Exam 3 Flashcards by Jacki Leigh

What are the causes of bleeding in the first trimester?

Spontaneous Abortion
Ectopic Pregnancy

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What are the causes of bleeding in the second trimester?

Gestational trophoblastic disease

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What are the causes of bleeding in the third trimester?

Placenta Previa
Abruptio Placenta
Vasa Previa

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A sponaneous Aborption is?

A pregnancy that ends as result of natural causes before 20 weeks

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What is a hydatidiform mole?

Gestational trophoblastic disease (GTD) is the proliferation and degeneration of trophoblastic villi in the placenta that becomes swollen, fluid-filled, and takes on the appearance of grape-like clusters. The embryo fails to develop beyond a primitive state and these structures are associated with choriocarcinoma, which is a rapidly metastasizing malignancy. Two types of molar growths are identified by chromosomal analysis.

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Gestational Trophoblastic Disease is also referred to as?

Hydatidiform Mole
Molar Pregnancy

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What are the qualifications for a complete mole?

All genetic materal is paternally derived

Ovum has no genetic material (or inactive)

No fetus, placenta, amniotic membrane or fluid

No placenta (hence hemorrage)

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What are the qualifications for a partial mole?

Both maternal and paternal genetic material

Normal ovum is fertilized by 1/2 sperm but meiodid or chromosome reduction does not occur

Often contains abnormal embryonic/fetal parts, amniotic sac and fetal blood

6% of partial mole progresses to a choriocarcinoma

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Some qualities of a hydatidiform mole are?

The clusters grow really fast
Fundal height is large
Belly grows both fast and big
Bleeding is often dark brown (resembling prune juice)
HcG us at a high level for 10-12 weeks gestation

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What is an incompetent cervix?

Passive dilation of the cervix during the second trimester

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What is the treatment for an incompetent cervix?

Cerclage at 12-14 weeks gestation for the best results that is removed at 37 weeks

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What are the symptoms of an incompetent cervix?

Increased pelvix pressure or urge to push
Pink stained vagina discharge
Possible gush of fluids (ROM)
Contractions with expulsion fetus
US showing short cervix (<25mm/funneling or effacing)

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What occurs in a placental abruption?

Premature separation of placenta from the uterus which can be partial or complete that normally occurs after 20 weeks in the 3rd trimester

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What are the symptoms of a placental abruption?

Placenta detaches
Dark red blood
Painful uterus
Abdominal is board like
If fetal heart tones are detected->Emergency C section

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If bright red bleeding in 3rd trimester accompanied by a soft uterus with no pain occurs, what is the likely diagnosis?

Placenta Previa

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What is placenta previa?

Occurs when the placenta abnormally implants in the lower segment of the uterus near or over the cervical OS instead of attaching to the fundus

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What is the inervention for an ectopic pregnancy?

Salpingostomy (removal of the effected area of the tube)
Before rupture

Salpingectomy (removal of the tube)
If ruptured or no desire for future pregnancy

All surgeries may be followed by a dose of Methotrexate to destroy any remaining tissue.

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What are the fetal complications of gestational diabetes?

Respiratory Distress
Hypoglcemia

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What is Oliogohyramnios?

Lack of aminiotic fluid that could indicate a renal issue

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What is polyhydramnios?

Too much amniotic fluid that could indicate a renal issue

Associated with diabetes

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What are the lab values that could indicate hyperemesis gravidarum?

Ketones in urine

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What are indications of positive rupture of membranes?

leakage of fluid
vaginal discharge/bleeding
pelvic pressure
no contractions
Fern test
nitrazine paper

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What is a fern test?

The Fern Test is one of several tests used to detect rupture of the membranes. Vaginal secretions are inspected under a microscope for crystallization or a ferning pattern. The crystallization is due to an increased concentration of protein and electrolytes within the fluid.

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When is a nitrazine paper test performed?

This test is done to ascertain the nature of fluid in the vagina during pregnancy especially when premature rupture of membranes (PROM) is suspect. This test involves putting a drop of fluid obtained from the vagina onto paper strips containing nitrazine dye. The strips change color depending on the pH of the fluid.

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What is PPROM?

Premature spontaneous rupture of membrane before 37 weeks

What are the complications of PPROM?

Infection (like chorioamnionitis, sepsis, endometritis) Prolapsed cord Abruption placentae Preterm labor

What is Chorioamnionitis?

Uterine tenderness Foul smelling amniotic fluid Fever Fetal Tachycardia

What are you looking for during a Nitrazine test?

Since the amniotic fluid is alkaline, the solution should turn blue (you need to know when the membrane was ruptured)

What is the test for preterm labor?

A fetal fibronectin test that tests for the glycoprotiec glue found in plasma that predicts who will NOT go into preterm labor

A negative fetal fibronectin test indicates?

That there is less than a 1% chance of giving birth within two weeks

-tocolytic medications do what?

Supress uterine activity and are given if at risk of preterm labor

What medication is given to mothers in premature labor that helps with fetal lung maturity?

Celestone/Betamethason 12mgIM then 12mg IM 24 hours after first injection

What is precipitous labor?

Labor that lasts less than 3 hrs from the onset of contractions to the time of birth

What is considered operative delivery?

Forcepts or vacuum guided birth

Forcepts or vacuum guided birth can have what complication?

It can cause a hematoma on the babies head

What is TOLAC?

trial of labor after cesaran

What are considered obstetric emergencies?

meconium stained amniotic fluid (dark green, pea green that can be caused from hypoxia in utero or breech presentation) Shoulder dystocia

What are puerperal infections?

Infections of the uterus and surrounding tissue after birth

What symptoms indicate a puerperal infection?

Fever after 24 hours of 100.4 (Fever of 100.4 in first 24 hours is ok)

What is endometritis?

Inflammation of uterine lining

What are the symptoms of endometritis?

Late PPH sign Pelvic pain Chills Fatigue Loss of Appetite Tender uterus Prolonged cramping Bleeding Foul smelling lochia

When does endometritis normally present?

Usually begins of the 2nd-5th day of PP

What is the treatment of endometritis?

Antibiotics

What is uterine subinvolution?

Uterus remains enlarged with continued lochia discharge

What are the risks of uterine subinvolution?

retained placenta (could be cause) Infection

If a mother is experiencing mastitis, how does this affect breastfeeding?

It doesn't-mom can still breastfeed on both sides for 15-30 minutes because it does not hurt the baby to feed on infected side

What is the most common cause of PPH?

Uterine Atony

What are the indications for PPH?

Blood loss of: 500mL vaginal birth 1000mL c-section (if they soak a pad in less than 10 minutes-it is too much PP)

Late PPH (after 24hrs to 12 weeks) is most likely caused by

Retained placental fragments

What is the 1st intervention for PPH?

fundal massage

What are the two classifications of PPH?

Early PPH Late PPH

What are the most common causes of early PPH?

Uterine Atony Trauma Lacerations Hematomas

What is oxytocin?

A uterine stimulant that promotes contractions

What are the adverse reactions for oxytocin?

Water intoxication-> lightheadedness Nausea Vomiting Headache Malaise This can lead to seizures, coma and death

What is Methylergonovine?

A uterine stimulant that controls PPH

In what patient demographic should you never administer Methylergonovine?

Patients with hypertension

What adverse reactions should you monitor for Methylergonovine?

Hypertension Nausea Vomiting Headache

What is Mistoprostol?

A uterine stimulant that controls PPH

What is carboporost tromethamine?

A uterine stimulant (hemabate)

What are the contraindicated patients for carboprost?

Asthma

What are the adverse reactions of carboprost?

Fever Chills Headache Nausea Vomiting Diarrhea

What are the symptoms of RDS (respiratory distress syndrome) in newborn?

Blue lips Nasal flaring Grunting Retractions Seesaw breathing

What causes RDS in newborns?

Hyperglycemia (it prevents surfactant production in infant's lungs-> the surfactant normally keeps lungs from closing)

Beractant, calfactant, and lucinactant are all?

Lung surfactant that can be given down ET tube

What is necrotizing enterocolitis?

A highly transerable inflammatory disease of the GI mucosa due to ischemia

What are the symptoms of necrotizing enterocolitis?

A distended abdomen Bloody Stools Impaired thermoregulation

What is short gut syndrome?

A condition that is secondary to removal of most or part of the necrotic small intestine from necrotizing enterocolitis

What is are the causes of small for gestational age?

IUGR Hypoglycemia after delivery Placental insufficency

What is retinopathy that is associated with prematurity?

Retinas of babies eyes are damaged due to complications of respiratory distress syndrome

A Postdate Newborn is?

A newborn that had a gestational age over 42 weeks

What are the risks of postdate newborns?

Meconium aspiration because of placental insufficency

What symptoms indicate neonatal abstinence?

High pitched cry Resists being swaddled or held Not consolable Hands at face

What is macrosomia?

Uncontrolled hyperglycemia during pregnancy that increases risks of injuries during birth including shoulder dystocia from large shoulders

What are the interventions for hyperbilirubinemia? What are the precautions for the therapy?

Phototherapy -Eye protection, turn baby every 2 hrs, assess for dehydration, and don't interrupt feeding schedule

What is a sign of fetal alcohol syndrome?

A thin upper lip

When does PPD enter into the realm of post partum psychosis?

When they start to develop hallucinations

When does PP psychosis develop?

2-3 weeks after delivery Biopolar depression puts mothers at higher risk

What can help initiate the process of grief?

Offer to hold/see the baby Say I'm sorry your baby has died