T4 Advanced Organizer Part 4 Flashcards
What are the different types of abortion?
- Threatened
- Inevitable
- Incomplete
- Septic
- Missed
- Habitual (Recurrent)
What makes up Threatened Abortion?
Bleeding: Vaginal spotting early in gestation
Cramping: Mild
Passage of tissue: No
Cervical dilation: No (cervix is closed)
Management for Threatened Abortion?
Possible mild activity restriction with bedrest 24-48 hours
no stimulation of sexual intercourse or orgasm for 2 weeks
What makes up Inevitable Abortion?
Bleeding: Moderate/heavy
Cramping: Mild-severe
Passage of tissue: Maybe (if all products of conception not passed spontaneously, they can be manually removed)
Cervical dilation: Yes
How may additional products of conception be removed?
- vacuum curettage (prostaglandin analog) to evacuate uterus
- D&C
Management of Inevitable abortion
Bed rest if no pain, bleeding or infection
if ROM, pain, bleeding, or infection then preg termination is accomplished by D and C
What makes up Incomplete abortion?
Bleeding: Heavy/profuse
Cramping: Severe
Passage of tissue: Yes
Cervical dilation: Yes, with tissue in cervix
Management of Inevitable Abortion?
May require additional cervical dilation before curettage
What makes up Complete abortion?
Bleeding: Slight
Cramping: Mild
Passage of tissue: Yes
Cervical dilation: No (cervix has already closed after tissue is passed)
Which abortion?
All fetal tissue and products of conception passed in bleeding; ultrasound shows empty uterus
Complete
Which abortion?
Involves expulsion of the fetus with retention of the placenta
Incomplete
What makes up septic abortion?
Bleeding: Varies (scant to heavy, malodorous)
Cramping: Varies
Passage of tissue: Varies
Cervical dilation: Yes, usually
Other: Fever, abdominal pain and tenderness
Management of Septic Abortion?
Termination of pregnancy
Culture and sensitivity studies to initiate appropriate antibiotics
Management of complete abortion?
No other interventions needed if UC are adequate to prevent hemorrhage and no infection is present
May need suction curettage to ensure there is no retained fetal or maternal tissue
Which abortion?
Has an ODOR
Septic
What makes up a missed abortion?
Bleeding: None, spotting
Cramping: None
Passage of tissue: No
Cervical dilation: No
Management of missed abortion?
If spontaneous evacuation of the uterus does not occur within one month uterus is evacuated by method appropriate to duration of pregnancy
Blood clotting factors monitored
DIC with uncontrolled hemorrhage may develop in cases of fetal death after week 12
Which abortion?
Retained nonviable embryo or fetus for 6 weeks or more– fetus has died and placenta atrophied but products of conception are retained; cervix is closed
Missed
What makes up habitual or recurrent abortion?
Bleeding: Varies
Cramping: Varies
Passage of tissue: Yes
Cervical dilation: Yes, usually
Which abortion?
3 or more consecutive losses before 20 weeks gestation
Habitual/recurrent
Management of recurrent abortion?
ID and treat underlying cause if possible
Prophylactic cerclage if r/t cervical insuffici
Education for after an abortion?
- Clean the perineum after each voiding or BM and change perineal pads often
- Shower (avoid tub baths) for 2 weeks
- Avoid tampon use, douching, and vag intercourse for 2 weeks
- Notify doc if an elevated temp (>100.4) or a foul smelling vag discharge develops; also notify doc if bright red bleeding occurs or if there is bleeding with tissue fragments
- Eat foods high in iron and protein to promote tissue repair and RBC replacement
- Seek assistance from support groups, clergy, or professional counseling as needed
- Allow yourself (and your partner) to grieve the loss before becoming a parent again
Early pregnancy loss
Don’t forget to look at handout!!
What is a missed abortion?
Retained nonviable embryo or fetus for 6 weeks or more–the fetus has died and the placenta is atrophied but products of conception are retained–the cervix is closed
How is a missed abortion treated?
If spontaneous evacuation of the uterus does not occur within one month, uterus is evacuated by method appropriate to duration of the pregnancy. Blood clotting factors are monitored
What may develop from a missed abortion?
DIC with uncontrolled hemorrhage may develop in cases of fetal death after week 12
What occurs with a D&C?
A surgical procedure in which the cervix is dilated if necessary and a curette is inserted to scrape the uterine walls and remove uterine contents
What pain relief is given during D&C?
Administer analgesics or sedatives IV or orally (conscious sedation)
Paracervical block using local anesthetic may be administered
What needs to be done prior to a D&C?
- Full history obtained
2. General and pelvic exams conducted
What is done after evacuation of particles from the uterus?
oxytocin is given to prevent hemorrhage
What is given for excessive bleeding after a miscarriage?
Methergine or prostaglandin derivative
contract the uterus
What is hyperemesis?
Severe vomiting of pregnancy that causes weight loss of > 5% of prepregnancy weight
What is the problem with hyperemesis?
Dehydration, electrolyte imbalance, nutritional deficiencies (to mom and growing baby).
Ketonuria (which CAN cross the placenta)
What causes hyperemesis?
- Increasing levels of: estrogen, progesterone, hCG
- Hyperthyroidism during pregnancy
- Esophageal reflux
- Reduced GI motility (progesterone works on smooth muscles)–decreased secretion of free HCl
- Psychosocial: ambivalence towards pregnancy, increased stress, conflicting feeling regarding motherhood, body changes, lifestyle alterations
What is heightened during pregnancy that may affect hyperemesis?
Sense of smell HEIGHTENED during pregnancy (nose becomes larger to allow for my oxygen) which can potentiate N/V
What kinds of food with a pt with hyperemesis need?
BLAND DIET with small frequent meals
Keep DRY foods at bedside
Dry to wet
Do not drink mass amounts of liquids with meals
Herbal remedies: ginger and lemon