Abortion Types & Pregnancy-Related Quick Facts Flashcards
A spontaneous abortion is pregnancy that ends before 20 weeks gestation. What is the only type that is potentially viable?
Threatened abortion
Threatened abortion
-products of conception:
-cervical os:
-Management
-POC: Intact
-Cervical OS: Closed
-Management: supportive, observation at home, close follow up, bedrest
Inevitable abortion
-POC:
-Cervical os:
-Management:
-POC: Intact
-Os: Dilated
-Management: Surgical evacuation (D&C < 16 weeks, D&E > 16 weeks) or Misoprostol
Incomplete abortion
-POC:
-Cervical os:
-Management:
-POC: Some POC expelled
-Os: Dilated
-Management: Expectant, Surgical evacuation, Misoprostol all options
Complete abortion
-POC:
-Cervical os:
-Management:
-POC: All POC expelled
-Os: Closed
-Management: RhoGAM, follow up beta-HcG
Missed abortion
-POC:
-Cervical os:
-Management:
-POC: intact
-Os: closed
-Management: evacuation or Misoprostol
Septic abortion
-POC:
-Cervical os:
-Management:
-POC: Some POC retained
-Cervical os: closed, cervical motion tenderness, foul brown discharge, fever, chills
-Management: D&E + Broad Spectrum ABX (Levo + Metronidazole)
Elective (Induced) Abortion
-Medical Options
–_______ safe up to 10 weeks
–_______ safe up to 7 weeks
-Mifepristone followed by Misoprostol 24-48 hours afterwards. Safe up to 10 weeks.
-Methotrexate followed by Misoprostol 3-7 days later. Safe up to 7 weeks. (this regimen is less effective)
Elective (Induced) Abortion
-Surgical options
–When can be they be performed UP to
-Dilation and Curettage (D&C): used during the first 4-12 weeks GA
-Dilation and Evacuation: used after 12 weeks GA
Can be performed UP TO 24 weeks GA
How do you diagnose placental insufficiency, and what exactly is placental insufficiency?
How do you treat it?
Impairment of placenta to provide oxygen and nutrients to the placenta
-Fetal heart monitoring: late decelerations (gradual decrease in heart rate at peak of contraction and into second half of contraction)
-Place mother on her side, oxygen by mask, and correcting hypotension.
When should a gestational diabetes screening take place (at which weeks)?
24-28 weeks
A baseline fetal heart rate is between _______ and ______ bpm.
For a non-stress test, a reactive test, which shows fetal well-being, is what?
Furthermore, for a contraction stress test (which measures fetal response to stress at times of uterine contraction), what is shown for fetal well-being?
120-160 bpm
Non-stress test, 2 or more accelerations of fetal heart rate 15 bpm or more from baseline lasting at least 15 seconds over a 20-min period.
Contraction stress test: NO late decelerations***
What are some complications of gestational diabetes?
What 2 steps of diagnostics should be done to diagnose gestational diabetes?
Treatment, both initial and pharm, for gestational diabetes?
-Fetal macrosomia (MC), preterm labor, delayed fetal lung maturity, neonatal hypoglycemia, neonatal hypocalcemia
-Step 1: 50g 1-hour glucose challenge test (at 24-28 weeks)
-Step 2: 100g 3-hour glucose challenge test (GOLD STANDARD) done if 1 hour test glucose > 130-140 mg/dL.
-Initial tx: diabetic diet and exercise (walking).
-Pharm: insulin***
What two diabetic medication should you remember cross the placenta and, therefore, should be advised against in use for gestational diabetes?
Metformin and Rosiglitazone
Explain the cardinal movements of labor, in order.
-Engagement
-Descent
-Flexion
-Internal Rotation
-Extension
-External Rotation
