OB FINAL Flashcards

Question

risk factors for ectopic pregnancy

Answer 1

o PID & endometriosis o Use of IUDs o Tubal surgery o Tubal tumors/congenital tubal anomalies  Accessory tubes, excessively long tubes o History of: -Previous ectopic pregnancy -Abdominal or pelvic surgery -Appendicitis/therapeutic abortion/infertility

Answer 2

1) abdominal pain-colicky, vague, cramping and can be localized to either the L or R 2) Amenorrhea 3) unilateral leg swelling 4) shoulder pain-referred pain 5) abnormal vaginal bleeding

Answer 3

when all products of conception are entirely expelled  Baby + placenta + membranes  Very few physical complications occur but emotional support is necessary

Answer 4

products of pregnancy are retained in uterus and infection sets in  Immediate termination of pregnancy by method appropriate to duration of pregnancy is needed  Cervical C & S studies are done and broad-spectrum antibiotic therapy is started (for anaerobic & aerobic initially) • Vaginal vault = aerobic • Uterine cavity = anaerobic

Answer 5

fetus dies but continues to be retained in the uterus for > 8 weeks

Answer 6

after 4 weeks with an infant dead within the mother |  The dead cells start to release enzymes that cause the breakdown of clotting factors and can lead to DIC in the mother

Answer 7

woman is repeatedly aborting  Get into the second trimester and weight of pregnancy begins to be more than what the cervix can hold  Individuals will get to ~15-20wks gestation and cervix will begin to dilate to allow pregnancy to pass

Answer 8

 A purse string suture called a Shirodkar (cerclage) or McDonald procedure may be done to close the cervix temporarily or permanently • Can be done to help maintain the pregnancy through the vaginal vault • May also be done through the abdominal cavity to the top of the cervix  requires C-section birth

Answer 9

by cesarean section @ 37 weeks if not before

Answer 10

sudden onset of painless vaginal bleeding

Answer 11

o Maternal hypertension o Preeclampsia o Folic acid deficiency – required for healthy placenta development o Severe abdominal trauma o Short umbilical cord- descending baby will create traction on the cord o Malnutrition o Sudden  in uterine size o Maternal age >35 o Rough or difficult external version  manipulating uterus to rotate baby o Cocaine use, especially crack • Warrants very close observation or cesarean section

Answer 12

o Board-like, rigid abdomen o Severe, relentless abdominal pain out of proportion to labor   level of discomfort is how to assess if pt having previa or abruptio o Back pain o Colicky, uncoordinated uterine contractions o Or continuous tetanic contractions o Bleeding o Pain localized or generalized o FHR shows periodic changes – late, variable, prolonged, sinusoidal o Loss of variability o Aggressive/exaggerated fetal movement o Increasing fundal height – d/t uterus filling with blood o Maternal shock o May not show on ultrasound  Can only confirm if it is complete or central but cannot r/o if marginal

Answer 13

placenta detachment- it's where it's supposed to be but it starts to detach from the uterine wall

Answer 14

previous uterine surgery (C-section)

Answer 15

o Previous uterine surgery (#1 cause) – C-section o Trauma o Uterine over distention o Uterine abnormalities o Placenta percreta: placenta has gone beyond its normal level of implantation o Choriocarcinoma

Answer 16

baby is too big to make it through the maternal pelvic or is in a position that makes it difficult to come through *maternal bony pelvis is often a factor*

Answer 17

o Arrest of dilation or descent o Abnormal labor patterns o Acute maternal discomfort – “bone on bone” pain o Maternal exhaustion or fetal exhaustion o Early fetal HR decelerations

Answer 18

``` o Reposition o Assess labor pattern o Assess fetal status o Keep provider appraised of progress or lack there of o Keep hydrated o Consider analgesia or anesthesia ```

Answer 19

umbilical cord escapes beyond the presenting part and becomes trapped between the presenting part and the bony pelvis -occurs when the membranes rupture before the baby is engaged enough to cork off the pelvis

Answer 20

o One person must do a continuous vaginal exam and hold the head up off of the cervix o Put patient in trendelenberg or knee chest position o Prepare for an immediate C-section o IV bolus o O2 via mask o Prepare for resuscitation of the infant

Answer 21

immediate cesarean section is warranted

Answer 22

head has come out, but the shoulders are too large and have gotten caught in anterior-posterior dimension of pelvis

Answer 23

classic retreat of the head after it has delievered o Head will recede back into vaginal vault o Considered life threatening for the baby

Answer 24

```  Abnormal pelvic anatomy  Gestational diabetes – baby big AND fat  Post-dates pregnancy  Previous shoulder dystocia  Short stature in patient ```

Answer 25

suspected macrosomia

Answer 26

 Assisted vaginal delivery (forceps or vacuum)  Protracted active phase of first-stage labor  Protracted second-stage labor

Answer 27

the use of extractor or forceps during delivery

Answer 28

 Postpartum hemorrhage  Rectovaginal fistula – extensive lacerations that can be difficult to repair  Symphyseal separation or diathesis, with or without transient femoral neuropathy • Anterior portion of pelvis where there is connective tissue b/w two halves of pelvis that becomes separated  Third- or fourth-degree episiotomy or laceration  Uterine rupture

Answer 29

 Brachial plexus palsy  shearing of nerves that go over arms  Clavicle fracture  Fetal death  Fetal hypoxia, with or without permanent neurological damage  Fracture of the humerus

Answer 30

embryo of the fetus has passed out of the fetus but the placenta remains

Answer 31

women experiences vaginal spotting or bleeding in early pregnancy CERVIX NOT DILATED and placenta still attached to uterine wall

Answer 32

placenta has separate from the uterine wall, CERVIX HAS DILATED, bleeding has increased CANNOT BE PREVENTED

Answer 33

1) elevated BP >140/90 2) protenuria 3) generalized edema

Answer 34

``` maternal age >35 nulliparity diabetes chronic HTN hydratiform mole fetal hydrosis ```

Answer 35

due to the vascular bed inability to maintain that 30-40% blood volume increase during pregnancy-MAIN MECHANISM IS VASOSPASM - body begins to spasm and spasm which leads to microshearing - as the RBC try to get through vessels that are broken due to vasospasm hemolysis occurs as they break down - platelets try to adhere to all the microshearing which leads to a low platelet count - this syndrome affects vascular organs primarily the liver which leads to elevated liver enzymes

Answer 36

- bedrest w close monitoring and status | - we want to try to deliever asap but also want to prolong it for baby's lung's to mature more so we give BETAMETHASONE

Answer 37

Signs and symptoms: o Edema o Proteinuria o increased BP o Headaches – usually frontal and not relievable by Tylenol § R/t cerebral edema o Nosebleeds o Nausea/vomiting o Epigastric pain – often associated when liver starts to become affected § High correlation for progression from preeclampsia to eclampsia o Visual disturbances – stars, flashes of light, diplopia o Hyperreflexia – CNS gets irritable o Oliguria

Answer 38

respiratory! lung maturity

Answer 39

given to prevent seizures BUT given cautiously bc it causes CNS depression and respiratory arrest so we want to monitor every 1 hour and do neuro checks - falls are also a risk and they have trouble with physical activity

Answer 40

-visual distortion or disturbances -eyes cannot accomodate -difficulty walking FALLS

Answer 41

Apresoline- if it's a hypertensive crisis but it decreases placenta perfusion

Answer 42

for ectopic pregnancies where the fallopian tube is intact

Answer 43

placenta previa

Answer 44

delievery by c-section @ or before 37 weeks NEVER VAGINAL DELIVERY

Answer 45

because if we wait, the cervix will thin and may cause the placenta to break away and severe hemorrhage may occur

Answer 46

WE DON'T DO and we don't do it especially if we don't know where the placenta is

Answer 47

multiple pregnancy- multiple placenta implants that leave behind scarring - previous placenta previa - previous therapeutic abortion

Answer 48

when the placenta goes beyond its normal level of implantation and implants on other organs

Answer 49

-the use of a vacuum extractor or forceps during delivery

Answer 50

weight gain within the normal range induction of labor with larger infants elective c-section good control of diabetes in pregnancy

Answer 51

hyperflexion of the maternal hips bilaterally | -increases anterior posterior dimensions of outlet of pelvis to maybe help the infant come through

Answer 52

1) Known or suspected pregnancies 2) Hx of thrombophlebitis or clotting disorders 3) If the patient is age 35 and is a smoker 4) Impaired liver function 5) breast or endometrial cancer 6) Factor 5 Leiden mutation 7) gallbladder disease 8) CV or CAD 9) Undiagnosed genital bleeding 10) Type II Hyperlipedemia 11) Cholestatic Jaundice 12) Hepatic adenomas, cancers or tumors

OB FINAL Flashcards

(79 cards)