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Maternal Newborn-MJ > T4 Advanced Organizer Part 4 > Flashcards

T4 Advanced Organizer Part 4 Flashcards

1
Q

What are the different types of abortion?

A
  1. Threatened
  2. Inevitable
  3. Incomplete
  4. Septic
  5. Missed
  6. Habitual (Recurrent)
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2
Q

What makes up Threatened Abortion?

A

Bleeding: Vaginal spotting early in gestation

Cramping: Mild

Passage of tissue: No

Cervical dilation: No (cervix is closed)

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3
Q

Management for Threatened Abortion?

A

Possible mild activity restriction with bedrest 24-48 hours

no stimulation of sexual intercourse or orgasm for 2 weeks

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4
Q

What makes up Inevitable Abortion?

A

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

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5
Q

How may additional products of conception be removed?

A
  • vacuum curettage (prostaglandin analog) to evacuate uterus

- D&C

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6
Q

Management of Inevitable abortion

A

Bed rest if no pain, bleeding or infection

if ROM, pain, bleeding, or infection then preg termination is accomplished by D and C

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7
Q

What makes up Incomplete abortion?

A

Bleeding: Heavy/profuse

Cramping: Severe

Passage of tissue: Yes

Cervical dilation: Yes, with tissue in cervix

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8
Q

Management of Inevitable Abortion?

A

May require additional cervical dilation before curettage

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9
Q

What makes up Complete abortion?

A

Bleeding: Slight

Cramping: Mild

Passage of tissue: Yes

Cervical dilation: No (cervix has already closed after tissue is passed)

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10
Q

Which abortion?

All fetal tissue and products of conception passed in bleeding; ultrasound shows empty uterus

A

Complete

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11
Q

Which abortion?

Involves expulsion of the fetus with retention of the placenta

A

Incomplete

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12
Q

What makes up septic abortion?

A

Bleeding: Varies (scant to heavy, malodorous)

Cramping: Varies

Passage of tissue: Varies

Cervical dilation: Yes, usually

Other: Fever, abdominal pain and tenderness

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13
Q

Management of Septic Abortion?

A

Termination of pregnancy

Culture and sensitivity studies to initiate appropriate antibiotics

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14
Q

Management of complete abortion?

A

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

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15
Q

Which abortion?

Has an ODOR

A

Septic

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16
Q

What makes up a missed abortion?

A

Bleeding: None, spotting

Cramping: None

Passage of tissue: No

Cervical dilation: No

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17
Q

Management of missed abortion?

A

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

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18
Q

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

A

Missed

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19
Q

What makes up habitual or recurrent abortion?

A

Bleeding: Varies

Cramping: Varies

Passage of tissue: Yes

Cervical dilation: Yes, usually

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20
Q

Which abortion?

3 or more consecutive losses before 20 weeks gestation

A

Habitual/recurrent

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21
Q

Management of recurrent abortion?

A

ID and treat underlying cause if possible

Prophylactic cerclage if r/t cervical insuffici

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22
Q

Education for after an abortion?

A
  • 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
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23
Q

Early pregnancy loss

A

Don’t forget to look at handout!!

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24
Q

What is a missed abortion?

A

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

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25
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
26
What may develop from a missed abortion?
DIC with uncontrolled hemorrhage may develop in cases of fetal death after week 12
27
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
28
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
29
What needs to be done prior to a D&C?
1. Full history obtained | 2. General and pelvic exams conducted
30
What is done after evacuation of particles from the uterus?
oxytocin is given to prevent hemorrhage
31
What is given for excessive bleeding after a miscarriage?
Methergine or prostaglandin derivative | contract the uterus
32
What is hyperemesis?
Severe vomiting of pregnancy that causes weight loss of > 5% of prepregnancy weight
33
What is the problem with hyperemesis?
Dehydration, electrolyte imbalance, nutritional deficiencies (to mom and growing baby). Ketonuria (which CAN cross the placenta)
34
What causes hyperemesis?
1. Increasing levels of: estrogen, progesterone, hCG 2. Hyperthyroidism during pregnancy 3. Esophageal reflux 4. Reduced GI motility (progesterone works on smooth muscles)--decreased secretion of free HCl 5. Psychosocial: ambivalence towards pregnancy, increased stress, conflicting feeling regarding motherhood, body changes, lifestyle alterations
35
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
36
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
37
Why is ketonuria so important in the hyperemesis pt.
- Ketones can cross the placenta to the baby | - It is a sign of acid-base imbalance--metabolic acidosis
38
When should a cerclage be placed?
11-15 weeks on patients known to have prior short cervix or spontaneous miscarriages
39
Why is a cerclage placed?
This is used in patients with incompetent cervix (cervical dilation without contractions or pain--cervix isn't holding the pregnancy) (11-15 wks)
40
What education do you give the patient who has cerclage?
- Monitor for s/s of preterm labor or infection - Antibiotics or anti-inflammatory meds may be administered - If labor begins, tocolytics may be administered Main thing: SUTURES MUST BE REMOVED before vaginal birth
41
S/S of pretrm labor/infection?
- PROM - Mom fever greater than 100.4 - Contractions - Decreased fetal movement
42
Why may a pt have sutures closing cervix?
(cerclage) of they have a short cervix/hx of abortion due to cervical insufficiency
43
What is gestational trophoblastic disease?
Abnormal growth of trophoblastic tissues, including the placenta and chorion MOLEY MOLEY MOLEY
44
Ovum with no yolk sac or partial yolk sac occurs in:
Gestational trophoblastic disease
45
What is gestational trophoblastic disease PRECURSOR TO?
Cancer!! | it must all be taken out!!
46
Assessment findings of gestational trophoblastic disease?
- Vaginal bleeding→ brown “prune juice” containing grape like vesicles - Disparity between uterine size/gest age - FHT absent (we’d normally be able to heat at 8-10 weeks) - Ultrasound shows characteristic molar pattern - Elevated hCG levels
47
What do you think about when a patient urinates what looks like brown prune juice?
Gestational trophoblastic disease | H. Mole
48
Treatment of H. Mole?
Suction evacuation regardless of type Most abort spontaneously, but suction curettage offers a safe, rapid, and effective method of evacuating a h. Mole if necessary Tested for evidence of malignancy Treatment initiated for malignancy
49
Dicharge teaching for H. Mole?
Follow up care for non-malignant GTD: - Weekly hCG levels iniitally to ensure that any remaining tissue does not turn malignant - hCG levels monthly for one year - Chemo prophylactic or as treatment - Encourage client to prevent pregnancy for one year
50
Official name of H. Mole?
Gestational trophoblastic disease
51
What is a Fertilized ovum implanted outside the uterine cavity?
Ectopic pregnancy?
52
What is the most common site of ectopic pregnancy?
Fallopian tube
53
Predisposing factors of ectopic pregnancy?
(main is STI) - History of STD or PID - Previous tubal pregnancy - Failed tubal ligation - IUD (scarring) - Multiple induced abortions - Maternal age > 35 - Assisted reproductive techniques
54
Why may STI be a precursor to Ectopic pregnancy?
because that causes scarring→ lots of scar tissue causes the egg to not be able to travel all the way through to the uterus so it implants somewhere else
55
Main STI to worry about with Ectopic pregnancy?
Gonorrhea
56
Signs/Symptoms of Ectopic Pregnancy?
Positive pregnancy test Vaginal spotting or severe bleeding Sharp abdominal pain, unilateral that GOES UP TO THE SHOULDER
57
What is this: Shoulder pain as a result of internal bleeding irritating the diaphragm and phrenic nerve
Ectopic pregnancy
58
How is ectopic pregnancy confirmed?
transvaginal ultrasound
59
What is DIC?
A pathologic form of clotting that is diffuse and consumes large amounts of clotting factors, causing widespread external bleeding, internal bleeding or both and clotting
60
Is DIC primary or secondary?
Secondary!! | Occurs b/c of something
61
What can trigger DIC?
- Abruptio placenta - Retained dead fetus (missed abortion) - AF embolus - Severe preeclampsia- - Gram- sepsis - HELLP syndrome
62
What is the main precursor to DIC?
Preeclampsia
63
What is the management of DIC?
Treat underlying problem -monitor for S/S of shock
64
How can the underlying problem of DIC be treated?
- If problem is retained dead fetus→ remove the dead fetus - If problem is preeclampsia→ treat preeclampsia - If problem is abrupted placenta→ remove abrupted placenta
65
What can be a consequence of DIC?
Renal failure monitor output
66
What is a D&C?
Dilation and curettage
67
What urinary output may indicate renal failure?
68
Symptoms of shock?
- Rapid thready pulse (tachycardia)--first thing you see - Pallor - Change in LOC - Hypotension (last thing)
69
Management for hypovolemic shock or hemorrhagic shock??
- IV fluids - T&C for blood products - Monitor VS & output - Measure blood loss
70
How can blood loss be measured?
Weight the pad! | 1g=1mL
71
Who is at more risk of developing placenta previa?
-Multiple gestation -Closely spaced pregnancies -Maternal age > 35 High parity -African or asian ethnicity -Previous placenta previa -Previous c/s or suction
72
What should NOT be done with a client with a hx of placenta previa?
- no vag exams | - no internal monitors on baby
73
What is placenta previa?
Placenta is planted in the lower uterine segment such that it completely or partially covers the cervix or is close enough to the cervix to cause bleeding when the cervix dilates or the lower uterine segment effaces
74
Symptoms of placenta previa?
PAINLESS bright red bleeding after 20 weeks
75
Management of placenta previa?
- observation and bedrest - NO VAG EXAMS - C section
76
Symptoms of Placental abruption
PAINFUL abdominal pain with or without bleeding, uterine tenderness, confirmed after delivery
77
What is placental abruption?
Premature separation of the placenta; the detachment of part or all of a normally implanted placenta from the uterus before the birth of the infant
78
P. previa or abruption? bleeding ALWAYS visible and bright red
P. Previa
79
P. previa or abruption? Bleeding may not always be present, if so it is dark red
P. Abruption
80
P. previa or abruption? No pain
P. Previa
81
P. previa or abruption? constant abdominal pain/tenderness
P. Abruption
82
P. previa or abruption? Continuous UC with minimal or no relaxation period
P. Abruption
83
P. previa or abruption? NOt in labor
P. Previa
84
P. previa or abruption? | fetal distress present late dcels
P. Abruption
85
What kind of dcels may be present with placental abruption?
LATE decels
86
P. previa or abruption? normal FHR unles HEAVY blood loss
P. Previa
87
P. previa or abruption? No relationship with the fetal presentation or station
P. Abruption
88
P. previa or abruption? fetal MALPRESENTATION is common; engagement absent
P. Previa
89
What presentation is common with Placenta previa?
breech or transverse lie engagement absent
90
P. previa or abruption? Fundal height is GREATER than expected for gestational age?
P. Previa
91
P. previa or abruption? Fundal heigh needs to be measured over time; increase height may be concealed bleeding
P. Abruption

Maternal Newborn-MJ (29 decks)

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