Exam 1 Flashcards
(97 cards)
1
Q
this is an obstetric emergency and leading cause of maternal morbidity and mortality in us
A
PPH
2
Q
Traditionally PPH is defined as cumulative blood loss of ____ and bleeding associated with s/s of hypovolemia within 24 hours of birth
A
> 500 ml after vaginal birth
>1000 ml after C-section
3
Q
PPH is classified as either
A
early or late
4
Q
early, acute or primary PPH occurs within __ hours of birth
A
24
5
Q
late or secondary PPH occurs more than ___ but less than __ week
A
24
6
6
Q
PPH is often unrecognized until mother has ___ symptoms
A
profound
7
Q
dark red blood comes from
A
veins and can come from superficial vaginal lacerations
8
Q
bright red blood comes from
A
arteries and can indicate deep lacerations in the cervix
9
Q
the greatest risk for PPH is during the ___ hour after birth
A
first
10
Q
there is a ___% change in Hct between labor and postpartum
A
10
11
Q
what is the leading cause of early PPH
A
uterine atony
12
Q
these are all associated with \_\_\_ high parity (multiple births) hydramnios ( a lot of amniotic fluid) macrosomic fetus (big baby) multifetal gestation (more than one baby) distention with clots
A
uterine atony
13
Q
What is the first action for uterine atony
A
fundal massage
14
Q
this happens when a placenta has not been expelled within 30 minutes after birth despite an upright posture, gentle traction on the umbilical cord, and uterine massage
A
retained placenta
15
Q
initial management of retained placenta is ___ separation done by doctor or midwife
A
manual
16
Q
when doctors go into remove retained placenta they may leave big part behind and possibly causing
A
- bleeding
- infection
- retained placenta fragments
17
Q
Surgery such as uterine curettage (DNC) may be needed to treat
A
retained placenta
18
Q
PPH can also be due to an abnormally implanted, invasive, adhered placenta into the uterus known as what
A
placenta accrete syndrome or morbidly adherent placenta
19
Q
Abnormal placenta adherence can be total, __ or focal depending on how much placental tissue is involved
A
partial
20
Q
slight penetration of myometrium
A
placenta accreta
21
Q
deep penetration of myometrium
A
placenta increta
22
Q
perforation of myometrium and uterine serosa, possibly involving adjacent organs
A
placenta percreta
23
Q
how can placenta accrete syndrome be diagnosed before birth
A
UD and MRI
24
Q
Though placenta accrete syndrome can be diagnosed before birth most often it isn’t recognized until there is excessive bleeding __ birth
A
after
25
this surgical procedure can be indicated for all three types of placenta adherence if bleeding is uncontrolled and almost always required for a placenta percreta or placenta increta
hysterectomy
26
true or false: lacerations can also be causes of PPH
true
27
lacerations can be ___ and cause bleeding
hidden
28
this is a collection of blood in the connective tissue and can be vulvar, vaginal, or retroperitoneal in origin
hematoma
29
indications of a hematoma are the mom reporting persistent perineal or rectal pain or a feeling of pressure in the vagina and a careful ___ needs to be made
examination
30
What are the most common kind of hematomas
vulvar
31
vulvar hematomas are ___ and painful
visible
32
vulvar hematomas are most common in association with what
- forceps-assisted birth
- episiotomy
- primigravity
33
retroperitoneal hematomas are the least common but most __
threatening
34
these types of hematomas are caused by laceration of one of the vessels attached to the hypogastric artery usually associated with rupture of cesarean scare during labor
retroperitoneal hematoma
35
with this kind of hematoma there may be minimal pain with initial signs of shock
retroperitoneal
36
we usually fix hematomas by performing what basic interventions
icing
pain meds
measure and mark them to monitor
37
___ evacuation may be indicated for hematomas depending on how serious they are
surgical
38
this happens when the uterus turns inside out
inversion of the uterus
39
inversion of the uterus after birth is ___ but a potentially ___-___ complication
rare
| life-threatening
40
inversion of the ___ can be complete, incomplete, or prolapsed
uterus
41
this type of uterus inversion can't be seen and a smooth mass can be palpated through the dilated cervix
incomplete
42
with a ___ inversion the lining of the fundus crosses through the cervical os and forms a mass in the vagina
complete
43
with a ___ inversion of the uterus it is obvious with a large, red, rounded mass protruding outside the uterus
prolapsed
44
s/s of inversion of the uterus
- hemorrhage
- shock
- pain
- uterus can't be palpated abdominally
45
what are the 2 main causes of uterus inversion
1. excessive umbilical cord traction with attached placenta
| 2. fundal pressure in the setting of a relaxed uterus
46
what is the treatment for uterus inversion
- push it back in
- perform firm fundal rub
- administer tocolytics to relax the uterus that way it's not painful to be put back in
- oxytocic meds can be given to make uterus firm
47
this is delayed return of the enlarged uterus to the nonpregnant size and function
subinvolution
48
what are some s/s of subinvolution
- prolonged lochial discharge
- excessive bleeding
- sometimes hemorrhage
49
what are some causes for subinvolution
- retained placental fragments
| - pelvic infection
50
treatment for subinvolution
- depends on the cause
- might give meds to promote contractions (methergine)
- DNC may be needed to remove placental fragments
51
the bakri balloon is an intervention for what complication
PPH
52
this device goes inside the uterus and it inflates and applies internal pressure in the uterus to help manage hemorrhage
it has a drainage system
Bakri balloon
53
hemorrhagic or hypovolemic shock results from
hemorrhage
54
this is an emergency situation in which perfusion of organs may become severely compromised and death may occur
hemorrhagic shock
55
What is the priority intervention for hemorrhagic shock
replenishing fluid to restore blood volume
56
with hemorrhagic shock is is important to monitor __ and ___
pulse
| BP
57
What are some s/s of hemorrhagic shock
- increase respiration
- increased HR
- decreased BP
- skin is cool, pale and clammy
- decrease urine output
- anxiety
58
this is an autoimmune disorder in which antiplatelet antibodies decrease the life span of the platelets
ITP
| idiopathic or immune thrombocytopenia purpura
59
this is a type of hemophilia and most common congenital bleeding disorder
-results form a deficiency in a blood clotting protein called von Willebrand factor
-von Willebrand disease
60
this results from a formation of blood clot or clots inside a blood vessel caused by inflammation or partial obstruction of vessel
venous thromboembolism (VTE)
61
what are the 3 thromboembolic conditions which are of concern postpartum
- superficial venous thrombosis
- deep venous thrombosis
- pulmonary embolism
62
this type of thromboembolic condition involves the superficial saphenous venous system
superficial venous thrombosis
63
this type of thromboembolic condition occurs most often in the lower extremities and involvement varies but can extend from the foot to the iliofemoral region
deep venous thrombosis
64
this type of thromboembolic condition is a complication of DVT when a part of a blood clot dislodges and moved to the pulmonary artery where it occludes and obstruct blood flow to the lungs
pulmonary embolism
65
what are the major causes of venous thromboembolic disorders
- venous stasis
| - hypercoagulation
66
DVT most occurs during
pregnancy
67
PE is most common in the
postpartum period
68
```
s/s of this thromboembolic condition are
pain
tenderness in lower extremity
warmth
redness
enlarged hardened vein
```
superficial venous thrombosis
69
many pregnant women who are diagnosed with DVT __ exhibit the classic symptoms
DON'T
70
```
s/s for this thromboembolic condition include
unilateral edema
erythema
warmth
pain
tenderness
positive Homan sign (NOT DONE ANYMORE)
```
DVT
71
```
s/s of this thromboembolic condition include
dyspnea
chest pain
tachypnea
tachycardia
apprehension
cough
hemoptysis
increased temp.
sweating
```
PE
72
__ risk infants are classified according to the following factors
birth weight
gestational age
predominant pathophysiologic problems
high
73
a baby whose birth weight is less than 2.5 kg (2500gm) regardless of gestational age
Low birth weight (LBW) infant
74
a baby whose birth weight is less than 1500 gm
very low birth weight (VLBW) infant
75
a baby whose birth weight is less than 1000 grams
extremely low birth weight (ELBW) infant
76
an infant whose birth weight falls between the 10th and 90th percentiles on intrauterine growth curves
appropriate for gestational age (AGA) infant
77
an infant born before completion of 37 weeks
preterm
78
an infant born from 34 (0/7) MEANS THE START OF THE WEEK through 36 (6/7) weeks of gestation. NEXT DAY THEY WOULD TURN 37
Late preterm
79
An infant born from 37 (0/7) through 38 (6/7) weeks of gestation.
Early term
80
An infant born from 39 (0/7) weeks through 40 (6/7) weeks of gestation.
full term
81
An infant born from 41 (0/7) through 41 (6/7) weeks of gestation.
late term
82
An infant born at 42 (0/7) or more weeks of gestation.
post-term
83
a majority of high-risk infants are those born in less than ___ weeks
37
84
preterm infants are at risk because their organ systems are __ and lack adequate reserves of bodily nutrient and lack that brown fat
immature
85
true or false: gestation and weight don't have to go hand in hand
true
86
these are the most common ___ anomalies that cause serious problems in neonates
- congenital heart disease
- neural tube defects
- cleft lip or palate
- clubfoot
- developmental dysplasia of the hip
congenital
87
CDC recommends reproductive age women consume ___ mcg of folic acid each day
400
88
this is a herniation of the brain and meninges through a skull defect usually in the occipital area
the brain and the bones of the skull aren't closed correctly
encephalocele
89
this is the most serious NTD and is the absence of both cerebral hemispheres and of the overlying skull
this is incompatible with life
Anencephaly
90
This is the most common defect of the CNS and results from the failure of neural tube to close in early gestation
spina bifida
91
what are the two form of spina bifida
- occulta
| - -manifesta
92
this type of spina bifida where the back bone is not fully formed or fails to close but the spinal cord or meninges don't herniate or protrude through the defect
there is a sacral dimple or tuft of hair
occulta
93
this type of spina bifida includes meningocele and myelomeningocele
spina bifida manifesta
94
this kind of spina bifida occurs when meninges and spinal fluid extend through an irregular vertebral opening
meningocele
95
this type of spina bifida is more severe and occurs when there is a herniation of the spinal cord and neutral elements through an opening in the spine
myomeningocele
96
this is a condition in which there is excess CSF in the ventricles of the brain due to overproduction or a decrease in reabsorption
hydrocephalus
97
this refers to an occipitofrontal head circumference that is more than two standard deviations smaller than the mean for gestational age weight and sex.
microcephaly
