Test 4: Intrapartum complications/Induction/Antepartum Dx/Monitor Strips/Age/Abuse Flashcards
1
Q
What are the twin demons and what do they have to do with the 200% increase in blood transfusions in the last 10 years (during childbirth)?
A
Denial and Delay of interventions of hemorrhages.
Denial because it’s not very obvious a lot of the time… just a steady flow, nothing overtly screaming “bleeding-out.”
Delay due to the denial. Delay of doing something about it… 1/2 of the 2-3 women who die every day are considered preventable.
2
Q
What is the U.S. ranked in terms of maternal morbidity?
A
47th
3
Q
What sort of things can we do to prevent loss of life due to hemorrhage?
A
- Recognizing the problem EARLY
- Mobilizing the team and having good communication.
- Having a sense of empowerment… knowing what’s right and advocating for it… understanding your role in that.
- Assessing acurate VS and quantifying the estimated blood loss (EBL).
- Being PREPARED for an Emergency! Having hemorrhage drills and having a set protocol in place.
4
Q
During the first trimester what are the most common causes of hemorrhage?
A
- SAB
- Ectopic
- Gestational Trophoblastic Disease
- Cervical Insufficiency
80% of fetal demise occur in the 1st trimester and are usually fetal-related (genetic/ faulty implantation/ endocrine imbalance).
5
Q
What are the most common causes of hemorrhage during the 2nd and 3rd trimesters?
A
- Placenta Previa
- Placenta Abruption
Fetal demise after 20 weeks is usually maternally-related (uterine anomalies/ Infections/ Maternal disease [CVD, DM]/ Substance abuse [esp. cocaine])
25-30% of all pregnancies have some bleeding.
6
Q
What classification of SAB is presented as bleeding, cramping/low back pain with a closed cervix?
A
Threatened.
ANY possible/actual SAB we need to asses the patient and support them where they are at… grieving, listening.
We can help them know what to expect emotionally or physically… they will react differently. PVH refers each and every fetal loss patient to bereavement support resources.
7
Q
What classification of SAB is presented as increased bleeding, cramping with a dilating cervix?
A
Imminent.
8
Q
What classification of SAB is presented as having experienced a SAB but not all of the tissue was expelled?
A
Incomplete.
Worry about hemorrhage and infection.
9
Q
What increases a woman’s chance of SAB and what classification do they fall under?
A
Habitual.
Greater than or equal to 3 SAB’s… after your 2nd your risk increases of more.
10
Q
What does HCG stand for?
A
Human Chorionic Gomadotrophin
Hormone produced early in pregnancy by the placenta; detection in the urine and serum is Dx.
If too low could be ectopic, if too high could be gestational trophoblastic disease or in regards to SAB, if levels have not continued to drop may have retained tissue.
11
Q
What do we use to visual the fetus if risk of SAB?
What are some medications that are commonly used with this occurrence?
A
Cytotec. This is used to reduce the risk of ulcers from NSAID use. It is contraindicated in pregnancy bc it causes preterm labor contractions by irritating the cervix. Since this is what we need after/during an SAB, it is used to insure all tissue has been expelled.
Antibiotic.
Rhogam. Depending on the maternal blood type.
12
Q
Besides SAB management with medications, what other method may be used to prevent hemorrhage and infection?
A
D and C - Dilation and Curettage
Removing anything that is retained in the uterus.
This procedure is also a possible risk for hemorrhage in itself so we need to WATCH their I’s and O’s for possible hemorrhage clues.
Must be on pelvic rest for ? depends on provider, at least a few days.
13
Q
What is the medication Methotrexate used for?
What is Terbutaline used for?
A
Dissolving the small, still growing, embryo of an ectopic implantation.
It’s a cytotoxic drug.
Option for medical management depending on mom’s risk factors and stage at Dx… and risk of fallopian tube rupture.
Terbutaline is a smooth muscle relaxer (β2-adrenergic agonist) that is often used as a tocolytic.
14
Q
Some causes of ectopic pregnancy:
A
- Scarring due to infection or surgeries or endometriosis or pelvic inflammatory disease
- Hormonal imbalances that may cause a delay of arrival of zygote to the uterus.
- Congenital malformations
15
Q
Signs and symptoms of ectopic pregnancy:
A
Usually becomes symptomatic with pain around the 6- 8 week gestation.
Spotting to heavy bleeding
Cramping to SHARP one-sided abdominal pain
Fever
Decreased H and H due to hemorrhage.
Shock symptoms also related to blood loss.
16
Q
What can be used to Dx an ectopic pregnancy?
What is a medical option involving a cytotoxic drug?
A
Ultrasound
hCG levels: if it hasn’t doubled in 72 hours then not enough room for the embryo to grow.
Can use methotrexate to dissolve the embryo.
17
Q
What are some nursing considerations regarding an ectopic pregnancy?
A
- Volume replacement, I and O’s to keep track of possible hemorrhage should the fallopian tube rupture.
- Emotional support. Loss of life, possible loss of fertility or at least decreased fertility.
- Life-threatening to the mom.
18
Q
What is the disease that is a neoplastic disorder that originates in the placenta?
A
Gestational Trophoblastic Disease.
- Gestational tissue is present but pregnancy is non-viable.
- Begins with conception: chorionic villi overgrow… leading to elevated levels of hCG.
19
Q
This disease is often diagnosed around 12 weeks of gestation and occurs in about 1/1500 pregancies:
A
Gestational Trophoblastic Disease.
Happens most in teens and peri-menopausal women.
20
Q
What is the cause of GT Disease?
How is it diagnosed?
A
Unknown… mabye:
genetic component
protein deficiency
advanced maternal age
Dx:
Ultrasound/FHTs
Spontaneous abortion of mole (us around 20 wks)
21
Q
What are the two types of gestational trophoblastic disease?
A
- Partial: fetal tissue is often present but non-viable.
2. Complete: no fetal tissue, no genetic material, all chromosomes are paternal?
22
Q
What are the signs and symptoms of gestational trophoblastic disease?
A
- Normal pregnancy symptoms initially
- Dark brown spotting/bleeding
- Elevated levels of hCG = HYPERemesis and higher fundal height
- Signs and symptoms of preeclampsia prior to 20 wks
- No fetal heart tones
23
Q
Due to the risk for hemorrhage, what are risks and treatments for GTD?
A
- Can give oxytocin to prevent hemorrhage
- Can perform D and C
- Risk for hysterectomy if the chorionic villi grew into the uterus. Cannot separate these tissues… just continues to bleed.
24
Q
What sort of emotional support may be needed regarding the outcome of GTD?
A
Follow up should consist of:
- Monitoring hCG levels
- Monitoring for DIC
- They should avoid pregnancy for at least 6 mos
- Close follow-up at 12 mos
- Possible chemotherapy?
Emotional support:
Scary Dx, increased risk for progression to choriocarcinoma.
Educate about future family planning.
25
This condition is presented with a dilating cervix in the absence of uterine contractions:
What are some causes of this?
Cervical insufficiency.
Caused by a structural defect or previous injury to cervix maybe from cancer or HPV... cone biopsy, colposcopy, LEEP (used as part of the diagnosis and treatment for abnormal or cancerous conditions).
26
At what gestation is a woman most at risk for cervical insufficiency?
Weeks 16-24.
Signs and symptoms:
* Painless dilation
* Effacement
* Spotting
* Cramping
27
How do we manage cervical insufficiency?
Decrease activity (including sex and maybe on bed-rest)
Cerclage procedure: (stitching the cervix closed)
Follow-up: frequent assessments to watch for signs of cervical progression, infection, and labor.
Induction/ expectant management: This is due to the risk of rapid labor/delivery.
28
What are some complications from an abnormal location of placental implantation?
Placenta Previa may have the following complications:
- Abruption
- Hemorrhage
- Accreta - placenta grows too deep in to the uterine wall... won't detach after birth. Due to its location, not as vascular so has to "tap in" to the deeper blood supply.
Classification depends on amount of coverage of cervical os (The internal os is the opening into the uterus from the cervix).
29
What are the risk factors involved in placenta previa?
1. Previous C-sec
2. Multiparity: won't attach to previously used sites, or scars, causing it to move lower for a nutrient available spot.
3. Smoking
4. Infertility treatment
5. AMA: advanced maternal age
30
When is placenta previa normally recognized?
Usu in the 2nd or 3rd trimester.
Occurs in 1/200 pregnancies.
31
Marginal, Partial, and Total are all classifications of what?
Degrees of the placenta previa.
Marginal: Placenta is implanted in the lower uterus but its lower border is greater than 3 cm from the internal cervical os.
Partial: Lower border of placenta is within 3 cm of internal cervical os but does not fully cover it.
Total: Placenta completely covers the internal cervical os.
32
Signs and Symptoms and how to Dx placenta previa:
- thin, bright red vaginal bleeding
- painless
- with or without contractions
- soft, non-tender abdomen
- fetal heart tones within normal limits
Dx:
Clinical exam, S and S
Ultra sound
33
Management of placenta previa include:
* Bedrest
* NPO: until out of danger of c-sec; stable
* Fetal monitoring
* NO sterile vag exams: may disrupt placenta
* Tocolytics: Tocolytics are medications used to suppress premature labor such as Terbutaline (controversial bc it's a smooth muscle relaxant = increase the bleeding?)
* C-section
* Emotional support: scary, education on when to call provider, feel out of control...
* Hemorrhage risk: even after delivery they are still at higher risk for bleeding.
34
This occurs at greater than 20 weeks gestation, has a maternal mortality of 6% and a neonatal mortality at 33%:
What are some causes of this condition?
Placental Abruption. Fetal loss usually occurs before arrival at the hospital.
CAUSES:
- Maternal HTN
- Maternal trauma: Domestic violence, falls, car accident
- Smoking/ Alcohol/ Drug use
- Preeclampsia
- DM (DM and preeclampsia both have endothelial damange occuring = increased risk of placental disruption.
- Short umbilical cord: increased risk of it pulling away
- Decompression of uterus: rupture of membranes, delivery of first twin = the change of pressure.
- AMA
35
What are the three classifications of placental abruption based on?
Classifications are based on the amount of separation and whether bleeding is concealed or not...
Marginal, Partial, or Complete... external bleeding is visible, concealed is not.
We Dx concealed bleeding indirectly with:
* Assessment and ultrasound
* Signs of fetal distress
* Contractions have low amplitude and high frequency
* Uterus does not rest
36
Signs and Symptoms of Placental Abruption:
* With external bleeding: Dark red, thick
* UC pattern: uterine contraction pattern of strong, continuous, no resting tone.
* Rigid, tender abdomen
* Shock symptoms: d/t hypovolemia
* Fetal distress
37
What are 7 complications related to Placental Abruption?
1. Hemorrhage
2. Hypovolemia
3. Hysterectomy
4. Renal failure
5. DIC
6. Fetal death
7. Risk of recurrence: in same pregnancy as well as subsequent pregnancies.
38
How is Placental Abruption managed?
- Obstetric emergency: call c-sec team to the unit STAT including all OR staff (surgeon, anesthesiologist).
- Side-lying position: to optimize perfusion
- O2: 10 L via non-rebreather face mask to hyper-oxygenate.
- Volume replacement: trying to get them hemodynamically stable whether by fluids or by blood. Need to type and cross pt to match for avail. blood products.
- Fetal monitoring: continuous
- C section, unless vaginal delivery is imminent.
- Emotional support: Scary. Try to be present for the patient and their family. Try to explain what's happening and what WILL happen. Be aware of emotional needs after the patient is stable.
39
What is the gestation range defined by "preterm"?
20-37 weeks
March of Dimes goal is to raise awareness and help decrease prematurity.
40
What risk factors are there regarding PTL?
PreTerm Labor risk factors:
- Idiopathic 70-80% of cases. =(
- *Previous PT delivery
1 previous = 35% risk
2 previous = 70% risk
- *Incompetent cervix (usually due to injury of cervix)
- Uterine anomalies: odd shapes or septums in the uterus.
- Infection: Cervical, Urinary, STIs
- Multiple gestation: the greater stretch, the more likely body will go in to labor... run out of room.
- Hydramnios: again, more stretch/strain on body
- Placenta previa/ abruption
- Tobacco/ Substance abuse
- Age/ Ethnicity: less than 18 or greater than 35/ African Americans have the highest rate.
41
What are some common signs and symptoms of preterm labor?
These are all normal in a healthy pregnancy so we need to teach the woman to watch for changes in her norm and to trust in her instinct.
* UCs
* Menstrual-like cramps
* Low backache
* Pelvic pressure
* Intestinal cramps/ diarrhea
* Vaginal discharge changes
* "Something is not right"
42
The CARES program is from the March of Dimes... what does CARES stand for and what are its goals?
Community, Advocacy, Research, Education, Support
- Expanding access to prenatal care
- Risk reduction programs
- Speaking out to legislation to support research, funding, and newborn screenings.
- Donated 60 million to research (found that microbiomes in preterm mother's are different than those that aren't)
- Education
- Support: those who are affected
43
What are some ways we can diagnose PTL?
1. Fetal fibronectin (fFN): is a protein (that's believed to help keep the amniotic sac "glued" to the lining of the uterus) normally found in fetal tissue. If found in vaginal secretion near cervix during weeks 22-34, strongly indicates will deliver in next 2 weeks. Absent = won't deliver. Taken by speculum and swab, ran in lab. After 34 weeks, fFN is normally found so not a reliable indicator after week 34.
2. Cervical length: normal 3-4 cm, shortening=effacement
3. Wet prep: Checks for any vaginal infections. Swab.
4. UA: Possible UTI
5. STI screening
44
Treatment for Preterm Labor:
- Immediate bedrest/ pelvic rest
- Decrease stress
- Hydration
- Empty bladder
- Medications
Main thing is to identify patients at risk and responding as early as possible; treating any underlying causes such as infection.
45
What is Nifedipine and what is it used for?
Nifedipine (Procardia) is a Ca channel blocker (PO). Usual dose is 20 mg/ 6 hrs.
- Mechanism of action: Decreases muscle (uterine) contraction.
- Side effects:
* Hypotension
* HA
* Tachycardia
* * Flushing
- Combination therapy:
* Can be given with Terbutaline but NOT with magnesium sulfate because they both block calcium.
46
What is Terbutaline and what is it used for?
Mechanism of action?
Adverse effects?
Terbutaline is a tocolytic, not the first line therapy for PTL but it's used a lot for short-term use, may delay delivery 2-7 days but doesn't prevent preterm birth.
-- Mechanism of action: Beta adrenergic agonist... relaxes smooth muscle.
-- Adverse effects:
* Arrhythmia
* Hypotension
* Hypokalemia
* Hyperglycemia = can lead to ketoacidosis
** Pulmonary edema is a big one to watch for.
If maternal HR is greater than 100 then it is contraindicated.
- - Side effects: epinephrine-type effects...
* Tachycardia
* Flushing
* N/V
* Palpitations
* Agitation
* Crosses placenta = fetal tachycardia
47
Why can't you give Nifedipine with Magnesium sulfate?
They both block Calcium.
48
What is a tocolytic?
Tocolytics (also called anti-contraction medications or labor repressants) are medications used to suppress premature labor (from the Greek tokos, childbirth, and lytic, capable of dissolving). They are given when delivery would result in premature birth.
49
What is the KEY health risk complication with Terbutaline?
Pulmonary edema
50
Nursing implications regarding Terbutaline:
Nursing implications:
* Short term use (less than 48 hours)
* Recommended use is to postpone PT birth (can't stop it from happening)
* Watch VS very closely
* Respiratory assessment = watching for pulmonary edema
* Fetal monitoring for tachycardia
* Cardiac monitoring for arrhythmia
* Anticipatory guidance and emotional support
51
Which glucocorticoid (IM) is used to increase the surfactant production in the fetus?
What is the dosing?
Betamethasone
Dosing:
2 doses 24 hours apart.
New research: now giving up to 37th week to help late-pre-term babies.
52
The smooth muscle tissue of the uterus is called what?
Myometrium.
53
Which medication has a direct effect on the myometrium and is a calcium antagonist?
What are the common side effects?
Magnesium sulfate. Given IV. Calcium is needed to produce prostaglandins to initiate labor.
Side effects:
DECREASED BP, RR, DTRs, and UO
54
Under what circumstances would we not want to delay preterm delivery?
- Fetal Infection
- Chronic fetal distress
- IUGR
- Intrauterine death
- Pulmonary maturity of newborn has been objectively assessed.
- Maternal distress (pre-eclampsia, DM, CVD)
- Placental abruption
55
What term is used to describe "dysfunctional labor?"
Dystocia. "Stuck"
= prolonged labor
56
What are the 5 P's regarding dystocia etiology?
1. Powers: the UC's
2. Passageway: birthcanal/ pelvis
3. Passenger: fetus and placenta: size position, health status, and gestation all play a part.
4. Psyche: Maternal stress: her child-birth knowledge base, her support network, her trust in the healthcare providers... all play a part.
5. Position: Maternal related... not moving, on back, etc.
57
If the UC's are occuring every 2-5 minutes and lasting between 1-2 minutes, what are these types of contractions considered?
Adequate.
Strength determined through palpating... palpating the tip of your nose is similar to a mild contraction, chin is like a moderate and your forehead is like a strong contraction.
58
What type of contractions have an etiology of a high frequency and a low amplitude?
This is HYPERtonic labor contractions.
Continue to be painful
1st stage, early phase
Decreased placental perfusion is an eventual risk.
Don't mention that these aren't strong contractions... say "You're having great contractions, but the cervix isn't changing yet."
59
How do we treat HYPOtonic labor?
- IV fluids
- I and O, straight cath PRN
- Augmentation, inductive medication such as Petocin
- Assess P's, how they may be affecting this labor
60
What type of contractions have an etiology of weak, irregular, ineffective UC's?
HYPOtonic labor.
- Cause: over distended uterus? Over distended bowel, bladder?
- Secondary inertia: may have been progressing and cervical change... then "stall out."
- Excessive analgesia can be a cause, also early epidural. Often a temporary problem.
Often occurs in the active phase of the first stage.
61
How do we treat HYPERtonic labor?
- SVE: change in cervix?
- Pain management: best rest, sedation, longer acting opioids (morphine), antiemetics?
- DC medications: giving the uterus a rest by stopping the oxytocin. Otherwise may end up with fetal distress.
- Tocolytics: terbutaline.
- Assess P's
62
Measuring the pelvis is a subjective assessment measuring the bi-parietal diameter.
Biggest area on baby's head to the narrowest of pelvis... or baby's predicted weight which is less accurate the further you are in gestation.
An x-ray or pelvimetry is most accurate... can maybe determine disproportion (CPD) if dilated and baby is still at a high station. Also associated with women of short stature.
63
What are some other causes of passageway problems besides cephalo-pelvic disproportion?
Placenta previa: the placenta may be blocking the way.
Bowel/ Bladder distension
64
Treatment for problems with passageway:
Pelvimetry: the assessment of the female pelvis in relation to the birth of a baby: adequate pelvic measurements.
Trial of labor: with careful monitoring
Delivery route: poor prognosis of vaginal delivery with platypelloid or android pelvises.
Positioning: squatting/ side-lying/ sitting/ hands and knees, hydro-therapy and sterile water blocks. Acupuncture, moxubustion, acupressure, chiropractic, herbal and water therapies. Otherwise c-sec.
Empty Bowel/ Bladder often
65
What are the two most suitable types of pelvises for successful deliveries?
Gynaecoid (best) and anthropoid.
66
Causes of complications related to "passenger" during delivery:
* Multi-fetal pregnancy
* Mal-presentation (face, brow, breech): increased risk of prolonged labor, prolapsed cord, perineum/fetal trauma, perinatal mortality.
* Occiput posterior is the most common passenger etiology (we want occiput anterior), increases labor time and increases pain (sacral nerve pressure - back pain). If you have a hard time finding fetal heart tones, may be indicative that the fetus's back is to the mother's back.
* Macrosomia: Greater than 4,000 grams
* Shoulder dystocia: obstruction of fetal descent by the axis of the fetal shoulders after fetal head has been delivered. (happens in 2%)
* Hydramnios... affects the progression.
* Chorioamnionitis: intra-amniotic infection is an inflammation of the fetal membranes due to a bacterial infection... affecting the progression.
67
Complications of shoulder dystocia:
Injury to brachial plexus: a network of nerves that originate in the neck region and branch off to form most of the other nerves that control movement and sensation in the upper limbs.
Humoral-Clavicular fractures.
68
What is the McRoberts maneuver?
Where the maternal knees are brought up tightly toward her shoulders to help open up her pelvis and applying suprapubic pressure. You have 9 minutes to deliver baby's body before neuro damage.
69
What are some causes of dystocia?
- Maternal exhaustion
- AMA
- Nulliparity
- Overweight
- Caffeine
- Hormone regulation: stress hormones are counterproductive.
- Support... lack of support increases the stress hormones. When they have support it decreases risk of assistance, proven.
70
What do catecholamines, cortisol, epinephrine, and beta-endorphines do to labor?
They slow the progress because these stress hormones act on the smooth muscle of the uterus and cause a decrease in contractility. They also decrease placental perfusion!!!
So, being stressed out during labor is counterproductive, non-therapeutic and prolongs labor.
71
What things can decrease placental perfusion?
Stress hormones.
Hyperventilation.
Tensing during contractions.
72
Treatment for maternal psyche:
* Continuous labor support: involve the partner, be available as the nurse, teach breathing techniques to optimize perfusion
* Control the environment: being calm and supportive, lighting, music, minimal interruption, ball, heat/cold, hydrotherapy, distraction
* Pain management
* Position changes: incorporated into all of the other etiologies.
* Education: prior to labor, as able during, and empowering the woman to make choices during.
73
What is the number one cause of fetal tachycardia (HR greater than 160)?
* Maternal fever
Others:
* Dehydration
* Drugs
* Early fetal hypoxia
74
What do irregular fluctuations in the baseline FHR (bpm) indicate?
They indicate an intact sympathetic and parasympathetic nervous system... implies adequate fetal oxygenation and correlated with absence of metabolic acidosis.
Measured peak to trough.
75
What are the bpm for a minimal variability, moderate, and marked variability?
Minimum variability: 1-5 bpm
(May indicate maternal drug use, hypoxia, decreased fetal reserves)
Moderate variability: 6-25 bpm **NORMAL
Marked variability: > 25 bpm
- -Unable to determine baseline because so much variability.
- - May indicate distress, may be okay... maybe maternal hypotension, placental abruption, uterine tachysystole (a condition of excessively frequent uterine contractions during pregnancy).
76
Fetal monitor strips: This is an abrupt increase in baseline FHR greater than or equal to 15 bmp for greater than or equal to 15 seconds but under 2 minutes:
Acceleration.
Reassuring sign - occurs with fetal movement, and UCs.
Absence of accelerations may indicate distress, may be okay -- continue to monitor.
77
Fetal monitor strips: This indicates fetal head compression and is seen as a uniform, smooth dip in baseline FHR is greater than 30 seconds to nadir; returns to baseline before or with UC:
Early Deceleration.
Mirrors UC's.
SVE
Pushing
FSE application (fetal scalp electrode)
ROM
Think molding and descent.
78
This is a sudden, erratic drop in FHR greater than or equal to 15 bpm lasting greater than or equal to 15 seconds but less than 2 minutes; less than 30 seconds to nadir:
Variable Deceleration.
No relation to UC's
Indicates fetal cord compression (which is like them holding their breath).
Tx:
Maternal position change
O2
Amnio-infusion (isotonic fluid is instilled into the amniotic cavity: decreases pressure on cord)
79
What are some possible reasons for fetal bradycardia?
Congenital heart defects
Maternal medication
Prolonged hypoxia
80
Fetal Monitor Strips: This is a uniform, smooth dip in baseline FHR; greater than or equal to 30 seconds to nadir and returns to baseline AFTER the contraction has ended:
Late Deceleration.
Indicates utero-placental insufficiency - ominous sign that baby is not tolerating contractions.
Tx:
Intra-uterine resuscitation and notify provider, prob. going to have c-sec if no improvement.
81
Fetal Monitor Strips: This is a decrease in baseline FHR greater than or equal to 15 bpm lasting 2 minutes or more but less than 10 minutes (bc then that would be a change in baseline):
Prolonged Deceleration.
Indicates: Many variables
Tx:
Intra-uterine resuscitation and notify provider
82
What term do we use when there is more than 5 contractions in a 10 minute period of time OR a single UC lasting greater than 2 minutes?
Tachysystole.
83
What are under 20 year old's at higher risk for during pregnancy?
-- Preeclampsia
-- Cephalopelvic Disproportion/ Dystocia
-- Preterm birth
-- Low birth weigh infants
-- Anemia (d/t not eating well)
Under 16's are at even greater risk of the above.
84
38 + year old's are twice as likely to develop ? during their pregnancy?
High BP
Gestational DM
85
What are the ratios of Down's Syndrome in 30, 40, and 45 year old's?
30 is 1 in 1000
40 is 1 in 100
45 is 1 in 30
86
What is thought to be the possible reason for 1st trimester SAB in AMAs?
Chromosomal abnormality.
87
What test is performed on AMA'd women to check for possible fetal abnormalities?
* Diagnostic amniocentesis
* Alpha fetoprotein (AFP)
* Chorionic villi sampling
88
This population age range is at greater risk of STDs, drug/ alcohol/ tobacco use, domestic violence, and account for 26% of all new HIV infections:
13 - 24 year olds.
Prenatal care is paramount and they are the least likely population to get it.
89
What is the first phase of the cycle of violence?
Escalation.
Increasing tension, anger, arguing
90
What comes after the escalation phase of the cycle of violence?
Explosion
Acute battering and abuse.
91
What is the third phase of the cycle of violence?
Honeymoon.
Calm stage, denial or remorse.
Try to justify it.
Sometimes it's a short phase, sometimes longer, sometimes no honeymoon phase. Explosion to explosion... Can occur in absence of anger.
92
What we need to watch out for to indicate possible abuse:
* Frequently missed appointments
* Frequent calls to office with vague complaints "I'm just not feeling well, I just want to make sure everything's all right..."
* Frequent physical symptoms with unknown cause (nausea, HA, back pain, insomnia, etc.)
* Withdrawn/ flat affect/ apathetic... may not seem interested in the pregnancy... don't ask any questions.
* Late entry to prenatal care: maybe hid the pregnancy, maybe partner doesn't allow...
Look at big picture and look for pattern.
93
```
What might the following be "clues" for?
History of:
GI problems/ anorexia
Fractures/ trauma injuries
Frequent accidents/ ER visits
Substance abuse
Suicide attempts
Refusal of hospital admittance
Miscarriages or "therapeutic" abortions
Depression
```
Possible abuse.
94
What factors are associated with greater risk for abuse in pregnancy?
- Adolescents, teens w/ teen partners
- Less educated
- Single
- Presence of co-existing medical problem or OB complication
- On public support (Medicaid)
- No race or ethnicity higher risk than another
95
What is the most common source of injury in women?
Domestic violence/ Intimate partner abuse
1 in 2 murders of women in CO were killed by their intimate partner.
About 1 in 4 women nationally are abused.
40% of abuse begins during pregnancy... also may occur up to 1 year postpartum.
96
Research on neonates of abused mothers have shown increased irritability, easily startles, lack of responsiveness, FTT, and developmental delays.
What are some signs that the father may give off during check ups?
- Hovering.
- Not letting her answer.
- Other odd/ extremely over-protective behavior.
97
You deserve better.
It's not your fault.
No one deserves to be hurt.
I'm concerned for you.
The most dangerous time for an abused woman is when she decides to leave.
98
If a patient tells you that she is being abused, are you required to report it?
NO. If she gives you permission, then you may, otherwise, as long as you are not treating any injury related to the abuse, you are not required.
If she IS showing signs of the abuse then you are required to report it at once to the police or sheriff of the county you are licensed in.
99
Which FHR deceleration indicates fetal head compression?
Early deceleration
100
Which FHR deceleration indicates fetal cord compression?
Variable deceleration
101
Which FHR deceleration indicates utero-placental insufficiency?
Late deceleration
102
The different categories on FHR monitoring documentation let you know an overview of how things are going... what are the 3 categories?
1. Category I: Normal (predictive of normal fetal acid-base status)
2. Category II: Indeterminate (Not predictive of abnormal fetal acid-base status: 80% of the time, patients are here)
3. Category II: Abnormal (Predictive of abnormal fetus acid-base status: prolonged deceleration, absent variability)
