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Flashcards in Dunno yet Deck (61):
1

General risk factors for pregnancy

Under 17 Over 35
Low socioeconomic class
Unmarried (in conjunction with age and socioeconomic status)
No prenatal care (27 weeks)

2

Obstetrical risks for pregnancy

Gestational beeties
Problems with previous pregnancies
Hx of spontaneous abortions
Excessive size of infant
Cesarean birth
Post term birth
Incompetent cervix
Abnormal fetal presentation
Rh neg a sensitized
PIH (preeclampsia, eclamp, HELLP)
Multiple gestation

3

Medical preggo risk factors

Autoimmune disease
The beeties
HTN
Anemia
Thyroid disease
Polycystic ovary syndrome
Infertility
Hx of STI
Cervical neoplasia
Kidney disease
BFF
Neuro disorders
Psych problems

4

Polycystic ovarian syndrome

Instead of developing true ova develop fluid filled cysts, increases chance of miscarriage and chance of multiple gestational from fertility meds
Increased androgens

5

Lifestyle risk factors

Drugs, ETOH, smoking, nutritional deficiencies

6

General danger signs/symptoms

Vag bleeding
Abortion
Ectopic
Gestational beeties
hyperemesis gravidarum
Multiple pregnancy
Placenta previa
Abruptio placenta
Acute infectious disease
Rh incompat
PIH

7

DANGER!

Vag bleeding
Severe, continuous headache (PIH)
Facial swelling (PIH)
Dimness, blurring or spots
Abdo or back pain - preterm or spontaneous smusmorshion
N/V (after 1st trimester)
Chills or fever
Sudden escape of fluid of vagina
BP > 140/90
Decreased urinary output

8

Preggo vitals

HRT ^ but BP down 10-15mmHg

9

Causes of vagina hemorrhage in 1st and 2nd trimester
Most common from top to bottom

Abortion
Ectopic
Ovarian cysts
Chronic epithelium infections
Carcinoma of cervix
Erosion of cervix

10

Causes of vag bleed 2nd and 3rd trimester

Placenta previa
Abruptio placentae
Infection
Ruptured uterus
Carcinoma of cervix
Erosion of serve x

11

Preggo vag bleed questions to ask

Vaginal discharge (amount, contents, durations, events prior)
pain description

12

TX for vag vleed

Tx for hypovolemic shock
High flow O2
Keep BP 100-120 w/ 20mL/kg
Repeat X2 PRN
Stat transport
Constant monitoring
Notify receiving hospital

13

Abortion definition

Termination or ending of pregnancy before fetus is viable at 20 weeks

14

Causes of spontaneous abortion

Principal is chromosomal abnormalities (trisomy 16 most common, and child can't live with it)
PID
Abnormalities of uterus
Damage to cervix
Maternal disease
Ingestion of drugs
Trauma
Hormones
Psychosomatic causes
Medical intervention

15

Types of abortions

Hypertonic, inject hypertonic saline into uterus
Vacuum that sucker right outta there
Drugs
RU486

16

RU486

Mifepristone (RU486) usually given with misoprostol - 95% abortion rate with the combo
Mifepristone is an antiadrogen, antiprogesterone antiglucocorticoid

17

Threatened spontaneous abortion

Unexplained cramping and hemorrhage - cervix closed and membranes in tact

18

Inevitable spontaneous abortion

Cramping and hemorrhage, cervix begins to dilate

19

Incomplete spontaneous abortion

Retained segments of the content of conception

20

Habitual spontaneous abortion

3 consecutive, most common from luteal insufficiency

21

Complete spontaneous abortion

Errrrything expelled

22

Missed spontaneous abortion

Fetus dies but no expulsion

23

Ectopic

Leading cause of 1st trimester fetal death, 11% of maternal death. Ectopics have gone up 6 fold since the 70s (now at 1-40 pregnancies)
Most rupture by 2-12 weeks

24

Causes of ectopic (delay or prevention from implantation)

Endometriosis
PID, STD --> Strictures
Adhesion from surgery
Previous ectopics
Tubule ligation, IUDs
Smoking

25

Endometriosis

Development of uterine-lining tissue outside the uterus. Symptoms may include abdo pain, heavy periods, infertility/
TX is pain relievers, hormones and surg

26

S/S of ectopic

Difficult to distinguish from PID, appendicitis or abortion
Classis triad is abdo pain, vag bleeding (may be absent) amenorrhea
Referred pain to shoulder/neck
N/V
Syncope or classic signs of shock

27

Cullen's sign

Periumbilical ecchymosis (can also be caused by trauma and severe pancreatitis)

28

Gest beeties onset

Manifests at 20 weeks, pregnancy may uncover an asymptomatic diabetic mama

29

Path of gest beeties

1st 1/2 of pregnancy increases insulin production
2nd half increases insulin resistance (multiple factors)
Some correlation to presence of Human Chorionic Somatomammotropin

30

Risk factors for gest beeties

Family hx of beeties
Over 25 mamma
Parity 3-4 or more
GDM previously
Obeast
Previous births with infants greater than 4kg
Women whos own birth weight >4kg

31

More risk factors for the beeties

Non white, weight gain, central fat, polycystic ovarian syndrome, dartskies, multiple pregnancies, chronic HTN, HTN, chronic steroid use, polyhydraminos

32

Beeties S&S

Thirst, hunger, urination, weakness, gylcosuria (usually first indicator) pregnancy decreases renal threshold

33

TX for GDM

Diet for most, 10-15% need slin

34

Prognosis for GDM

S&S disappear a few weeks after, 35-50% will show deterioration of carb metabolism in next 15 years

35

Effects of preggo beeties

Mom HTN
Macrosomia

36

Fetal trauma from being a big baby

Cephalhematoma
Paralysis of facial nerve (being squished)
Fracture of clavicle
Branchial plexus paralysis
Erb-Duchenne (upper arm) paralysis

37

Hyperglycemia during pregnancy congenital defects

Congenital heart defects, tracheoesophageal fistulae, CNS anomalies

38

Infants of IDM moms

Increased risk of RDS - high levels of insulin interefere with surfactant production
Increase risk of hypoglycemia after birth, over production of infant insulin, monitor baby's blood sugar constantly

39

More on infants of IDM moms

Polycythemia (hematocrit > 65% ) response to poor oxygenation during fetal life, hyperbilirubinemia after birth (bilirubin has a high affinity and destroys neuro tissue)

40

Hydramnios (excessive amniotic fluid)

Increased frequency for pre term birth, premature rupture of membranes (PROM)

41

Macrosomia

Common outcome of IDM moms
If moms had IDM and poor dietary control and maternal vascular involvement baby will be small

42

Hyperemesis gravida

Severe and intractable form of N/V in pregnancy
Primigravida (higher incidence)
Peaks 8-12 weeks, usually resolves at 16
Bad if severe or prolonged

43

Primigravida

First pregnancies

44

Patho of hyperemsis gravidarum

Not sure, but associated with high levels of HCG

45

Dangers of hyperemesis gravidarum

Poor nutrition, weight loss, dehydration, fluid and lyte problems, ketosis
Extreme cases oliguria, jaundice

46

Multiple pregnancies numbers

Twins 1 in 80
Triplets 1 in 6400
Fertility drugs increase odds

47

Fraternal twins

Two ovum, 75% of twins, common in females over 35, genetic siblings
Two placentas and amniotic sacs

48

Maternal twins

Identical
25% of twins
Genetically identical
One OR two placentas
One OR two amniotic sacsDi

49

Complications of multiple pregnancy (maternal)

Anemia
Hydramnios
Pre-eclampsia (PIH)
Preterm labor
Postpartum uterine atony (sleepy uterus from first birth)
Postpartum hemorrhage
Fetal/placental insufficiency

50

More complications of multiple pregnancy (fetal)

Inappropriate presentation (first usually lines up proper, second often doesn't)
Placenta previa
Abruptio placenta
PROM (premature rupture of the membrane)
Preterm
Umbilical cord prolapse
Intrauterine growth restriction
Congenital anomalies
BEETIES
Increased perinatal morbidity and mortality

51

Hydatidiform mole

Fertilization occurs, ova degenerates and dies, placenta continues to grow as a neoplasm.
Still secerets hCG. Increases rapidly.
May found out during ultrasound or it just fucking pops out

52

Hydatidiform mole etiologies

Risks in 35 and hx of multiple births
TX D&C, hysterectomy (if carcinoma)

53

D&C

Dilate and curettage

54

Placenta previa

It is low implantation
3 types (low lying, partial complete)
Uterus stretches --> placenta --> Hemorrhage
Common cause of hemorrhage after 20 weeks
1 in 200 pregnancies

55

Risk factors for placenta previa

Defective vascular or previous infections of the upper uterus
Uterine scarring from previous c-section or D&C
Previous placenta previa
Endometriosis
Multifetal gestation and multiple births

56

Placenta previa assessment

Painless vag bleed
Uterus relaxed and not tender
HX of stretching event/activity by mom (reaching for high objects to trauma)

57

Placenta previa complications

Hemorrhage (spotting or intermittent) continuous flow is rare
Hypovolemic shock, infection, fetal outcome related to % blood loss

58

TX for placenta previa (spotting/bleeding without pain but continuous is rare)

Minimal pt movement
Oxygen
Large bore IV
Monitor vital signs
Prepare for hypovolemic shock
Stop labour with tocolytic meds
C-section
Bedrest from time of previa to delivery (stuck in hospital, monitored all the time)

59

Abruptio placenta

1 out of ~80
3 types - central, marginal, complete)
Late pregnancy >20 weeks or early labour

60

Abruptio placenta

PIH - vasoconstriction of maternal circulation creates poor interface between placenta and uterus
Previous ones
Trauma
Polyhydramnios with rapid decompression
Short umbilical cord
Smoking
ETOH
COCAINE!!
Folic acid deficiency

61

Presentation of abruptio placenta

Pain - sharp and knife-like
Hemorrhage - yes (but not in central)
S/S of hypovolemic shock
TX - minimal pt movement, O2, large bore IV, monitor vitals, may need C section