Term
| what is the most crucial trimester for embryonic/fetal organ development? |
|
Definition
|
|
Term
| how much folic acid is recommended per day |
|
Definition
|
|
Term
| how does the fetus get nutrients |
|
Definition
| the uterine-placental- fetal unit |
|
|
Term
| factors contributing to nutrient need in crease in pregnancy |
|
Definition
- maternal blood volume
- maternal mammary development
- metabolic needs
- the uterine placental fetal unit |
|
|
Term
| why do you need more iron during pregnancy? |
|
Definition
| because there is excess plasma which decreases hemoglobin concentration causing physiologic anemia of pregnancy |
|
|
Term
| how much more blood do pregnancy women have? |
|
Definition
|
|
Term
|
Definition
<18.5 is low
18.5-24.9 is normal
25-29.9 is overweight
>30 is obese |
|
|
Term
| how much should a pregnant women gain |
|
Definition
normal bmi- 25-35
underweight- 28-40
overwight- 15-25
obese- 11-20
twins 46-62 |
|
|
Term
| what trimesters have most growth in maternal tissues? |
|
Definition
|
|
Term
| risk factors with obesity during pregnancy |
|
Definition
- gestational diabetes
- preeclampsia
- neural tube defects
- macrosomia
- cesarean birth
- postpartum complications |
|
|
Term
|
Definition
iron- can take away effects of certain drugs but is needed for hemoglobin and iron storage
- calcium: teeth and bones, same DRI as usual
- magnesium: energy and metabolism
- potassium
- sodium
- zinc
- fluoride
- idodine- metabolic rate
- protein 46 g (for growth)
- vitamin c for tissue
- folate- increased rbc formation, avoid neural tube defects
- B6/pyroxidine- protein metabolism
- B12- nucleic acids/ proteins
- Vitamin A- cell development
- Vitamin D- calcium/ phosphorous absorption
- vitamin E- antioxidant, prevent RBC breakdown
- Vitamin K |
|
|
Term
| what is B6 / pyroxidine important for? |
|
Definition
|
|
Term
| what is B12 important for? |
|
Definition
|
|
Term
| what is something that may interfere with folic acid absorption? |
|
Definition
|
|
Term
| what to focus on for adolescent pregnancy? |
|
Definition
- knowledge/ meal planning
- nutrition
- prenatal access |
|
|
Term
| what is something that can contribute to preeclampsia? |
|
Definition
|
|
Term
| benefits of exercise during pregnancy |
|
Definition
improves muscle tone, shortens course of labor, and sense of well being
* be sure to drink fluids and eat extra to make u p for caloric loss |
|
|
Term
| nutrition needs during lactation |
|
Definition
- similar to those during pregnancy
- extra 330 kcal recommended! |
|
|
Term
|
Definition
- heartburn
- common during pregnancy |
|
|
Term
|
Definition
|
|
Term
| spicy food may cause what during pregnancy |
|
Definition
|
|
Term
|
Definition
- risks originating in mother or fetus
- affect development/ functioning
- genetics
- nutritional status
- medical/obstetric disorders |
|
|
Term
|
Definition
maternal behaviors/ adverse lifestyle
smoking, caffeine, psychologic status |
|
|
Term
|
Definition
- aris from mother and her family
- lack of prenatal care
- low infcome
- age
- adolescents
- parity/ number of preveous pregnancies (ftm more likely to get preeclampsia)
- residence
-ethnicity (AA highest prematurea nd low birth weight) |
|
|
Term
|
Definition
- infections
- radiation
- chemicals
- drugs
- pollution
- paternal exposure to mutagenic agents |
|
|
Term
|
Definition
-disturbed interpersonal relationship
- unwanted pregnancy, abuse
- emotional distress
- inadequate social support
- substance abuse |
|
|
Term
|
Definition
- less than 300 mL fluid
- renal agenesis
- premature rupture of membrane
- prolonged pregnancy
- severe IUGR
-maternal hypertensive disorder |
|
|
Term
| chromosomal abnormalities |
|
Definition
- advanced age
- parental chromosomal rearrangement
- previous pregnancy with automal trisomy
- abnormal ultrasound |
|
|
Term
|
Definition
|
|
Term
| what can lead to polyhydramios? |
|
Definition
| poorly controlled Diabetes Mellitus |
|
|
Term
|
Definition
| - hypertensive disorders, diabetes, renal disease, poor weight gain, smoking, alcohol/drugs, high altitude |
|
|
Term
|
Definition
|
|
Term
| Daily fetal movement count (DFMC) |
|
Definition
2 goals
1. identify fetuses risk for injury caused by interruption of oxygen
2. identify appropriately oxygenated fetuses to avoid unnecessary intervention
methods
- once a day for 60 mins
- 2-3 x daily
- 10 movements in 12 hour period
- fetal alarm signal that lets you know if movement stops for > 12 hrs |
|
|
Term
|
Definition
- fetal heart rate activity
- gestational age
- fetal growth rate
- fetal anatomy
- genetic disorders
- placental position/ function
- down syndrome (neck and nose)
- placenta privia
- visual assistance
- Doppler blood flow analysis
- amniotic fluid volume
- biophysical profile |
|
|
Term
|
Definition
- fluid volume
- fetal breathing movement
- fetal movement
- fetal tone
- heart rate is scored
- noninvasive |
|
|
Term
|
Definition
|
|
Term
| MRI magnetic resonance imaging |
|
Definition
- images of multiple planes
- fetal structure/ growth
- placenta, position, density, presensce of getational trophoblastic disease, quantity of amniotic fluid, maternal structures, biochemical status of tissues/organs, soft tissue, metabolic, or functional anomalies |
|
|
Term
|
Definition
- done AFTER 14 weeks
- feto maternal hemorrhage- entry of fetal blood into maternal circulation (possible with RH isoimmunization)
- infection
- labor
- abruptioplacentae- placenta pulls away from uterine wall
- intestinal/ bladder damage possible
- amniotic fluid embolism- ambiotic fluid enters maternal blood stream
** done with genetic concerns, women over 35, family history of chromosomal abnormalities,
** done to determine fetal maturity
- L/S and S/A ratios- serial lecithin/ sphingomyelin ratios and surfactant/ albumin ratios to check for lung maturity.
** fetal hemolytic disease check |
|
|
Term
| amniotic fluid embolism can happen how |
|
Definition
| when amniotic fluid enters maternal blood stream (from amniocentesis) |
|
|
Term
| what do they check for during the amniocentesis when looking at fetal maturity of lungs |
|
Definition
-L/S and S/A ratios- serial lecithin/ sphingomyelin ratios
- surfactant/ albumin ratios |
|
|
Term
| chorionic villus sampling |
|
Definition
DONE AT 10-13 weeks
- earlier diagnosis and rapid results
- removal of small smaple of tissue from fetal portion of placenta
- chorionic villi originate in zygote
- tissue reflects genetic makeup of fetus |
|
|
Term
| which has earleier diagnostics? Chorionic villus sampling or amniocentesis? |
|
Definition
CVS- 10 - 13 weeks
amnio- 14 |
|
|
Term
percutaneous umbilical blood sampling (PUBS)
or
cordocentesis |
|
Definition
- direct access to fetal circulation
- insertion of needle directly into fetal umbilical tissue
- ultrasound guidance
- been replaced by placental biopsy in many centers |
|
|
Term
| what test allows direct access to fetal circulation |
|
Definition
| percutaneous umbilical blood sampling (PUBS) or cordocentesis |
|
|
Term
|
Definition
1. alpha fetoprotein (AFP)
- maternal serum levels screened
- 80-85% of open Neural tube defects and abdominal wall defects can be detected early
- recommended for all pregnancy women
2. multiple marker screens (11-14 weeks)
- detects chromosomal abnormalities
- used with increased risk for downs syndrome
3. coomb's test
- test Rh incompatability
- detects other antibodies for incompatability with maternal antigens
4. cell free DNA in maternal blood
- new screening message for non invasive prenatal genetic diagnosis can show fetal Rh status, gender, and paternally transmited single gene disorders, works by amplifying cell free DNA |
|
|
Term
| which maternal assay detects neural tube defects and abdominal wall defects 80-85% of the time?! |
|
Definition
alphafetoprotein
( recommended for all pregnant women) |
|
|
Term
| what maternal assay would be used on a woman with increased risk for downs syndrome child? |
|
Definition
| multiple marker screens (11-14 weeks) |
|
|
Term
| cell free DNA in maternal blood can show what |
|
Definition
- rh status of fetus
- gender
- paternally transmitted single gene disorders
* works by amplifying cell free DNA |
|
|
Term
| antepartal assessment using electronic fetal monitoring |
|
Definition
- determine if intrauterine environment is supportive to fetus
- nonstress test: activity determination, procedure, interpretation (reactive or non reactive) |
|
|
Term
| for the non stress test what is considered reactive? |
|
Definition
| 2 accelerations in 20 minute period each lasting at least 15 seconds peaking at at least 15 beats above baseline |
|
|
Term
|
Definition
- see if fetus is able to handle contractions
- nipple stimulated contraction test- causes oxytocin release
- oxytocin- stimulated contraction test
- provides warning of fetal compromise earlier than non stress testw |
|
|
Term
| what can provide a warning of fetal compromise earlier than the non stress test? |
|
Definition
| the contraction stress test |
|
|
Term
| nursing role in antepartal assessment for risk |
|
Definition
- educate
- support
- assist physician with procedures
- perform NSTS, CSTS, BPPs
- initial asessments |
|
|
Term
| group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both |
|
Definition
|
|
Term
| most common endocrine disorder associated with pregnancy |
|
Definition
|
|
Term
| what is the key to diabetes mellitus management? |
|
Definition
| strict maternal glucose control b/c poor glycemic control is associated with congenital anomalies of fetus |
|
|
Term
|
Definition
type 1- abrupt onset, young age
type 2- most prevalent, insulin resistence, often undiagnosed
gestational- any degree of glucose intolerance with onset or recognition during pregnancy
other- infection caused or drug induced |
|
|
Term
| pregestational diabetes mellitus |
|
Definition
- occurs in women who have preexistin disease
- complicated by vascular disease, retinopathy, or nephropathy
- type 2 most prevalent
- almost all are insulin dependent
- |
|
|
Term
| insulin doses increase after ____ trimester or _____ weeks |
|
Definition
1st trimester
- around 14-16 weeks |
|
|
Term
| risks and complications with pregestational diabetes |
|
Definition
- marosomia
- hydramios (polyhydramios)
- ketoacidosis
- hyperglycemia
- hypoglycemia
- still birth
- malformations
- CVS, CNS, skeletal malformation
- 2-5% of all fetal deaths occur in mother swith preexisting diabetes |
|
|
Term
| special considerations for patients with pregestational diabetes |
|
Definition
- baseline renal function test
- glycosylated hemoglobin A
- needs more monitoring
- may require c section
- insulin requirements decrease substantially postpartum |
|
|
Term
| why would you encourage breastfeeding in pregestational diabetes patients? |
|
Definition
it has an antidiabetogenic effect
- 1/2 as much insulin is needed |
|
|
Term
| why is oral contraception controversial |
|
Definition
| - risk of thromboembolytic and vascular complications and effect on carbohydrate metabolism |
|
|
Term
| gestational diabetes test |
|
Definition
-1 hour >130-140
- 3 hour
1 hr > 95
2 hr > 155
3 hr > 140 |
|
|
Term
|
Definition
90-95% graves disease
- rare in pregnancy
- heat intolerance
- sweating
- fatigue, anxiety, tachycardia |
|
|
Term
|
Definition
- hashimotos
- risk for infertility/ miscarriage
- many infertility patients just hypothyroidism
- miscarriage
- slow weight gain, lethargy, decrease exercise capcity
- cold intolerance |
|
|
Term
| maternal phenylketonuria (PKU) |
|
Definition
- cause of mental retardation
- inhibits melanin production
- autosomal recessive
- deficiency in enzyme phenylalanine hydrolase)
- toxic accumulation of phenylalanine in blood that infeteres with brain development
- key to prevention is identification of women with disorder in their reproductive years
** ADVISE AGAINST BREAST FEEDING!!! |
|
|
Term
| who would you advise against breastfeeding? |
|
Definition
| maternal phenylketoneuria (PKU) patients |
|
|
Term
| cardiovascular changes during pregnancy affecting women with cardiac disease |
|
Definition
- increased intravascular volume
- decreased systemic vascular resistance
- cardiac output changes during labor and birth
- intravascular volume changes that occur just after child birth |
|
|
Term
| classification of cardiovascular disease |
|
Definition
class I- asymptomatic
class II- symptomatic with slight limitations
class III- marked limitation
class IV- inability to carry out physical activity without discomfort
***DETERMINED AT 3 months and AGAIN at 7/8 MONTHS~~
PROGRESSION MAY OCCUR |
|
|
Term
| when is the class of CVD determined? |
|
Definition
***DETERMINED AT 3 months and AGAIN at 7/8 MONTHS~~
PROGRESSION MAY OCCUR |
|
|
Term
| what are the risks associated with cardiovascular disease during pregnancy? |
|
Definition
- miscarriage
- preterm labor/ birth
- IUGR more common
- congenital heart lesion incidence increases in fetus |
|
|
Term
| congenital cardiac disease |
|
Definition
- atrial septal defect
- ventricular septal defect
- coartication of aorta
- tetralogy of fallot |
|
|
Term
|
Definition
|
|
Term
| what is the most common congenital defect in pregnancy? |
|
Definition
|
|
Term
| ventricular septal defect |
|
Definition
opening between ventricles
- left to right shunt |
|
|
Term
|
Definition
- ventricular septal defect
-overriding aorta
- right ventricular hypertrophy
- right to left shunt
- pulmonary stenosis |
|
|
Term
| what is the most common cyanotic heart defect? |
|
Definition
|
|
Term
| acquired cardiac diseases |
|
Definition
- mitral valve prolapse: back flow of blood into the atrium
- mitral valve stenosis: narrowing of opening (almost aways d/t rheumatic heart disease) |
|
|
Term
| what acquired cardiac issue is almost always due to rheumatic heart disease? |
|
Definition
|
|
Term
|
Definition
| myocardial infarction: acute ischemic event |
|
|
Term
|
Definition
- persistant pulmonary hypertention (contraindicatory in pregnancy)
- peripartum cardiomyopathy (CHF with cardiomyopathy)
- infective endocarditis
- eisenmeneger syndrome- right to left shunt
- marfan syndrome- autosomal dominant enlongated hands and face with heart problems |
|
|
Term
| what must be assessed for woman who has had a heart transplant? |
|
Definition
- ventricular function and potential rejection of transplant before conception
- postpone conception for 1 year after transplant in case of rejection |
|
|
Term
| signs and symptoms of heart decompensation |
|
Definition
- dyspnea
- crackles
- irregular weak pulse
- cough
- palpitations |
|
|
Term
|
Definition
-USE HEPARIN ONLY FOR PREGNANY WOMEN!
- heparin is large and does not cross placenta
(WARAFIN WILL) |
|
|
Term
|
Definition
| - given intrapartum to prevent bacterial endocarditis |
|
|
Term
| how long after birth should you monitor for cardiac decompensation? |
|
Definition
|
|
Term
| what is a sign of impending ventricular failure? |
|
Definition
- rr > 24
- HR > 100
- with dyspnea |
|
|
Term
|
Definition
22-60% pregnancies affected
1. iron deficiency anemia: dark green leafy, citrus to absorb, whole grains, maet
2. sickle cell hemolobinopathy- genetic
3. thalassemia- genetic insufficient amount of hemoglobin (Mediterranean, Asian, middle eastern) |
|
|
Term
|
Definition
- exacerbations and remissions
- hyperreactive airways
- effected pregnancies unpredictable
- increase risk of POSTPARTUM HEMMORHAGE |
|
|
Term
|
Definition
- autosomal recessive
- infants of mother with CF will be carriers
- pregnancy complicated by CHRONIC HYPOXIA and FREQUENT PULMONARY INFECTIONS
- resp and GI problems
- survival 29 male 27 female
- EXOCRINE GLANDS PRODUCE EXCESSIVE VISCOUS SECREITIONS |
|
|
Term
| what happens during pregnancy with cystic fibrosis that makes it complicated? |
|
Definition
- chronic hypoxia
- frequent pulmonary infections
- resp and GI problems |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| patches on palms of hands |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| neurofibromatosis (von Recklinghausen disease) |
|
Definition
| tumors grow in nervous system |
|
|
Term
| pruritic urticarial papules/ plaques (PUPP) |
|
Definition
|
|
Term
|
Definition
- liver disorder
- pruritis
- 3rd trimester
- elevated bile acids and liver function tests
- jaundice possible |
|
|
Term
| how much more insulin is needed in the third trimester? |
|
Definition
|
|
Term
|
Definition
- most common neurologic disorder
- failure to take meds is a common factor
- risk of anomalies from anticonvulsants |
|
|
Term
| what is the most common neurologic disorder? |
|
Definition
|
|
Term
|
Definition
| - bed rest and steroids used to treat acute exacerbations |
|
|
Term
| what is used to treat MS? |
|
Definition
|
|
Term
| systemic lupus erythematosus |
|
Definition
- autoimmune antibody production
- skin, joints, kidney, lungs, CNS, liver, organs effected
- exacerbated by pregnancy
- immunosuppressive medications not recommended in pregnancy
*efforts aimed at reducing risk of infection |
|
|
Term
| with women with lupus efforts are aimed at what? |
|
Definition
| reducing risk of infection |
|
|
Term
| what disease is exacerbated by pregnancy? |
|
Definition
|
|
Term
|
Definition
autoimmune motor (muscle) endplate disorder
- muscle weakness in eyes, face, neck, limbs, and respiratory muscles
- usually tolerate labor well
- may require vaccuume/forceps |
|
|
Term
| less than 10% of which pregnant women receive prenatal care |
|
Definition
|
|
Term
| preeclampsia complicates what percent of pregnancies? |
|
Definition
| 5-10% (usually first time pregnancies) |
|
|
Term
| what may be elevated in the 2nd trimester? |
|
Definition
|
|
Term
| what is the most common medical complication reported in pregnancy? |
|
Definition
|
|
Term
| eclampsia/ preeclampsia is |
|
Definition
| high blood pressure and protein in the urine |
|
|
Term
| high blood pressure with onset after week 20 and no protein in the urine is |
|
Definition
|
|
Term
| high blood pressure with onset after 20 week due to a vasospastic systemic disorder and protein in the urine |
|
Definition
|
|
Term
|
Definition
- seizures
- coma
- no history of issues
- seizures before, during, and after birth |
|
|
Term
|
Definition
| present before pregnancy or diagnosed before 20 weeks |
|
|
Term
| present before pregnancy or diagnosed before 20 weeks |
|
Definition
|
|
Term
| women with chronic hypertension may aquire what |
|
Definition
|
|
Term
| what happens with preeclampsia? |
|
Definition
- inadequate vascular remodeling
- hypoxia
- decreased placental perfusion
- endothelial cell dysfunction
- placental itching
- generalized vasospasm
- increased peripheral resistance
- reduced kidney perfusion (build up of urine causing kidney infection and increased uric acid)
-increased endothelial cell permeability
- decreased tissue perfusion
- not enough oxygen and nutrients to fetus |
|
|
Term
|
Definition
- family history
- multifetal pregnancy
- African americans
- obesity
- <19 or >40 years old
- preexisting medical conditions |
|
|
Term
|
Definition
-variant of severe preeclampsia
- laboratory diagnostic
- hepatic dysfunction
(hemolysis (H), elevated liver enzymes (EL), low platelets (LP)
risks:
*pulmonary edema
- renal failure
- liver hemorrhage/failure
- DIC
- placental abruption
- ARDS
- sepsis
- stroke
- death of fetus or mother |
|
|
Term
| what does HELLP stand for |
|
Definition
H- hemolysis
EL- elevated liver enzymes
LP- low platelets |
|
|
Term
| assessment for preeclampsia |
|
Definition
- edema
- dtr diminished
- clonus
- proteinuria |
|
|
Term
| when do preeclampsia usually deliver |
|
Definition
|
|
Term
| what do you give to severe preeclampsia patients intrapartum? |
|
Definition
| magnesium sulfate- to prevent seizures (may also slow down contractions or stop them) |
|
|
Term
| with women with chronic hypertension what increased risks are there |
|
Definition
- placental abruption
- superimposed preeclampsia
- preinatal mortality
- fetal growth restriction
- preterm birth (<38 wk)
- |
|
|
Term
| what meds are used with hypertension in pregnancy/ breastfeeding |
|
Definition
| methyldopa and hydralazine (for breastfeeding) |
|
|
Term
|
Definition
- excessive vomiting
- dehydration
- electrolyte imbalance
- ketosis
- acetonuria
- weight loss, decreased BP, increased pulse, poor skin turgor
- iv therapy |
|
|
Term
|
Definition
| loss of pregnancy before 20 weeks |
|
|
Term
| placental ischemia can be caused by |
|
Definition
preeclampsia
( it causes endothelial cell dysfunction by stimulating the release of a substance that is toxic to endothelial cells) |
|
|
Term
| what is the problem with reduced kidney perfusion caused by preeclampsia? |
|
Definition
| - kidneys are responsible for excretion so a reduced perfusion will lead to a build up in kidneys (uric acid, protein, etc) |
|
|
Term
| poor perfusion in preeclampsia is a result of |
|
Definition
vasospasms
reduced plasma volume |
|
|
Term
| what leads to impaired liver function and elevated LFT levels in preeclampsia? |
|
Definition
|
|
Term
| vasospasm and poor organ diffusion are characteristic of |
|
Definition
|
|
Term
| with the HELLP syndrome what increases |
|
Definition
|
|
Term
|
Definition
|
|
Term
| meds to control blood pressure necessary if bp is over |
|
Definition
|
|
Term
|
Definition
raise bed rails
pad them with folded blanket or pullow
- lower head of bed and turn woman onto her side to prevent aspiration
- assess women, suction, start magnesium IV, check they are not in labor
- |
|
|
Term
| hemorrhagic disorders in pregnancy are _____ |
|
Definition
medical emergencies
* maternal blood loss decreases oxygen carrying capacity!!RISKS:
- hypovolemia
- anemia
- infection
- preterm labor/ birth
- adversely affect oxygen delivery to fetus
- fetal risk include blood loss, anemia, hypoxemia, hypoxia, anoxia, and preterm birth |
|
|
Term
|
Definition
- ends before 20 weeks d/t natural causes
types:
1. threatened- chance of miscarriage is likely
2. inevitable- rupture of membranes and cervical dilation- passage of the products of conception
3. incomplete- heavy/profuse bleeding- expulsion of uterus with retension of placenta
4. complete- all fetal tissue expelled, may have slight bleeding
5. missed- fetus died but products of conception are retained in utero for up to several weeks
clinical manifestations: bleeding, contractions, pain
management: depends on classification of miscarrigage, s/s
psychosocial aspects of care/ grief
follow up necessary, emphasize need for rest
1. medical management (to end pregnancy)
2. dilation and currttage (D&C)- cervix is dilated and sucked out |
|
|
Term
| common bleeding disorders of early pregnancy |
|
Definition
- miscarriage
- reduced cervical competence
- ectopic pregnancy
- hydatiform mole |
|
|
Term
| reduced cervical competence |
|
Definition
- bed rest, pessaries, progesterone, anti-inflammatory drugs, antibiotics
- cervical cerclage by McDonald technique
- prophylactic cerclage is placed at 11-15 weeks of gestation> usually removed by 37 weeks
- abdominal cerclage may be done at 11-13 weeks |
|
|
Term
| when is a prophylactic cerclage placed? and when is it removed? |
|
Definition
11-15 weeks
removed at 37 weeks |
|
|
Term
| when is an abdominal cerclage done? |
|
Definition
|
|
Term
|
Definition
| slip stich, can close the cervix |
|
|
Term
|
Definition
- fertilized ovum is implanted outside uterine cavity
- 95% in uterine tube (most on ampulla)
- can also be on ovary, abdominal cavity, or cervix
METHOTREXATE GIVEN!! induces abortion
- extreme abdominal pain, delayed menses, spotting, usually how you diagnose it before rupture
medical removal: methotrexate
surgical: salpingectomy- removal or the entire tube; cant get pregnant after
surgical= salpingectomy |
|
|
Term
|
Definition
| given to expel contents of ectopic pregnancy |
|
|
Term
|
Definition
removal of uterine tube
(d/t ectopic pregnancy)
can no longer get pregnant after |
|
|
Term
gestational trophoblastic disease
2 types |
|
Definition
- hydatifiform mole (molar pregnancy)
- 1/1000
- abnormal fertilization without a viable fetus
1. complete(classic): mole results from fertilization of egg with los or inactivated nucleus
2. partial mole: result of two sperm fertilizing a normal ovum
**can lead to cancer
** cant get pregnant within year
clinical manifestations: vaginal bleeding, significantly larger uterus
management: most pass spontaneously, suction curettage
*induction of labor by oxytocin is not recommended
"snowstorm pattern" |
|
|
Term
| choriocarcinoma may develop due to what |
|
Definition
|
|
Term
| 2 forms of birth control should be used when what |
|
Definition
| a year after gestational trophoblastic disease |
|
|
Term
placenta previa
types
outcomes |
|
Definition
- placenta in lower uterine segment
- near internal cervical os or over it
- s/s: bleeding
- fetal risks for preterm birth, anemia, congenital anomalies (not enough oxygen)
*CLASSIFICATIONS
1. complete: total coverage of cervix
2. marginal: part is covering cervix; the edge of the placenta is seen on transvaginal ultrasound to be 2.5 cm or closer to the internal cervical os
3. low lying- when exact relationship of the placenta to the internal cervical os hasn't been determined or in apparent PP in 2nd trimester- getting close
otucomes:
- abnormal placental attachment
- excessive bleeding
- preterm birth, anemia of fetus
- congenital anomalies |
|
|
Term
| what is done to look for placenta previa |
|
Definition
| transabdominal ultrasound exam |
|
|
Term
| management of placenta privia |
|
Definition
- expectant management: observation and bed rest to allow fetus time to mature
- cesarean birth: will always occur if it is COMPLETE
- home care
- active management: if 36+ weeks, bleeding is excessive, will need immediate C section |
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Term
| premature separation of placenta (abruption placentae) |
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Definition
placenta pulls away from inside of uterus after 20 weeks
- most common reason in maternal hypertension, cocaine use, or trauma
- 1 mild, 2 moderate, 3 severe
*pain and hard abdomen, can happen very quickly
outcomes:
- mother prognosis depends on extent of detachment, blood loss, degree of coagulopathy present and time between placental detachment and birth
Management:
- expectant management: if less than 34 weeks and stable
- active: immediate birth if at term or heavy bleeding |
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Term
| if placenta is away from the uterus you have how long to deliver |
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Definition
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Term
| velamentous insertion of cord |
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Definition
- rare
- associated with placenta previa and multiple gestation
- cord vessels branch at membranes and course into placenta
- rupture of membranes or traction on cord may tear one or more fetal vessels which could lead to fetus bleeding to death
- fetus may rapidly bleed to death as a result
- 3 vessels in umbilical cord |
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Term
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Definition
| when fetal vessels lie over the cervical os |
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Term
| velamentous insertion of cord is associated wtih |
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Definition
| placenta privia and multiple gestation |
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Term
|
Definition
- placenta has divided into 2 or more lobes
- fetal vessels run between the lobes
- one or more lobes may remain attached after delivery
- increased risk of hemorrhage for the mother |
|
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Term
| battledore (marginal) insertion of cord |
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Definition
- increases risk of fetal hemorrhage
- especially after marginal separation of placenta
- attached at margin of placenta |
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Term
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Definition
- homeostasis between opposing hemostatic and fibrinolytic systems
- hemostatic system is involved in lifesaving process: it stops flow of blood from injured vessels through formation of insoluble fibrin, which acts as a hemostatic platelet plug
coagulation process: involves interaction of coagulation factors, in which each factor sequentially activated the factor next in line, "cascade effect"
fibrinolytic system process
- fibrin split into fibrinolytic degradation products
- circulation restored
- prevents blood clots from growing and becoming problematic |
|
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Term
| what is produced through the hemostatic system that acts as a hemostatic platelet plug? |
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Definition
|
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Term
| DIC (disseminated intervascular coagulation) |
|
Definition
- diffuse clotting causing widespread external and internal bleeding
- triggered by severe preeclampsia, HELLP, and gram negative sepsis |
|
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Term
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Definition
asymptomatic bacteriuria- no symptoms
cystitis- dysuria, frequency, urgency
pyelonephritis- most often in 2nd trimester, hospitalization may be necessary |
|
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Term
| when is pyelonephritis most common in pregnancy? |
|
Definition
|
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Term
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Definition
- appendicitis: most common nonobstetric surgical emergency during pregnancy- right lower quadrant pain
- cholelithiasis(gallstones)- avoid high fat foods
- cholecystitis (inflammation of gall bladder)- avoid high fat foods
- gynecologic problems: ovarian cysts, twisting/torsion, etc |
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Term
| effect of trauma on pregnancy is influenced by what |
|
Definition
- length of gestation
- type and severity of trauma
- degree of disruption of uterine and fetal physiologic features |
|
|
Term
| physiologic characteristics of maternity to consider during trauma care |
|
Definition
- uterus and bladder positioning: Uterus is enlarged and bladder is displaced forward
- elevated levels of progesterone
- decreased tolerance for hypoxia and apnea
- cardiac output- increases
- circulating blood volume- increases |
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Term
| fetal monitor tracing works as a _____ of internal maternal well being |
|
Definition
|
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Term
|
Definition
| MVA, battering or falls, head injury, usually placental abruption will be cause of fetal death if that happens |
|
|
Term
| penetrating abdominal trauma |
|
Definition
- bullet or stab wounds
- uterus may protect mother |
|
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Term
|
Definition
- pulmonary contusion
- pneumo/hemothorax |
|
|
Term
| perimortem cesarean delivery |
|
Definition
| if no maternal pulse after 4 minutes |
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