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OB > Chapter 6: Rebecca Sweet (Placental Abruption and Fetal Loss) > Flashcards

Chapter 6: Rebecca Sweet (Placental Abruption and Fetal Loss) Flashcards

1
Q

combined oral contraceptives what it is and MOA

A
  • combo of estrogen and progestin
  • suppresses ovulation and thickens cervical mucus so sperm can’t pass
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2
Q

combined oral contraceptives route and dosing

A
  • oral
  • 20-35 ug
  • same time each day
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3
Q

combined oral contraceptives common side effects

A
  • nausea
  • breast tenderness
  • headache
  • period/bleeding irregularities
  • mood changes
  • libido changes
  • vaginal discharge changes
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4
Q

combined oral contraceptives CI

A
  • migraine headache with aura
  • BP >130/90 mmHg
  • hx of smoking
  • age > 34 y
  • current preg
  • hx of blood clots, stroke
  • hx of estrogen dependent cancers
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5
Q

combined oral contraceptives warning signs

A

ACHES
* abd pain
* chest pain
* headache (new, severe)
* eyes (vision changes)
* severe leg pain

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6
Q

common early preg complaints

A
  • breast tenderness, pain, tingling
  • n/v
  • leukorrhea (incr. vaginal discharge)
  • ptyalism (excess salivation)
  • persistent nasal congestion
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7
Q

n/v interventions

A
  • avoid being too full
  • avoid liquids with meals
  • frequent, small meals
  • avoid fried and odorous foods
  • fresh lemon smell
  • peppermint, ginger
  • acupressure
  • b6 vit
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8
Q

leukorrhea interventions

A
  • not preventable
  • milky, odorless discharge
  • wear panty liner
  • call provider if new onset odor or pruritis (itching)
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9
Q

ptyalism interventions

A
  • associated w. nausea so try n/v interventions
  • mouthwash, brush teeth
  • sucking candies, chewing gum
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10
Q

persistant nasal congestion interventions

A
  • saline nasal spray
  • humidifier
  • exercise
  • avoid irritants
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11
Q

breast tenderness, pain, tingling intervention

A

wear supportive bra

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12
Q

preg danger sign: vaginal bleeding

A
  • 1st trimester: miscarriage
  • 2nd/3rd trimester: placenta previa, placental abruption, bloody show
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13
Q

preg danger sign: dysuria, urinary freq, and/or urgency

A

UTI

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14
Q

preg danger sign: fever

A

infection

preg women can be 0.4-0.6 F warmer than baseline

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15
Q

preg danger sign: nonstop vomiting

A

hyperemesis gravidarum

–> weight loss, dehydration, nutritional/electrolyte imbalances, death if untreated

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16
Q

preg danger sign: severe headache

A

preeclampsia

17
Q

preg danger sign: epigastric (upper, central abd) pain

A

preeclampsia

18
Q

preg danger sign: fluid leaking from vagina

A
  • premature membrane rupture (before contractions): lots of clear, odorless discharge
  • infection (if w. odor, itching, irritation)
19
Q

preg danger sign: uterine contractions, pelvic or abd pain/cramping, pelvic pressure, lower backache

A

preterm labor

20
Q

symptoms of placental abruption? (7)

A
  • vaginal bleeding
  • back or abd pain
  • uterine tenderness
  • tetanic contractions (uterus doesn’t completely relax b/t contractions)
  • maternal tachycardia and hypotension
  • fetal distress
  • DIC and maternal shock risk
21
Q

risk factors for placental abruption? most sig to least (12)

A
  1. hx of placental abruption
  2. abd trauma
  3. cocaine/drugs
  4. eclampsia
  5. chronic HTN
  6. polyhydramnios
  7. chorioamnionitis
  8. premature membrane rupture
  9. HTN disorders of preg
  10. hx of preeclampsia
  11. small for gest age baby in previous preg
  12. smoking in preg
22
Q

Category I FHR

A

GOOD!!! reassuring, normal, not concerning
* no variable or late
* w. w/o early decels
* w. or w/o accelerations
* mod variability (6-25 bpm)
* baseline HR 120-160 bpm

23
Q

Category II FHR

A
  • IFFY!!! nonreassuring, indeterminate
  • keep monitoring
24
Q

Category III FHR

A
  • BAD!!! nonreassuring, abnormal
  • need interventions or stat c-section
  • sinusoidal pattern (smooth, undulating/wave-like, symmetric)
  • absent variability
  • recurrent late and variable decels
  • bradycardia
25
Q

DIC lab values (3)

A
  • decreased fibrinogen
  • elevated fibrin degradation products
  • elevated D-dimer (but less reliable in preg)
  • coagulation studies
26
Q

severe placental abruption monitoring (4)

A
  • HR, BP (look for tachycardia and hypotension)
  • urine output (min 30 mL/hr)
  • blood loss (weigh soiled and compare to nonsoiled)
  • continuous FHR
27
Q

severe placental abruption interventions

A
  • blood transfusion (typically if blood loss > 500 mL or 1L)
  • IV access with 2 wide bore needles
  • administer LR
28
Q

severe placental abruption labs

A
  • blood type and cross
  • CBC
  • creatinine
  • liver func if preeclamptic
  • coagulation studies to rule out DIC

OB (7 decks)

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