Module 9 Flashcards by Kristin Godsey

implantation spotting
cervicitis
fibroids
subchorionic hemorrhage
1st trimester pregnancy loss (abortion)
ectopic pregnancy
Post-coital spotting
Polyps
Vaginal Infection
STI
Cervical friability

common causes of 1st trimester bleeding

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fever?
how heavy is bleeding?
cramping/pain?
severity of pain?
location of pain?
LMP?
positive pregnancy test?
passing any clots?
Past history (ectopic pregnancies, SABs, medical disorders, risk factors, fibroids)

subjective data for woman reports 1st trimester vaginal pain

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Light spotting lasting one or two days that occurs approximately 7 to 11 days after conception.

implantation spotting

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two tests to confirm ectopic pregnancy

beta hCG + ultrasound

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S/S of \_\_\_\_\_\_\_\_\_\_\_\_\_\_:
•Abdominal – generalized or localized
•Amenorrhea, positive pregnancy test
•Bleeding often brownish in color
•May have breast tenderness, nausea, and other pregnancy signs
•PE: adnexal mass, acute pain or CMT

ectopic pregnancy

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Signs of \_\_\_\_\_\_\_\_\_\_\_\_\_\_:
Hypotension
nausea
pallor
shoulder pain
urge to defecate

ectopic pregnancy rupture

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(Woman @ 8w5d pregnancy) Tests to complete with: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_:
Ultrasound
Serum Beta hCG
Blood type
Rh factor
Antibody screen
Speculum exam

bright red bleeding

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BPP Movement Score 2

≥ 3 gross body movements in 30 minutes

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BPP Movement Score 0

< 3 gross body movements in 30 minutes

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BPP Tone Score 2

≥ 1 movement of limb from flexion to extension and back to flexion

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BPP Tone Score 0

Limb extension with no return to flexion

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BPP Breathing Score 2

≥ 30 seconds of sustained fetal breathing movements in 30 minutes

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BPP Breathing Score 0

< 30 seconds of sustained fetal breathing movements in 30 minutes

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BPP Fluid Score 2

≥ 1 AF pocket measuring ≥ 2 x 2 cm in two perpendicular planes

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BPP Fluid Score 0

No AF pocket measuring ≥ 2 x 2 cm in two perpendicular planes

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BPP FHR Score 2

≥ 2 accelerations of > 15 bpm lasting ≥ 15 seconds in a 40 minute period

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BPP FHR Score 0

< 2 accelerations of > 15 bpm lasting ≥ 15 seconds in a 40 minute period

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The risk of fetal asphyxia is very low (1/1000 risk of perinatal death within 1 week if not intervention) with these BPP results:

10/10
8/10 with normal fluid
8/8 (without NST)

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BPP test result that means potential chronic fetal hypoxia

8/10 with ABnormal fluid

this is an equivocal BPP test result

6/10 with normal fluid

BPP test result that means possible fetal asphyxia

6/10 with ABnormal fluid

BPP test results that mean risks of fetal asphyxia is increased

4/10
2/10
0/10

If membranes intact and there is no renal malfunction/abnormality, delivery is indicated if fetus is term/ If < 34 weeks, increased surveillance may be preferred d/t risks of prematurity
with this BPP result:

8/10 with ABnormal fluid

Repeat test within 24 hours if BPP results are:

6/10 with normal fluid

Deliver if term/ If < 34 weeks consider clinical picture and whether increased ANFS to prolong pregnancy is preferred with this BPP result

6/10 with ABnormal fluid

Deliver no matter what with these BPP results:

4/10 2/10 0/10

the best time to iniate kick counts is ___-___ weeks

34-36

routine use of __________ has not improved perinatal outcomes

ultrasound

the best practice of fundal height measurement:

same midwife each time

using acoustic stimulator and waiting longer on NST increases:

reactivity

``` risk factor for _____________: Hx pelvic inflammatory disease IVF gynecological surgery current IUD tubal ligation previous ectopic pregnancy Infertility Hx of STIs History of multiple partners at a young age Smoking Douching ```

ectopic pregnancy

``` Objective Data for __________: Vital Signs Abdominal Exam Speculum Exam Bimanual exam ```

bleeding/spotting

``` Differential Dx for ____________: Spontaneous Abortion (miscarriage) Ectopic Pregnancy Hydatidiform Mole Subchorionic Hemorrhage Trauma ```

first trimester bleeding

medication used to terminate ectopic pregnancy

methotrexate

labs to collect with spontaneous pregnancy loss

beta hCG

cervical os is open, there is increased bleeding with cramping/contractions, products of conception may be visible at the cervical os.

inevitable abortion

products of conception have been expelled. The uterus is small and contracted, the cervix is generally closed (it closes quickly after the products of conception are expelled), there is scant bleeding or cramping.

complete abortion

Placental tissue or products of conception remain in the uterus or cervix. Bleeding and cramping are present. The uterus is smaller than expected, but not contracted well.

incomplete abortion

In utero fetal death before 20 weeks with a retained fetus and closed cervix.

missed abortion

Diagnosis of____________: | Ultrasound may have an abnormal yolk sac, the fetal heartbeat may be slow or absent.

spontaneous abortion

presence of vaginal bleeding, but the cervical os is generally closed and the uterus is appropriately sized.

threatened abortion

Signs that indicate an ectopic pregnancy is a _______________: Abdominal rigidity Abdominal guarding Severe tenderness Evidence of hypovolemic shock (hypotension, tachycardia)

surgical emergency

``` Differential Dx for _____________: Ectopic pregnancy Upper genital tract infections Ovarian issues (cysts, torsion) Fibroids Abnormal uterine bleeding Endometriosis Appendicitis UTI Kidney stones Diverticulitis or other bowel diseases ```

abdominal pain in early pregnancy

tests to order when you suspect ectopic pregnancy

Pregnancy test Serum beta HCG test (if pregnancy test was negative and yet you suspect ectopic) Transvaginal ultrasound

hCG will ____________ or _____________ with ectopic pregnancy

plateau or increase slowly

ectopic pregnancy sx typically appear at ___-___ weeks gestation

6-8

calculated by adding the depth of the largest vertical pocket in each of the 4 uterine quadrants. (normal= 8 cm - 24 cm)

AFI