Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ANTEPARTUM lectures: SAB & PreEclampsia > SAB & Pre-Eclampsia > Flashcards

SAB & Pre-Eclampsia Flashcards

1
Q

first trimester bleeding etiology

A

often unknown

goal –> exclusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

differential diagnosis for FIRST TRIMESTER bleeding

A
  1. SAB
  2. Ectopic pregnancy
  3. Hydatidiform mole
  4. Normal/other
  5. Subchorionic hemorrhage
  6. Trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Normal Etiologies of FIRST TRIMESTER bleeding

A
  1. Polyps
  2. cervivitis
  3. vaginal infection
  4. STI
  5. implantation spotting
  6. increased vascularization of the cervix in pregnancy= increased friability
  7. post-coital spotting due to increase friability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

implantation spotting

A

which is most often scant, 7-11 days after conception, lasting only a day or two; minority of pregnant women have this kind of spotting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

how would you evaluate when first trimester bleeding present

A

History: severity, amount, associated s &sx, pain , and cramping
Past history: previous ectopic, prior SABs, medical disorders, risk factors, fibroids/

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

physical examination of first trimester bleeding

A

vital signs
abdominal exam (pain, FHTs)
SPECULUM EXAM- observe internal and external
bimanual exam: CMT, adnexal masses, uterine enlargement.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

spontaneous abortion (SAB)

A

most common early pregnancy complication
80% are in the 1st 12th week of gestation
incidence varies 25-30% of all conceptions
Chromosomal errors most common reason

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

SAB risk factors

A

smoking
alcohol
immune factors (recurrent loss)
inherited blood dyscrasias (recurrent loss)
excessive caffeine >500mg daily
environmental exposures : pesticides arsenic, lead, formaldehyde, benzene.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

threatened SAB

A

closed cervix, uterus appropriated sized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

inevitable SAB

A

cervix dilated, increased bleeding with cramps, ctx, products of conception can be at os

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

completed SAB

A

small contracted uterus, open cervix, scant bleeding/cramping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

incomplete SAB

A

placental tissue remaining, cervix open, POC can be at the os, uterus smaller than expected for gestational but not well contracted, variable bleeding/ cramping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

missed SAB

A

in utero death of embryo prior to 20th week with retention of pregnancy for prolonged period of time. Cervix closed. +/- bleeding.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

diagnosis SAB

A

Ultrasound KEY
may see abnormal yolk sac, slow or absent FHT, hematoma

Serial b-hCG adjunct to determine viability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

serial b-hCG

A

adjunct to determine viability
double every 2-3 days
max levels at 8-10 weeks, then decline
serial measures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

management of SAB

A

type and screen

give Rhogam if Rh negative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

management of threatened AB

A

expectant management if no infection present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

inevitable & complete AB

A 
per MD (consult & referral) 
can be expectant or D&C
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

ectopic pregnancy

A

approximately 2% of pregnancies (or 20/1000)
increasing incidence
clinical manifestation commonly between 6-8 weeks, can occur later
many women asymptomatic when you see them.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

ectopic pregnancy risk factors (HIGH)

A

tubal ligation
tubal pathology/surgery
prior ectopic
IUD- esp. mirena

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

ectopic pregnancy risk factors (moderate)

A

infertility
assisted reproduction technology
prior hx of genital tract infection (Chlamydia, GC, salpingitis)
multiple sex partner (secondary to increase risk for PID)
smoking (dose dependent)
african american

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

ectopic pregnancy risk factors( lower )

A

prior cesarean

douching

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

signs &symptoms of ectopic pregnancy

A

abdominal pain
amenorrhea - positive pregnancy test
bleeding (profuse if cervical pregnancy)

many women no symptoms
may have breast tenderness, nausea, other pregnancy signs.
signs of rupture : shoulder pain (blood irritating diaphragm)
Urge to defecate (blood pooling in the cul de sac)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

evaluation of ectopic pregnancy

A

pregnancy test on all reproductive aged women with abdominal pain
pelvic exam for adnexal mass
assess cervical motion tenderness ( sometimes your first clue on routine 1st visit exam)

ultrasound - may or may not see extrauterine sac
serial B-hCG - may see slower rise, may be normal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

management of ectopic pregnancy

A

refer
surgery for rupture or failed medical therapy
METHOTREXATE therapy: unrupture
hcG < 500 !

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Gestational trophoblastic disease

A 
made up of interrelated lesions from trophoblastic epithelium of placenta 
Hydatidiform mole (80%) 
gestational trophoblastic neoplasia (GTN)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

hydatidiform mole

A

complete - no fetal tissue- high incidence of becoming malignant
partial-some fetal tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

gestational trophoblastic neoplasia

A

invasive mole, choriocarcinoma
characterized by persistent B-hCG, no tissue.
incidence: 1-2/1000 pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

gestational trophoblastic neoplasia risk factors

A

teens and age >35
prior molar pregnancy
oral contraceptive use
smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

gestational trophoblastic neoplasia clinical manifestation

A

marked NAUSEA & VOMITING of pregnancy
increase uterine size
bleeding - occasional spotting to heavy bleeding.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

diagnosis gestational trophoblastic neoplasia

A

USN

B-hCG ** may see abnormally high level, SLOWER rise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Management of gestational trophoblastic neoplasia

A

D & C
hysterectomy
post evacuation surveillance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

subchorionic hemorrhage

A

bleeding r/t separation of chorion from uterine lining
see on USN
outcomes usually good

34
Q

midwifery care for FIRST TRIMESTER pregnancy

A

feeling of loss & grief, often more than women expect
emotional healing takes longer than physical healing
loss of future plans, dreams, and hope
sensitive, caring language
reassurance about what does not cause early loss to reduce blame

35
Q

causes of late pregnancy bleeding

A 
placenta previa 
abruption 
rupture vasa previa 
uterine scar dehiscence 
cervical polyp 
bloody show
preterm labor/labor
cervicitis or cervical ectropion 
vaginal trauma
cervical cancer 
STIs
36
Q

Placenta Previa

A

1/300
at 16-20 weeks gestations, low liine placenta is seen in 50% of the women, however 90% of those will be normal implantation by 30 weeks gestation. therefore, reassure women during normal ultrasound.

37
Q

risk factors for placenta previa

A 
maternal age >35 
multiparity of 5 or greater 
smoking 
unexplained MSAFP 
frequent D & Cs 
Previous C/S 
Previous placenta previa
38
Q

potential problem from placenta previa

A

Cesarean section
preterm birth
Third stage issues: placenta accreta, hemorrhage, hysterectomy

39
Q

signs & symptoms of placenta previa

A

BRIGHT red PAINLESS BLEEDING
often is intermittent
may occur with : intercourse, vaginal exam, cervical dilation & no preceding event.

40
Q

midwifery management of placenta previa

A

consider STERILE SPECULUM exam as a first line assessment
no vaginal exam
confirmation by ultrasound
delivery by C/S for most

41
Q

midwifery management for woman is stable & preterm

A 
consult/collaborate
bed rest or modified activity
outpatient monitoring 
pad counts 
abstinence, nothing in vagina
education & support
42
Q

placenta abruption

A

partial separation or all of the placenta from the uterine wall.
secondary to clot or hematoma . size of clot or hematoma determine the extend of seperation

43
Q

prevalence & risk factors of placental abruption

A

1/200
a severe abruption leading to fetal death occurs in 1/830
hypertensive disorder
cigarette smoking
scar tissue
abdominal trauma: blunt force
cocaine use (vasocontriction)
previous placental abruption
advance maternal age and less than 20 years of age.
poor nutritional status
chorionitist
hx thrombofibrin
any that decrease the uterine volume such as rupture placental membrane
elevated maternal placental protein which is associated with increase abruption

44
Q

history : placental abruption

A 
onset duration & severity 
color amount characteristic of discharge 
any precipitory event? 
any contraction? 
describe abdominal pain or not at all 
recent examination or intercourse 
trauma ? 
gestational age? 
when is the last ultrasound done ? 
gravid para 
blood type 
risk factors: multiparity, age greater than 35, previous placeta previa, uterine scar, multiple pregnancy
45
Q

physical examination of placenta abruption

A

vital sign
pain
FHT
abdominal exam –hard board like
speculum exam: visualize dilation, check for erosion, polyps, STI ?
bimanual exam to check for : dilation, effacement, station, presenting part, status of membrane

46
Q

potential problems with placental abruption

A 
hemorrhage 
shock
coagulopathies/DIC
hysterectomy
stillbirth
hypoxia
preterm delivery
fetal death
47
Q

signs & symptoms of ABRUPTION

A 
PAIN (hallmark symptom) - mild to severe 
bleeding -may or may not (conceal? )
backache- posterior abruption ?  
contractions
may report decreased fetal movement
48
Q

frequency of symptoms with abruption

A

vaginal bleeding : 80%
Abdominal or back pain and uterine tenderness: 70 %
fetal distress: 60%
abnormal uterine contractions (hypertonic, high frequencty): 35%
idiopathic premature labor: 25%

49
Q

complications associated with placental abruption –FETAL

A

growth restriction (chronic abruption)
preterm birth and associated morbidity
perinatal mortality
fetal hypoxemia or asphyxia

50
Q

complications associated with placental abruption- MATERNAL

A 
Hypovolumia (secondary to blood loss) 
blood transfusion 
DIC
cesarean section
renal failure
ARDS
multisystem organ failure
death
51
Q

midwifery management for placental abruption

A

call for USN
call for consultant
NST
Labs per consultant: CBC PTT fibrinogen BUN type & Rh

52
Q

emergency management of placental abruption

A

mask O2 at 10L/min
assess uterine tone, any relaxation, contractions
pain monitoring and management-dont want to mask pain that may be diagnostic
IV fluids-volum support, replacement and venous assess
foley cath-output monitoring, expect decreased amount, increased concentration

53
Q

pathophysiology of preeclampsia

A

increase BP is most common presentation, pathologic process starts well before maternal signs & symptoms
Pathologic process originated with placental development, early in 1st trimester
characterized by widespread maternal endothelial cell dysfunction
result in mild-severe microangiopathy of target organs such as brain, liver, kidney, placenta

54
Q

causes preeclampsia

A

placental or maternal response to placenta development

  • -> SHALLOW PLACENTATION: invasion of fetal trophoblasts into the maternal spiral arteries incomplete
  • -> this causes the SPIRAL ARTERIES to REMAIN SMALLER, FIRM and RESISTANT, instead of remodeling to relaxed and less resistant (pseudovascularization)
55
Q

why pseudovascularization is incomplete

A

genetic factors
immunologic factors
early hypoxic episode to differentiating cells

56
Q

causes of late pregnancy bleeding

A 
placenta previa 
abruption 
rupture vasa previa 
uterine scar dehiscence 
cervical polyp 
bloody show
preterm labor/labor
cervicitis or cervical ectropion 
vaginal trauma
cervical cancer 
STIs
57
Q

Placenta Previa

A

1/300
at 16-20 weeks gestations, low liine placenta is seen in 50% of the women, however 90% of those will be normal implantation by 30 weeks gestation. therefore, reassure women during normal ultrasound.

58
Q

risk factors for placenta previa

A 
maternal age >35 
multiparity of 5 or greater 
smoking 
unexplained MSAFP 
frequent D & Cs 
Previous C/S 
Previous placenta previa
59
Q

potential problem from placenta previa

A

Cesarean section
preterm birth
Third stage issues: placenta accreta, hemorrhage, hysterectomy

60
Q

signs & symptoms of placenta previa

A

BRIGHT red PAINLESS BLEEDING
often is intermittent
may occur with : intercourse, vaginal exam, cervical dilation & no preceding event.

61
Q

midwifery management of placenta previa

A

consider STERILE SPECULUM exam as a first line assessment
no vaginal exam
confirmation by ultrasound
delivery by C/S for most

62
Q

midwifery management for woman is stable & preterm

A 
consult/collaborate
bed rest or modified activity
outpatient monitoring 
pad counts 
abstinence, nothing in vagina
education & support
63
Q

placenta abruption

A

partial separation or all of the placenta from the uterine wall.
secondary to clot or hematoma . size of clot or hematoma determine the extend of seperation

64
Q

prevalence & risk factors of placental abruption

A

1/200
a severe abruption leading to fetal death occurs in 1/830
hypertensive disorder
cigarette smoking
scar tissue
abdominal trauma: blunt force
cocaine use (vasocontriction)
previous placental abruption
advance maternal age and less than 20 years of age.
poor nutritional status
chorionitist
hx thrombofibrin
any that decrease the uterine volume such as rupture placental membrane
elevated maternal placental protein which is associated with increase abruption

65
Q

history : placental abruption

A 
onset duration & severity 
color amount characteristic of discharge 
any precipitory event? 
any contraction? 
describe abdominal pain or not at all 
recent examination or intercourse 
trauma ? 
gestational age? 
when is the last ultrasound done ? 
gravid para 
blood type 
risk factors: multiparity, age greater than 35, previous placeta previa, uterine scar, multiple pregnancy
66
Q

physical examination of placenta abruption

A

vital sign
pain
FHT
abdominal exam –hard board like
speculum exam: visualize dilation, check for erosion, polyps, STI ?
bimanual exam to check for : dilation, effacement, station, presenting part, status of membrane

67
Q

potential problems with placental abruption

A 
hemorrhage 
shock
coagulopathies/DIC
hysterectomy
stillbirth
hypoxia
preterm delivery
fetal death
68
Q

signs & symptoms of ABRUPTION

A 
PAIN (hallmark symptom) - mild to severe 
bleeding -may or may not (conceal? )
backache- posterior abruption ?  
contractions
may report decreased fetal movement
69
Q

frequency of symptoms with abruption

A

vaginal bleeding : 80%
Abdominal or back pain and uterine tenderness: 70 %
fetal distress: 60%
abnormal uterine contractions (hypertonic, high frequencty): 35%
idiopathic premature labor: 25%

70
Q

complications associated with placental abruption –FETAL

A

growth restriction (chronic abruption)
preterm birth and associated morbidity
perinatal mortality
fetal hypoxemia or asphyxia

71
Q

complications associated with placental abruption- MATERNAL

A 
Hypovolumia (secondary to blood loss) 
blood transfusion 
DIC
cesarean section
renal failure
ARDS
multisystem organ failure
death
72
Q

midwifery management for placental abruption

A

call for USN
call for consultant
NST
Labs per consultant: CBC PTT fibrinogen BUN type & Rh

73
Q

emergency management of placental abruption

A

mask O2 at 10L/min
assess uterine tone, any relaxation, contractions
pain monitoring and management-dont want to mask pain that may be diagnostic
IV fluids-volum support, replacement and venous assess
foley cath-output monitoring, expect decreased amount, increased concentration

74
Q

pathophysiology of preeclampsia

A

increase BP is most common presentation, pathologic process starts well before maternal signs & symptoms
Pathologic process originated with placental development, early in 1st trimester
characterized by widespread maternal endothelial cell dysfunction
result in mild-severe microangiopathy of target organs such as brain, liver, kidney, placenta

75
Q

causes preeclampsia

A

placental or maternal response to placenta development

  • -> SHALLOW PLACENTATION: invasion of fetal trophoblasts into the maternal spiral arteries incomplete
  • -> this causes the SPIRAL ARTERIES to REMAIN SMALLER, FIRM and RESISTANT, instead of remodeling to relaxed and less resistant (pseudovascularization)
76
Q

why pseudovascularization is incomplete

A

genetic factors
immunologic factors
early hypoxic episode to differentiating cells

77
Q

inflammation and preeclampsia

A

maternal infection like UTI, periodontal disease, chlamydia, etc, are associated with increased rates of preeclampsia

78
Q

endothelial dysfunction

A

endothelium regulates vascular elasticity, permeability and coagulation cascade

79
Q

increase insulin resistance

A

linked to pathophysiology of preeclampsia

  • characterized by microvascular dysfunction
  • may be primary pathway for adverse fetal effects- like FGR- in severe preeclampsia
  • check this out for a deeper understating of relationship
80
Q

how preeclampsia lead to high blood pressure

A

increased vascular resistance –> decrease cardiac output–> widespread vasoconstriction–> increase BP

81
Q

Maternal effects from preeclampsia

A

kidney - capillary edema, glomerular cell dysfunction
CNA- vasospasm= headaches, visual changes
liver- fibrin deposits
Blood- hemoconcentration
- thrombocytopenia
uterus- underperfusion, utero-placental insufficiency.

82
Q

Fetal effects from preeclampsia

A

decreased utero-placental blood flow may cause:

  • placental infarctions
  • oligohydramnios
  • placental abruption
  • fetal growth restriction
  • non-reassuring fetal status

ANTEPARTUM lectures: SAB & PreEclampsia (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions