week 3 Flashcards
what is the definition of a high-risk pregnancy?
The life or health of the mother or newborn is jeopardized by a disorder or medical factors
Age considerations: Adolescent Pregnancy
Risk
● Adolescent individuals (ages 10 to 19 years) are at increased risk for eclampsia,
puerperal endometritis, and systemic infections
● Mortality
● Perinatal complications are the leading cause of death for 15- to 19-year-old girls
globally (WHO, 2016).
● Early pregnancy or marriage causes an estimated 5% to 33% of girls (aged 15 to
24 years) to drop out of school (World Bank, 2017).
Age Pregnancy > 35 years risks
Increased risk of:
- Maternal death (even higher over 40)
- Miscarriage
- Stillbirth
- Preterm
- Low birth weight
- Perinatal mortality
- Down syndrome
Despite higher risk, overall risks are still low for women who are healthy, and free of
pre-existing disease
* Risk higher for women with pre-existing medical conditions
abuse during pregnancy increases the risk for?
placental abruption, preterm birth, low-birth-weight infants, and infections from nonconsensual sex
-prematurity, NICU, infant/maternal mortality
-maternal depression
-substance abuse
IPV Screening Tools
what is the RADAR Tool ?
Remember to ask routinely about IPV as a matter of routine patient care
Ask directly about violence with such questions as “at any time, has a partner hit, kicked
or otherwise hurt or frightened you?” interview your patient in private at all times
Document findings related to suspected intimate partner violence in the patient’s chart
Assess your patient’s safety. Is it safe to return home? Find out if any weapons are kept
in the house, if the children are in danger, and if the violence is escalating
Review options with your patient. Know about the types of referral resources in your
community (e.g., shelters, support groups , legal advocate)
types of pregnancy loses include
A: Threatened
B: Inevitable
C: Incomplete
D: Complete
E: Missed
-septic
-recurrent
threatened abortion
bleeding: slight, spotting
uterine cramping: mild
cx: close
-no explosion of products
-bed rest is ordered (not rlly info evidence based to say this works)
-repetitive transvaginal ultrasounds
and assessment of the human chorionic
gonadotropin and progesterone levels may be
done to determine if the fetus is still alive and in
the uterus
inevitable abortion
bleeding: moderate
uterine cramping: mild-severe
cx: open
-no explosion of products
-bed rest if no fever, pain, or bleeding is present
-if the membranes rupture, bleeding, and pain is present, the uterus is immediately emptied usually by dilation and curettage
incomplete abortion
bleeding is heavy and profuse
-uterine cramping is severe
-CX is open
-expulsion of products
-may require additional cervical dilation before curettage
-suction curettage may be performed
complete abortion
bleeding: slight
uterine cramping: mild
CX: close
expulsion of products
no further intervention may be needed if uterine
contractions are adequate to prevent hemorrhage
and no infection is present
-suction curettage may be performed to ensure no retained fetal or maternal tissue
missed abortions
bleeding: none, spotting
-uterine cramping none
CX: closed
no explosion of products
-If spontaneous evacuation of the uterus does not
occur within 1 month, pregnancy is terminated by
method appropriate to gestational age.
-monitor blood clotting until the uterus is empty
DIC (disseminated intravascular coagulation) and in coagulability of blood with uncontrolled hemorrhage may develop if fetal death products are still retained after the 12th weeks for longer than 5 weeks
sceptic abortion
bleeding: usually varies
uterine cramping: varies
CX: open usually
expulsion of products
Immediate termination of pregnancy by method
appropriate to duration of pregnancy. Cervical
culture and sensitivity studies done, and broad-
spectrum antibiotic therapy (e.g., ampicillin)
started.
Treatment for septic shock initiated if necessary
recurrent abortion
bleeding: varies
uterine cramping: varies
CX: open
expulsion of products
Prophylactic cerclage may be performed if
premature cervical dilation is the cause.
Tests of value include parental cytogenetic
analysis and lupus anticoagulant and
anticardiolipin antibody assays on the patient.
teaching after pregnancy loss
-Advise the patient to report any heavy, profuse, or bright red bleeding
● A scant, dark discharge may persist for 1 to 2 weeks.
● Avoid putting anything into the vagina for 2 weeks or until bleeding has stopped
(e.g., no tampons, no vaginal intercourse).
● Take antibiotics as prescribed.
● Report to health care provider elevated temperature or a foul-smelling discharge
● Advise the patient to eat foods high in iron and protein
● Acknowledge that the patient loss.
● Speak with family and seek support from friends.
● Refer the patient to support groups, clergy, or professional counseling, as
needed.
● Postponed for at least 2 months to allow their body to recover
Cervical insufficiency
Passive and painless dilation of the cervix without
contractions or labor
-can be d/y structural weakness or cervical trauma
treatment for Cervical insufficiency
- Cervical cerclage (placed at 12 to 14 weeks of gestation).
- Importance of continuous close observation and
supervision for the rest of the pregnancy. - Report signs of preterm labour, rupture of membranes,
and infection.
when should the pt visit the hospital immediately from a cervical cerclage?
Visit the hospital immediately: presence of regular strong contractions, preterm PROM, severe perineal
pressure, and an urge to push
what is the treatment of choice for cervical weakness?
Cervical cerclage
what are the indications for cerclage placement?
- poor obstetrical history (three or more previous early preterm births or second-trimester losses), a short (less than 25
mm) cervical length identified on transvaginal ultrasound, and an open cervix found on digital or speculum examination
Ectopic Pregnancy
Fertilized ovum implanted outside uterine cavity
* 95% occur in uterine (fallopian) tube
* Most located on ampullar
-basically pregnancy that occurs outside the uterus
what are the clinical manifestations of ectopic pregnancy?
Abdominal pain
* Missed menstrual period
* Abnormal vaginal bleeding (spotting)
* er rupture has occurred,
* referred shoulder pain present (diaphragmatic
irritation)***
* one-sided, or deep lower-quadrant acute abdominal pain
how to diagnose an Ectopic Pregnancy?
Ultrasonography, Serum progesterone, and β-hCG levels
what is the medical management of ectopic pregnancy?
Methotrexate: antimetabolite and folic acid antagonist that destroys rapidly dividing cells
* Surgical management (Salpingostomy or Salpingectomy)
* general pre and post)
what teaching to give with Methotrexate?
Advise the patient to do the following:
* Avoid intake of foods and vitamins
containing folic acid.
* Avoideating“gas-forming”foods.
* Avoidsunexposure.
* Avoid sexual intercourse until the β-hCG
level is undetectable.
* Keep all scheduled follow-up
appointments.
* Contact health care provider immediately
if experience severe abdominal pain, which may be a sign of impending or actual tubal rupture.
what is Hydatidiform Mole? (molar pregnancy)
A gestational trophoblastic disease (GTD) * Abnormal fertilization without a
viable fetus
-direct cause is unknown
there are two different kinds of Hydatidiform Mole. what are they?
-Complete mole: results from fertilization of egg with lost or inactivated nucleus
* Partial mole: result of two sperm fertilizing a normal ovum
hydratidiform mole clinical manifestations?
- Vaginal bleeding
- Significantly larger uterus
medical management of hydratidiform mole
Most pass spontaneously.
* Suction curettage is safe, rapid, and effective, if necessary.
* Induction of labour with oxytocin or prostaglandins is not recommended.
* Administration of Rho(D) immune globulin, if indicated
Late Pregnancy Bleeding: Placenta Previa
Placenta previa: the placenta is implanted in the lower uterine segment such that
it partially or completely covers the cervix to cause bleeding when the cervix
dilates or the lower uterine segment effaces
Complete placenta previa
internal cervical os totally
Marginal placenta previa
the edge of the placenta to the internal
cervical os
Low-lying placenta
relation between the placenta to the internal
cervical os has not been determined
clinical manifestations of placenta previa
-Bright red bleeding during 2nd or 3rd trimester
* Pain absent
* Uterine is normal
* Normal fetal HR
-fundal height is often greater than expected
what is the major maternal complicated associated with placenta previa?
-the major maternal complication associated with placenta previa is hemorrhage
-Bleeding,
-Preterm birth and
-IUGR
-Another serious complication is development of an abnormal placental
attachment
placenta previa is diagnosed through?
- transabdominal or vaginal ultrasound
what are the risk factors of placenta previa ?
-Smoking
● Multiparity
● Cocaine use
● Erythroblastosis
● Nonwhite ethnicity
● Infertility treatment
● Recurrent abortions
● Prior uterine surgery
● Advancing age (>35 years)
● Low SES
● Short interpregnancy interval
● Multiple gestation (larger surface area of the placenta)
expectant management of placenta previa
➢ Patient is less than 36 weeks of gestation
➢ Not in labor and the bleeding is minimal or has stopped,
➢ may remain in the hospital or be at home if bleeding is stable.
➢ No vaginal or rectal examinations are performed
➢ Ultrasound examinations may be done every 2 weeks
● Bleeding is assessed by checking the amount of bleeding on perineal pads
(weighing pad: 1 gram = 1 ml of blood)
-potential emergency b/c massive blood loss
-Antepartum steroids (betamethasone) may be ordered to promote fetal lung
maturity if the patient is at less than 34 weeks of gestation
placenta previa active management:
Cesarean birth (fetus is mature, excessive bleeding develops, or active labour
begins)
placenta abruption
Detachment of part or all of the placenta from its implementation site
Grades: 1 (mild), 2 (moderate), 3 (severe)
1. partial separation- concealed hemorrhage
2. partial separation - apparent hemorrhage
3. complete separation- concealed hemorrhage
placental abruption clinical presentation
Clinical presentation: vaginal bleeding, abdominal pain, uterine tenderness,
and contractions
Major cause antepartum hemorrhage
