Module 9 & 10 - Fetal Well-Being; Nutrition & Exercise Flashcards
(57 cards)
T/F - Etiology is usually apparent in 1st trimester bleeding.
False - etiology is often unknown
T/F- Goal during dx with 1st trimester bleeding is one of exclusion.
True
All of the following are ___________ ________ of 1st trimester bleeding:
Polyps, cervivitis, vaginal infection, STI, implantation spotting (which is most often ____, ___ to ____
days after conception, lasting only a day or two; a
minority of pregnant women have this kind of
spotting), increased vascularization of the cervix in
pregnancy = increased friability, post-coital spotting due to increased friability
Normal etiologies;
scant, 7-11 days;
It is important to assess bleeding _________, __________, associated __________ & ___________, ___________ and __________.
severity, amount, associated signs and symptoms, pain, and cramping.
Pertinent past history for 1st trimester bleeding includes: previous \_\_\_\_\_\_\_\_ prior \_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_ disorders \_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_
ectopic SABs medical risk factors fibroids
Physical exam for 1st trimester bleeding includes:(4)
Physical exam
• Vital signs
• Abdominal exam – pain, maybe FHT,s
• Speculum exam – observe internal and external
• Bimanual exam – CMT, adnexal masses, uterine
enlargement
_____________ _____________ is the most common early pregnancy complication.
Spontaneous abortion
_____% of SABs are in the 1st 12 weeks.
80%
____________ _____________ are the most common reason for SABs.
Chromosomal errors
SAB rate is ___ to ____ % of all conceptions.
25-30%
Risk factors for SAB include: (7)
Risk factors • Smoking • Alcohol • Immune factors (recurrent loss) • Inherited blood dyscrasias (recurrent loss) • Excessive caffeine, >500 mg daily • Environmental exposures • Pesticides, arsenic, lead, formaldehyde, benzene
(A) Inevitable (B) Missed (C) Incomplete (D) Threatened (E) Complete
_____ closed cervix, uterus appropriately sized,
_____ cervix dilated, increased bleeding with
cramps/ctx, products of conception can be at os
_____ small contracted uterus, open cervix,
scant bleeding/cramping
____ placental tissue remaining, cervix open,
POC can be at os, uterus smaller than expected for
gestational but not well contracted, variable
bleeding/cramping
____ in utero death of embryo prior to 20th wk with
retention of pregnancy for prolonged period of time.
Cervix closed, +/- bleeding
D) Threatened A) Inevitable E) Complete C) Incomplete B) Missed
_________ is key to diagnosis of SAB
• May see abnormal ____ ____, slow or absent____,or
___________
_______ ____ is adjunct to determine viability
• _________every 2-3 days
• Max levels at __ - ___ weeks, then declines
• Serial measures
Ultrasound;
yolk sac; FHT; hematoma
Serial b-hCG;
Doubles; 8-10 weeks;
Ectopic pregnancy occurs in about ___ % of pregnancies, clinical manifestations usually occur in the ___ to ___wk of pregnancy, but can occur later.
2%; 6-8 weeks
T/F - All women with an ectopic will be symptomatic when you see them.
False - many are asymptomatic
\_\_\_\_\_ risk factors for \_\_\_\_\_\_\_\_\_: • Tubal ligation • Tubal pathology/surgery • Prior ectopic • IUD – especially Mirena \_\_\_\_\_\_\_\_\_ risk factors for \_\_\_\_\_\_\_\_\_\_\_: • Infertility • Assisted reproduction technology • Prior hx of genital tract infection (Chlamydia, GC, salpingitis) • Multiple sex parters (secondary to increased risk for PID) • Smoking – risk is dose dependent \_\_\_\_\_\_\_\_\_ risk factors for \_\_\_\_\_\_\_\_\_\_: • Prior cesarean • Douching
High; ectopic
Moderate; ectopic
Lower; ectopic
Signs/sx of ectopic may include ___________, ________________/____________, and _____________ (profuse if cervical pregnancy).
abdominal pain, amenorrhea/+preg test, bleeding
T/F- Women with an ectopic may experience normal pregnancy signs, like breast tenderness, nausea, etc.
True
Signs of a ruptured ectopic may include ___________ _________ (from blood irritating the diaphragm) and _________ to ___________ (from blood pooling in the cul de sac).
shoulder pain; urge to defacate
T/F - A pregnancy test should be done on all women of childbearing age who present with abdominal pain.
True
Evaluation for suspected ectopic should include:
• _______ exam for _______ mass
• Assess ________ _______ _______ (sometimes your
first clue on routine 1st visit exam)
• ___________ (may or may not see __________sac)
• Serial _______ (may see _____ rise, may be normal)
pelvic; adnexal
cervical motion tenderness
Ultrasound; extrauterine
B-hCG; slower
Midwifery management of ectopic is to ____________.
refer!
MD may proceed with medical mgt (_________) rather than surgery, if _________ and hCG
Methotrexate; unruptured;
A complete hydatidiform mole has ____ ____ _____. A partial mole has _______ _________ _________.
no fetal tissue; some fetal tissue.
