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NM 706 Adv Midwifery Care-Perinatal & Neonatal > Module 2 Study Guide > Flashcards

Module 2 Study Guide Flashcards

1
Q

What differential diagnoses exist for abdominal pain in pregnancy?

A

Appendicitis
Cholecystitis
Cholelithiasis
Pancreatitis
Renal Stones
Placental Abruption
Pyelonephritis

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2
Q

What is appendicitis?

A

Acute inflammation of the appendix

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3
Q

What are the risk factors for appendicitis?

A

More likely to rupture in pregnancy, more common in the second trimester, major risk is bowel perforation, abscess formation and peritonitis.

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4
Q

What are the symptoms of appendicitis?

A

Sharp mid-abdominal pain that increases over time then becomes more localized to the RLQ. RLQ is most common but can also present as RUQ/Right Flank pain due to displacement from the uterus. Patient may also complain of nausea/vomiting and decreased appetitie. Pregnant women may have significant heartgurn, bowel irregularity, flatulence, malaise, urinary symptoms, and diarrhea. McBurneys point: may reveal tenderness but can be shifted in late pregnancy.

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5
Q

What diagnostic tests should be used to evaluate for appendicitis?

A

U/S or MRI
CBC with diff, CRP, U/A, LFTs (to r/o other etiologies)
Note: WBC may not be helpful in pregnancy due to elevation of WBC in pregnancy.

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6
Q

What labs and imaging offer a definitive diagnosis of appendicitis?

A

Ultrasound is effective but a negative result does not rule out appendicitis. MRI can also be performed. Lab testing is not diagnostic but can be helpful.

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7
Q

How should the nurse-midwife manage appendicitis in pregnancy?

A

OB/Surgeon should be consulted for suspected appendicitis

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8
Q

What is cholecystitis?

A

the acute inflammation of the gallbladder usually resulting from bile accumulation when the cystic duct becomes occluded by gallstones or biliary sludge.

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9
Q

What are the risk factors for cholecystitis?

A

Hormonal changes (i.e. increased estrogen causes biliary sludge) of pregnancy, obesity, DM, and formation of gallstones (cholelithiasis).

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10
Q

What are the symptoms of cholecystitis?

A

Nausea, vomiting, heartburn and acute epigastric/RUQ pain exacerbated by a fatty meal that often radiates to the right shoulder.
Positive murphys sign

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11
Q

What diagnostic tests should be used to evaluate for cholecystitis?

A

CBC with diff, LFTs, alkaline phosphatase, amylase, lipase
U/S

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12
Q

What labs and imaging offer a definitive diagnosis of cholecystitis?

A

U/S is diagnostic and effective in pregnancy

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13
Q

How can cholecystitis be managed in pregnancy?

A

If suspected, OB/MD consultation is warranted but collaboration may be used.

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14
Q

What is pancreatitis?

A

An acute inflammatory condition of the pancreas.

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15
Q

What are the risk factors for pancreatitis?

A

Cholelithiasis from gallstone blockage of pancreatic duct. Hypertriglyceride-induced pancreatitis secondary to estrogen levels and genetically elevated triglyceride levels.
Associated with increased risk of PTL, PTB, IUFD. Maternal complications associated with acute pancreatitis include pancreatic pseudocyst, hemorrhage, and necrosis, generalized peritonitis; acute respiratory syndrome; DIC; acute renal failure, and death. Sepsis, and shock.
It occurs more often in the third trimester, PP, and in multips but is extremely rare.

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16
Q

What are the symptoms of pancreatitis?

A

Severe epigastric pain, anorexia, nausea with ot without vomiting and fever.

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17
Q

What diagnostic tests should be used to evaluate for pancreatitis?

A

Serum amylase
Serum Lipase
Calcium

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18
Q

What labs and imaging offer a definitive diagnosis of pancreatitis?

A

Serum lipase may need to do serially
⅔ criteria must be met for diagnosis: serum amylase and/or lipase >3 times normal levels, cholelithiasis viewed on U/S, and severe epigastric pain.

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19
Q

How should the nurse-midwife manage pancreatitis in pregnancy?

A

OB/MD should be notified and referred. Pt may need surgery but conservative management is usually effective.

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20
Q

What are ambiguous genitalia?

A

a rare condition in which an infant’s external genitals don’t appear to be clearly either male or female.

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21
Q

What is hypospadias?

A

a birth defect in boys in which the opening of the urethra is not located at the tip of the penis

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22
Q

What is epispadias?

A

a rare birth defect located at the opening of the urethra. In this condition, the urethra does not develop into a full tube, and the urine exits the body from an abnormal location.
In boys with epispadias, the urethra opens in top of the penis rather than the tip. The space between this opening and tip of the penis appears like an open book (gutter). In girls with epispadias, the urethral opening is towards the clitoris or even belly area.

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23
Q

What is a unicornuate uterus?

A

During typical fetal development, two tubelike structures, called the Mullerian ducts, fuse together to create the uterus. The upper portions form the fallopian tubes. If one of the ducts fails to develop, it may result in a single-horned uterus, called a unicornuate uterus.

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24
Q

What is uterine didelphys?

A

a disorder present before birth in which a female develops two uteruses instead of one.

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25
Q

What is a bicornate uterus?

A

a uterine malformation that is produced due to impairment in the fusion of Mullerian ducts.

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26
Q

What is a septate uterus?

A

a normal shaped uterus with a wall of tissue creating two cavities.

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27
Q

What is an arcuate uterus?

A

a minor irregularity in the shape of your uterus. Unlike a typical pear-shaped uterus, an arcuate uterus has a small dent at the top of the uterus. It doesn’t cause health concerns and doesn’t require treatment.

28
Q

What are undescended testicles?

A

An undescended testicle (cryptorchidism) is a testicle that hasn’t moved into its proper position in the bag of skin hanging below the penis (scrotum) before birth. Usually just one testicle is affected, but about 10 percent of the time both testicles are undescended.

29
Q

What are cleft lip and palate?

A

Cleft lip: an opening or split in the upper lip that occurs when developing facial structures in an unborn baby don’t close completely.
Cleft palate: an opening or split in the roof of the mouth that occurs when the tissue doesn’t fuse together during development in the womb.

30
Q

What is an esophageal atresia?

A

a birth defect in which part of a baby’s esophagus (the tube that connects the mouth to the stomach) does not develop properly.

31
Q

What is gastroschisis?

A

a birth defect where there is a hole in the abdominal wall beside the belly button.

32
Q

What is an omphalocele?

A

a birth defect in which an infant’s intestine or other abdominal organs are outside of the body because of a hole in the belly button (navel) area. The intestines are covered only by a thin layer of tissue and can be easily seen.

33
Q

What is a diaphragmatic hernia?

A

a birth defect where there is a hole in the diaphragm

34
Q

What is anencephaly? How is it diagnosed? What are the expected outcomes of anencephaly?

A

-a serious birth defect in which a baby is born without parts of the brain and skull.
-Can be diagnosed through prenatal testing: QUAD Screen, U/S, Amniocentesis
-This is not compatible with life- death may occur in days or weeks of life.

35
Q

What is spina bifida occulta? How is it diagnosed? What are the expected outcomes of spina bifida occulta?

A

-A mild form of spina bifida caused by a gap forming between the vertebrae in your spinal cord. Many people dont know they have it.
-Can be diagnosed in pregnancy during an ultrasound but this may be missed and not diagnosed ntil adulthood after an accident or injury when an x-ray is needed.
-Many times, spina bifida occulta is not discovered until late childhood or adulthood. This type of spina bifida usually does not cause any disabilities.

36
Q

What is a meningocele? How is it diagnosed? What are the expected outcomes of meningocele?

A

-the simplest form of open neural tube defects. a sac of fluid comes through an opening in the baby’s back. But, the spinal cord is not in this sac.
-Can be diagnosed in pregnancy during U/S, ADP, or amniocentesis. Can be assessed/diagnosed after delivery through imaging with x-ray, MRI, or CT.
-There is usually little or no nerve damage. This type of spina bifida can cause minor disabilities.

37
Q

What is a myelomeningocele? How is it diagnosed? What are the expected outcomes of myelomeningocele?

A

-the most serious type of spina bifida. With this condition, a sac of fluid comes through an opening in the baby’s back. Part of the spinal cord and nerves are in this sac and are damaged.
-Can be diagnosed in pregnancy during U/S, ADP, or amniocentesis. Can be assessed/diagnosed after delivery through imaging with x-ray, MRI, or CT.
-This type of spina bifida causes moderate to severe disabilities, such as problems affecting how the person goes to the bathroom, loss of feeling in the person’s legs or feet, and not being able to move the legs.

38
Q

What is PEP?

A

An itchy benign skin condition/rash that can develop in third trimester of pregnancy.

39
Q

What are the signs and symptoms of PEP?

A

Lesions often are pruritic urticarial papules along the abdominal striae and spread to the thighs, buttocks, arms and legs. Face palms, soles, umbilicus and mucus membranes are usually spared.

40
Q

In which trimester does PEP most commonly occur?

A

Third trimester but rarely can occur PP

41
Q

What are the maternal outcomes of PEP? What are the fetal outcomes? What are the neonatal outcomes?

A

No risk associated

42
Q

When does PEP typically resolve?

A

Typically resolves 1-6 weeks PP, scaring is rare.

43
Q

What diagnostic tests are used in the evaluation of PEP?

A

There are no diagnostic tests. It is diagnosed based on H&P and exclusion of other conditions.

44
Q

What are the recommended treatment options for PEP? How is it managed?

A

Symptomatic relief is the primary goal. Oral antihistamines are first line (loratidine, ceftrizine, and fexofenadine). Topical corticosteroids, emollient creams and antipruritic meds can be used as well.

45
Q

What is pemphigoid gestationis?

A

A rare autoimmune pruritic dermatosis of pregnancy associated with several adverse fetal outcomes. It appears as a result of placental proteins being recognized as foreign by the body. Women with an autoimmune disease have higher incidence of PG.

46
Q

What are the signs and symptoms of pemphigoid gestationis?

A

Severe pruritis with erythematous papules in the periumbilical area and extremeties
Urticarial papules and annular plaques followed by the formation of subepidermal vesicles and bullae.

47
Q

In which trimester does pemphigoid gestationis most commonly occur?

A

Second and third trimester with a small percentage occurring PP. In the majority of cases, PG worsens as birth becomes imminent and improves after.

48
Q

What are the maternal outcomes of pemphigoid gestationis? What are the fetal outcomes? What are the neonatal outcomes?

A

Increased risk of LBW, PTB, fetal growth restriction, SGA, IUFD and neonatal skin lesions

49
Q

When does pemphigoid gestationis typically resolve?

A

Eruptions generally disappear 4 weeks pp, urticaria can persist for up to 14 weeks PP. There is a high rate of reoccurance with subsequent pregnancies.
If neonate develops lesions, they typically are mild and resolve spontaneously in 3 months of life.

50
Q

What diagnostic tests are used in the evaluation of pemphigoid gestationis?

A

Diagnosis based on H&P, biopsy needed for definitive diagnosis with direct immunoflourescense (DIF). Serum ELISA testing can also be useful due to high sensitivity and specificity.
Absence of lesions in the striae gravidarum and presence in the umbilical area are suggestive of PG.

51
Q

What are the recommended treatment options for pemphigoid gestationis? How is it managed?

A

High potency topical corticosteroids and emollients for preblistering stage, Oral antihistamines for pruritis relief (1st gen for 1st trimester, 2nd+ for later in preg). Oral corticosteroids (prednisone) with the lowest needed. Pt should be reevaluated within 2 weeks of therapy initiation.
Peds shoulde be consultation, collab with ob/perinatal/derm.

52
Q

What is AEP?

A

Includes a range of benign conditions that typically occur in the first or second trimester that are thought to represent either pregnancy-related atopic or immunoglobulin-E associated conditions. [Atopic dermatitis of pregnancy, pruritic folliculitis of pregnancy, and prurigo of pregnancy]

53
Q

What are the signs and symptoms of AEP?

A

Excoriated papules/nodules, follicular papules, pustular eruptions. Notes on extensor surface of arms, legs, abdomen, and chest
Pruritis, eczema and papules of chronic or relapsing nature with characteristic distribution on the face, neck, flexor surfaces and extremities. Lesions are often red, edematous with oozing and crusting, evidence of scratching with skin lichenidentification occurring over time.
Secondary infections can result due to scratching.

54
Q

In which trimester does AEP most commonly occur?

A

First and second trimester

55
Q

What are the maternal outcomes of AEP? What are the fetal outcomes? What are the neonatal outcomes?

A

None known

56
Q

When does AEP typically resolve?

A

Lesions usually resolve within 12 weeks PP. Typically regresses PP but can reoccur in subsequent pregnancies.

57
Q

What diagnostic tests are used in the evaluation of AEP?

A

Diagnosis based on H&P. Key is a history fo atopic symptoms, dietary, psychosocial and environmental triggers.

58
Q

What are the recommended treatment options for AEP? How is it managed?

A

Stepwise approach: non-soap cleansers and use of emollients, antihistamines (1st gen: benadryl, chlorpheniramine. 2nd gen: loratadine, certrizine), topical steroids of mild to mod. Strength on affected areas and sparingly in first trimester [top. Steroids may increase risk for SGA], systemic steroids are used for severe symptoms only and only at the lowest efefctive dose.
Key: avoid triggers, prenatal supplements may decrease risk of fetus developing AED, skin care education, referral to derm if diagnostic uncertainty or treatment ineffective.

59
Q

What is ICP?

A

A potentially serious liver disease that can develop in pregnancy due to a build up of bile acids. The increased serum bile acids are deposited in the skin where they cause intense itching.

60
Q

What are the signs and symptoms of ICP?

A

Intense pruritis without lesions on palms of hands and soles of feet. More intense itching noted at night.

61
Q

In which trimester does ICP most commonly occur?

A

Third trimester

62
Q

What are the maternal outcomes of ICP? What are the fetal outcomes? What are the neonatal outcomes?

A

PTB, fetal distress, mec-stained fluid, IUFD, neonatal respiratory distress. Co-occuring maternal vit. K def. Can result in antepartum fetal hemorrhage. This risk to the fetus uncreases as the total bile acid levels rise and/or if jaundice is present. Induction should occur at 35-57 weeks.

63
Q

When does ICP typically resolve?

A

Typically resolve shortly after birth.

64
Q

What diagnostic tests are used in the evaluation of ICP?

A

Diagnosed using H&P and serum bile acids (will be elevated), LFTs (may be elevated) and Vit. K (may be low)
Other conditions should be ruled out.
Additional tests to be performed: GGT, ALP, total bilirubin, PT, PTT, INR

Mild=10-19.9, Mod.=20-39.9, Severe=>40

65
Q

What are the recommended treatment options for ICP? How is it managed?

A

Serial fetal evaluation should begin immediatly. Goal of treatment is to reduce bile acid levels below 40. This can be done using Ursodiol (1st line).
Patient can use baths, topical antipruritics, amollients, and primrose oil for itching. Antihistamine can be used for sleep but does not reduce itching.
Consultation and collaboration with OB and perinatal should be done for severe ICP.

NM 706 Adv Midwifery Care-Perinatal & Neonatal (11 decks)

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