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Flashcards in OB test 2 Deck (83)
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1

Spontaneous abortion

pregnancy that ends before 20 weeks.

ends by natural causes.

most occur with in the first 12 weeks.

2

Possible causes of spontaneous abort

  • chromos abnormalities
  • endocrine disorder- hypothyrodism
  • infections- syhphillis. G/C
  • implantation disorders
  • structural factors (incompetent uterus)
  • immunologic factors

3

s/s of abortion

Bleeding, uterine cramping/pain/ctx

4

complications of an abortion

  • risk for infection
  • risk for hemorrhage
  • tissue/organ damage with instrumental procedures
  • potential RH sensitization

5

Threatened abortion

typically just bleeding

days or weeks

may have cramping, back and pelvic pressure which indicates increased risk for inevtiable abortion

6

management for threatend abortion

speculum rxam w/ gentle SVE

ultrasound

type and screen, beta hCG and progesterone (maintains preg, develops lining)

pelvic rest

pad count

7

inevitable abortion s/s

SROM

dilation

ctx's

active bleeding

8

incomplete abortion s/s

partial expulsion of parts of conception (the parts will leave uterus but remain in vagina due to being so small)

severe abd cramping

uterine bleeding

dilation

tissue passed

 

9

managment of incomplete

stablize mom= Vs O2 and IV

Labs: t&s, antibody screen

once stable: sedation, vaccum curettage or D&C, oxytocin or methergine after, PhoGAM PRN

10

complete abortion

All POC passed, incomplete becomes complete onces all parts pass

cramping and bleeding subside

cervix closes

loss of preg symptoms

11

management of complete

Beta hCG tracked (will go down), pad count, monitor for infection, No intercouse until check, RhoGAM PRN

12

Missed abortion

Dead fetus is retained in uterus

s/s- loss of preg symptoms @

size < date

possible brownish-red vag bleeding

13

managemen of misses

U/S - will be no FHR

beta hCG - decreased

evacuation procedure or labor initiation

RhoGAM PRN

A D&C will be done in 1st trimester

Cytotec or methylitrexate - used to expell fetus

14

reccurrent abortion

2 or morse losses in 1st trimester

causes:

genetic or chromosomal

reproductive tract anomalies 

systemic conditions

STDS

DM, Lupus

15

incompetent cervix

reproductive tract abdnormality that cause painless dilation of cervix in 2nd trimester

cannot hold preg to term

 

16

possible causes of incompetent cx

scarring

lacerations/trauma hx

over-stretching

excessive cx dilation in previous D&C

shorten cx

infections

LEEp or cone procedure - takes part of uterus

17

Cerclage

A small stitch put on the cervix to help it stay closed

done between 13-14 wks, rarely done after 25 wks, took out at 37 wks, and some will go right into labor, some dont .

Risks- Rupture of members, chorioaminoitist (infection), Pre term labor from stimulating the uterus.

18

nursing care post cerclage

montior for contractions, SROM, signs of infection

19

medical termination of pregnancy < 7 wks

RU-486 & cytotec

methotrexate

20

medical termination of pregnancy >7 wks

thru 12th week - vacuum aspiration

after 12th wk- dilation and evacuation.

21

s/s of ectopic preg

missed period, vag bleeding, abd pain, + preg test, shock s/s possible if full on rupture

unrupture - dull/ intermittent to colicky pain

rupture- acute pain

22

management of ectopic preg

check labs- hcG will be down and progeterone will be done, get CBC, type & cross match, RH

Transvaginal U/S done

salpingostomy - open and scrap out tube

methotrexate - folic acid antagonist - stops pregnancy

23

complete mole 

hydatidiform mole

results from fertilized egg with no nucleus

looks like a bunch of white grapes on u/s
-no fetus, placenta, membranes or fluid

20% progess to choriocarnioma later on

vag bleeding/hemorrage are common

hcG goes up 

24

incomplete mole

hydatidiform mole

often contrains embryonic or fetal parts and amniotic sac

congential anomolies common

rarely develop cancer later

symptoms may mimic an imcomplete or missed AB

25

s/s of molar pregnancy

absense of F<3R

vag bleeding

n/v- casued by increase hcG levels

preg induced hypertension before 20 wks

26

management of molar preg

dx by u/s and b-hcG

tc for HEG or preeclampsia

follow-up care
- serial b-hcG for 1 year 
-delay another preg 

27

risk for placenta previa

previous c/s

increase risk with multiple gestations- more babies more chance a placenta will implant near OS

cocaine use

smoking

mulitpara

28

Assessment of previa pt.. s/s

sudden onset of Paibless birght red bleeding after 20 wks, scant to profuse amount, may cease, may recur

VS-normal,FHT- reassuring 

abd- soft, relaxed, non-tender, with normal tone, fetus often unengaged due to placental location

29

management of previa pt

get hx- bleeding hx?, amt of bleeding

general status and VS - usually no chagne till late

external fetal monitoring - fetal status, ctx's

labs: CBC, T&S, coags

US

spec exam, NO SVE

if 36 wks and lung maturity documented or is in labor is active significant bleedin - immediate labor !

30

Assessment of abruptio pt

may have vag bleeding (dark red) or it may be concealed

abd or low back pain =dull or ache

uterine tenderness- localized - slight to ridgid/board-like

uterine activity = irritability with hypertoncity common or hyerstimulation

elevated uterine resting tone