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1

excessive or pernicious vomiting during pregnancy leading to dehydration and starvation

hyperemesis gravidarum

2

what would you give through an IV for a pt with hyperemesis gravidarum

LR bc has electrolytes

3

what is a possible etiology of hyperemesis gravidarum

possible bc of increase level of HcG, thyroid dysfunction, disruption of GI motility, increase estrogen level

4

S/Sx of hyperemesis gravidarum

N & V , intractable

5

Tx for hyperemesis gravidarum

hydration (3000mL within 24 hours
Rx (Zofran, phenegran)
nutritional supplements (ensure)
monitor for keytones

6

cervix is unable to support the increasing weight of the pregnancy, results in painless dilation of cervical os without labor or contractions, associated with repeated 2nd trimester abortion )16-28 weeks)

incompetent cervix

7

predisposing factors for incompetent cervix

prior traumatic delivery, Hx of D&C, conization, cauterization, mother of pregnant women who took DES, anomaly of uterus or cervix

8

Dx of incompetent cervix

Hx, examination (vag exam), U/S

9

Tx for incompetent cervix

cerclage or purse string suture, inserted in cervix to prevent preterm cervical dilation and pregnancy loss, tightened and secured anteriorly

10

spontaneous ROM prior to onset of labor

premature rupture of membranes
*gestational age doesn't matter

11

spontaneous ROM: latent period

time from ROM to onset of labor (usually within 24 hours)

12

spontaneous ROM: interval period

time from ROM to birth

13

Etiology of PROM

unknown, contributing factors: infection, Esp. UTI, polyhydramnious, trauma, mult gestation

14

what maternal risks can happen because of PROM

INFECTION
chorioamnionitis: inflammation of membranes
endometritis: postpartum infection of endometrial lining

15

what neonatal risks can happen because of PROM

RDS, sepsis

16

Management of PROM

Abx, bedrest, CBC, fetal monitoring, Temp Q4 hours, daily WBC, corticosteroids and amniocentesis prn, L/S ratio to check lung maturity

17

occurrence of regular uterine contractions at less than 10 minute intervals after 20 weeks but prior to 37 completed weeks gestation, it is the greatest single problem in OB

premature labor

18

what Rx can you give to stop labot

Tocolytics

19

what do you need to do to identify those pts at risk for premature labor

gather Hx, cervical length and funneling, ffn (fetal bibronectin), Sx of preterm labor

20

funneling

greater than 50% funneling before 25 weeks has a 80% risk of preterm delivery

21

extracellular matrix protein of fetal membranes binds placenta and membranes to decidua, found before 20 weeks and after 34 weeks

fetal fibronectin

22

if there is fetal fibronectin present between 20 and 34 weeks this is what

abnormal = risk for premature labor

23

preterm labor Sx

abd tightness, menstrual cramping, back discomfort (comes and goes), pelvic pressure, intestinal cramping

24

what can the pt do to decrease the risk for preterm labor

regular PN care, refrain from sexual intercourse, empty bladder Q2 hours, curtail work activities, allow for rest, left lateral position, maintain adequate nutrition and hydration

25

what are the contraindications of suppressing labor

confirmed fetal death, fetal distress, gestational age less than 20 weeks

26

Ritodrine

1st and only Rx approved, works on beta receptors in smooth muscle
risks: pulmonary edema
assess: BP, HR, RR, I&O, lung sounds
contraindications: concurrent Tx with glucocorticosteriods

27

Supress labor

cervix less 4 cm dilated, gestation less 37 weeks, viable infant, documentation of contractions, membranes intact, no medical or obstricial disorders

28

Terbutaline

B-adrenergic, relaxes smooth muscle, SQ or inhalation, Terbutanline pump
SE: tacycardia

29

Magnesium sulfate

CNS suppressant, secondary action-relaxes smooth muscle, monitor reflexes and BP

30

antidote for Magnesium sulfate

calcium gluconate