

A

linear salpingostomy

41
Q

If the tube has ruptured because of ectopic pregnancy what surgery will be performed?

A

laparotomy with salpingectomy

42
Q

Why is the woman’s beta-hCG level still monitored until it is undetectable after treatment?

A

to ensure that any residual trophoblastic tissue that forms the placenta is gone

43
Q

What is the hallmark sign of ectopic pregnancy?

A

abdominal pain with spotting 6-8 weeks after missed menses

44
Q

How long should you encourage the patient to use contraceptives after ectopic pregnancy?

45
Q

What are the two most common types of Gestational Trophoblastic Disease (GTD)?

A

Hydatiform mole

Choriocarcinoma

46
Q

GTD

A

gestational tissue is present but the pregnancy is not viable

47
Q

Hydatiform Mole

A

a benign neoplasm of the chorion which the chorionic villi degenerate and become transparent vesicles containing clear vesicle fluid
-complete or partial
An “Empty Egg”

48
Q

Signs and symptoms of complete mole

A

vaginal bleeding, anemia, excessively enlarged uterus, preeclampsia, and hyperemesis

49
Q

Signs and symptoms of partial mole

A

missed or incomplete abortion, vaginal bleeding, small or normal size for date uterus

50
Q

Choriocarcinoma

A

chorionic malignancy with metastasis to other organs

51
Q

What are the signs and symptoms of choriocarcinoma?

A

Usually asymptomatic

shortness of breath indicating metastasis to lungs

52
Q

What is the treatment for GTD?

A

immediate evacuation of the uterine contents as soon as the diagnosis is made and long term follow up to detect any tissue that might become malignant

53
Q

How long are serial levels of hCG used to detect residual trophoblastic tissue?

A

every 3 weeks for 1 year

54
Q

How long is the client advised to receive extensive follow up therapy?

55
Q

How long should the patient avoid pregnancy after experiencing GTD?

A

1 year

Use contraceptives for 1 year

56
Q

Signs and symptoms of GTD

A 
reports of early signs of pregnancy
brownish vaginal discharge 
anemia 
no fetal heart rate 
preeclampsia
uterine size larger than expected 
fluid retention and swelling
57
Q

Nursing Management for GTD

A
  • preparing for D&C
  • emotional support
  • educating about the risk of cancer
  • educating on strict adherence for follow-ups
58
Q

Cervical Insufficiency

A

premature dilation of the cervix
-a weak, structurally defective cervix that spontaneously dilates in the absence of uterine contractions in the second trimester or early third trimester resulting in loss of pregnancy

59
Q

Therapeutic management for cervical insufficiency

A

bedrest, pelvic rest, avoid heavy lifting, progesterone supplements, cervical pessary, or surgically via cervical cleavage

60
Q

Cervical Cleavage

A

using a heavy purse-string suture to secure and reinforce the internal os of the cervix

61
Q

Risk Factors for cervical insufficiency

A

previous cervical trauma
preterm labor
fetal loss in second trimester
previous surgeries or procedures

62
Q

Signs and Symptoms of Cervical Insufficiency

A

pink-tinged vaginal discharge or pelvic pressure, cramping w/ vaginal bleeding, and loss of amniotic fluid

63
Q

When is a transvaginal ultrasound performed to asses for cervical insufficiency?

A

B/t 16 and 24 weeks to determine cervical length, evaluate for shortening, and attempt to predict preterm labor

64
Q

Cervical Shortening w/ insufficiency

A

Can be viewed on ultrasound as funneling between 16-24 weeks

65
Q

Placenta Previa

A

bleeding condition that occurs during the last 2 trimesters

-the placenta implants over the cervical os

66
Q

What can increase the risk of placenta previa

A

history of cesarean births

67
Q

How is placenta previa classified?

A 
By amount of coverage 
Total
Partial
Marginal 
Low-lying
68
Q

What does the therapeutic management of placenta previa depend on?

A
  • extent of bleeding
  • amount of coverage
  • fetal development
  • position of the fetus
  • mother’s parity
  • presence or absence of labor
69
Q

Risk Factors for Placenta Previa

A
  • older than 35 years of age
  • previous c/s
  • multiparity
  • uterine injury
  • cocaine use
  • prior placenta previa
  • infertility treatment
  • multiple gestations
  • surgical abortions
  • smoking
  • hypertension or diabetes
70
Q

How is the position of the placenta validated for placenta previa?

A

Transvaginal ultrasound

71
Q

Nursing Management for Placenta Previa

A
  • focuses on maternal health status
  • assessing s/s of vaginal bleeding and fetal distress
  • avoidance of vaginal exams
  • FHR
72
Q

Abruptio Placentae

A

premature separation of a normally implanted placenta after the 20th week of gestation prior to birth which leads to hemorrhage

73
Q

How is abruptio placentae classified?

A 
According to extent of separation and amount of blood loss from maternal circulation 
Mild-grade 1
Moderate-grade 2
Severe-grade 3 
-complete or incomplete
74
Q

Mild-Grade 1 AP

A

minimal bleeding, marginal separation, tender uterus, no coagulopathy, no signs of shock, no fetal distress

75
Q

Moderate Grade 2 AP

A

moderate bleeding, moderate separation, continuous abdominal pain, mild shock, normal maternal BP, maternal tachycardia

76
Q

Severe Grade 3 AP

A

absent to moderate bleeding, severe separation, dark vaginal bleeding, agonizing abdominal pain, decreased maternal BP, significant maternal tachycardia, development of DIC

77
Q

Therapeutic Management for Abruptio Placentae

A

Assess, control, and restore amount of blood loss; provide positive outcome; prevent coagulation disorders (DIC)

78
Q

What emergency measures will be taken for Abruptio Placentae?

A

Starting 2 large-bore IV lines with normal saline or lactated ringers solution

NU314 OB (21 decks)

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