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(PA School) Women's Health > Week 8 pt 2 highlights > Flashcards

Week 8 pt 2 highlights Flashcards

(84 cards)

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1
Q

Define recurrent abortions

A

Three successive spontaneous abortions

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2
Q

List some causes of recurrent abortions

A

1) Uterine causes
2) Chromosomal abnormalities
3) Lupus
4) Endocrine
5) Thrombophilias
6) Antiphospholipid syndrome
7) Maternal Infections, especially TORCH infections

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3
Q

Incompetent cervix: Cervical length of less than _____ cm and/or internal cervical os open 1 cm or greater is diagnostic

A

2cm

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4
Q

“Funneling” of the cervix may be noted on US with what?

A

Incompetent cervix

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5
Q

Cold Knife Cone procedures, LEEP procedures (like for CINs) are risk factors for what?

A

Incompetent cervix

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6
Q

Cerclage has better outcomes if done _______ membranes are visible

A

before

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7
Q

Define macrosomia and name a risk

A

Birth weight of 4000-4500 Grams (8lbs13 – 9lbs15)
-DM is a risk

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8
Q

Macrosomia can only be diagnosed _____ the baby is born

A

after

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9
Q

Abdominal circumference greater than _________ on ultrasound very predictive of baby weighing > 8lbs 13oz

A

35cm

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10
Q

Macrosomia is associated with increased ____________ risk

A

fetal/maternal

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11
Q

Give examples of risks with macrosomia

A

1) Neonatal injury
2) Neonatal morbidity
3) Maternal injury
4) C. Section

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12
Q

True or false: Cesarean Section has an inherent increased risk due to surgery and anesthesia

A

True

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13
Q

Macrosomic babies significantly more likely to be ___________

A

stillborn

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14
Q

Antenatally, you should watch for large fetuses for their dates by what?

A

fundal height

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15
Q

If fundal height is ____ cm larger than expected, assess by ultrasound and may need to re-evaluate for diabetes

A

3-4cm

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16
Q

______________ babies must be delivered by someone experienced and comfortable with delivering a baby with shoulder dystocia

A

Macrosomic

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17
Q

Macrosomic babies must be delivered in a setting where an _______________ is an option

A

emergency C-Section

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18
Q

Macrosomia babies need careful glucose monitoring: at risk for ______________

A

hypoglycemia

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19
Q

Most macrosomic babies are delivered from either _____________ or ___________ diabetics

A

diagnosed or UNDIAGNOSED

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20
Q

Macrosomia: What should you watch mom for after delivery? Why?

A

Watch mom for increased bleeding.
May be uterine atony or an undiagnosed cervical laceration

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21
Q

Define Intrauterine Growth Restriction (IUGR)

A

Fetus whose weight is below the 10th percentile for gestational age

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22
Q

Placental issues may cause what?

A

Asymmetrical IUGR

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23
Q

TORCH infections may cause what?

A

Symmetrical IUGR

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24
Q

Most common cause of fetal growth restriction is what?

A

Abnormal placentation causing placental insufficiency

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25
IUGR associated with increased _____ mortality
perinatal
26
List 3 aspects of IUGR management
Strenuous antenatal surveillance: 1) Ultrasound 2) Fetal biometry measurements 3) Fetal surveillance
27
What is stillbirth also called?
Intrauterine Fetal Demise (IUFD)
28
How is fetal demise confirmed?
By absence of fetal heart tones or cardiac motion on ultrasound
29
Absence of fetal movement (later in pregnancy) is confirmed by what?
Ultrasound
30
What is fetal demise confirmed with after absence of fetal heart tones and u/s?
Serially falling hCG and u/s documentation
31
In Tennessee, a fetal death is the death of a fetus weighing ______ or more grams.
350
32
In pregnancies before ________ weeks, inadequate amniotic fluid generally prevents normal development of the alveoli within the fetal lungs.
24
33
Pregnancies before ______ weeks are not considered viable
24
34
Define PROM
Premature (pre-labor) rupture of the membranes = rupture of the membranes before the onset of labor (mom is already greater than 37 weeks pregnant)
35
Define PPROM
Preterm PROM = refers to PROM before 37 weeks gestation
36
Rare incidence of DIC associated with waiting for birth after what?
Fetal death
37
What is the best Tx for fetal death?
Delivery (usually with an induction)
38
List 2 causes of PROM and PPROM
1) Doubled risk in women who smoke 2) Previous PROM (two-fold risk)
39
PPROM/PROM: Fluid passing through the vagina must be presumed to be _________ until proven otherwise
amniotic fluid
40
PROM/PPROM: 1) What is one thing you should do? What should you not do? 2) List 4 tests
1) Sterile speculum exam NO digital exam 2) Nitrazine test, amnisure test, fern test, ultrasound
41
How can you induce delivery for PROM at term?
Oxytocin
42
What is the mgmt of PROM and PPROM heavily dependent on?
Gestational age
43
Preterm Birth is defined as birth before ______ completed weeks of gestation (259 days)
37
44
Most common cause of perinatal morbidity and mortality is what?
Preterm birth
45
What are the 2 main categories of preterm birth?
Spontaneous vs indicated
46
40-50% Spontaneous preterm labor occurs with _________ membranes
intact
47
25-40% Spontaneous preterm labor is from _________
PPROM
48
Give the short definition of preterm labor
Regular contractions + cervical changes Occurring before 37 weeks gestation
49
Give 2 risk factors for preterm labor
Multiple gestation Prior preterm birth
50
List some factors improving outcomes of preterm labor. Which causes Decreased incidence of respiratory distress syndrome, intraventricular hemorrhage? Which decreases incidence of CP?
1) NICU 2) Corticosteroids = Decreased incidence of respiratory distress syndrome, intraventricular hemorrhage 3) Tocolytic therapy 4) Magnesium sulfate administered prior to preterm birth Decreased incidence of cerebral palsy 5 )GBS prophylaxis
51
Give some examples of tocolytics (need to know these)
52
Perinatal survival has improved in babies >____ gestational weeks
27
53
List 6 aspects of assessing preterm labor
1) Uterine monitoring 2) Fetal fibronectin testing 3) Cervical evaluation 4) U/s 5) Urinalysis 6) Amniocentesis (not always)
54
Preterm labor Tx: Typically, do NOT start ________ after 35 to 36 weeks (or if + infection)
tocolysis
55
Preterm labor Tx: From ______ to _____ weeks, steroids have been shown to hasten lung maturity in the fetus (single dose)
24 to 34
56
Preterm labor Tx contraindications: Heavy vaginal bleeding suggestive of placental disruption may indicate what?
Placental abruption
57
Cervix is more __________ and _________ in pregnancy
vascular and friable
58
What are the 2 most common causes of third trimester bleeding?
Placenta previa Placental abruption
59
List some important characteristics of Placenta Previa
-Bleeding is bright red and PAINLESS. -Associated with an increase in preterm birth and perinatal mortality and morbidity -Usually known due to ultrasound -Complete placenta previa rarely resolves spontaneously
60
Is Placenta Previa painful or painless? (important/ know this)
Painless
61
What are some important parts of placenta previa mgmt if fetus is premature and bleeding is not heavy enough to warrant immediate delivery?
Close observation Frequent BP measurements Fluid administration Bed rest Steroids
62
Placenta previa: if stable,_________ delivery between 36 0/7 – 37 6/7 weeks
c-section
63
Associated with other placental implantation abnormalities, such as what?
Placenta accreta, increta, percreta; may require hysterectomy after c-section
64
What is Vasa Previa? What needs to be done?
amnion with vessels is in front of the presenting part Apt test to differentiate maternal blood from fetal blood
65
Placental abruption: Premature separation of the placenta from the uterine wall after _____ weeks but before birth of baby
20 wks
66
With ______________ placental abruption, part of the placenta starts to come away from the uterus, bleeding and pain increases
partial
67
Name a big risk of placental abruption (hint: it's obvious)
History of abruption
68
Placental abruption: Does amount of blood necessarily correspond with the degree of separation?
No; amount of blood does NOT necessarily correspond with the degree of separation
69
List 2 Sx of placental abruption
1) Abd pain 2) Vaginal Bleeding
70
Placental abruption: Non-reassuring fetal heart rate: How may diagnosis suspected by PE be confirmed?
Bedside ultrasound
71
Placental abruption in labor generally results in what?
A c-section
72
If the abruption is due to_______ and is not ________, particularly if the baby is premature and not exhibiting signs of distress, patient/baby can be observed
trauma; enlarging
73
When is delivery often by c-section?
Placental abruption
74
List 2 important points abt Couvelaire Uterus
May require hysterectomy to control bleeding after delivery Can be life-threatening
75
Placental Abruption has a close association with what? What are 3 findings with this?
DIC; Increased fibrin degradation products (FDP) Decreased platelet count Increased PTT
76
What is the biggest risk factor for breech babies? Why?
Prematurity; many babies don’t “flip” before 32 weeks
77
List some other malpresentations besides breech
Face, brow, shoulder, compound
78
___________________ (chin facing anterior and is presenting part of the face) is the only face presentation that will allow for vaginal delivery
Mentum anterior
79
Post term pregnancy = pregnancy that has gone beyond _____ completed weeks
42
80
Post Term Pregnancy: What is the most common cause? Does it incr. risk for mom or baby?
Incorrect estimation of gestational age; incr. risk to baby
81
True or false: Due to increased morbidity, most practices will not let go beyond 42 weeks
True
82
Post Term Pregnancy: List some things it's associated with
1) Macrosomia 2) Shoulder dystocia 3) Meconium aspiration syndrome (MAS) 4) Dysmaturity syndrome 5) Oligohydramnios
83
As the patient approaches 41 weeks, determine plan; what are your 2 options?
1. Induction of labor -VS- 2. Antepartum fetal surveillance
84
Induction of labor at _______ weeks has become the preferred management of post-term pregnancy
41

(PA School) Women's Health (48 decks)

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