Term
| Ectopic Pregnancy: high risk |
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Definition
- tubal surgery (30%)
- previous ectopic (15%)
- Hx of PID (15%)
- Using or used IUD (9%)
- hx of infertility |
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Term
| Where do ectopic pregnancies usually occur? |
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Definition
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Term
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Definition
1. amenorrhea
2. AUB - dark brown to tarry spotting
3. Abdominal/pelvic pain complaints
4. Unilateral lower quadrant pain
5. Lower back pain or shoulder pain
6. Hemodynamic changes if in SHOCK |
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Term
| Ectopic pregnancy: Exam (4) |
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Definition
- Positive CMT
- Tender adnexa w/ possible mass
- uterine enlargement w/ Hegar's sign
- Positive peritoneal signs if rupture and maybe vaginal bleeding |
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Term
| Ectopic pregnancy: Diagnostic tests |
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Definition
- Serum hCG (quantitative)
- CBC type and Rh
- Ultrasound
- Preop labs |
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Term
| What do u do for ectopic pregnancies? |
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Definition
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Term
| Spontaneous abortion: first trimester cause |
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Definition
| - due to random chromosomal abnormalities, do not repeat in subsequent pregnancies |
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Term
| Spontaneous abortion: second trimester cause |
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Definition
| - due to cervical incompetence, infection, or uterine abnormalities |
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Term
| Spontaneous abortion: management |
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Definition
1. refer
2. bed rest if threatened or inevitable
3. abstinence
4. Labs - HCG, ultrasound, CBC and Rh, coag profile |
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Term
| Surgical abortion: 3 types |
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Definition
1. Vacuum D and C: to 12 weeks
2. D and E: 13 to 14 weeks to 20 to 22 weeks
3. Hysterotomy/hysterectomy |
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Term
| Medical abortion - 2 types |
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Definition
*Indicated through 49 days pregnancy
1st trimester: Mifepristone (mifeprex) AKA RU 486
2nd trimester: Prostaglandin (Misoprostol) |
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Term
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Definition
| BP>140/90, OR rise in systolic > 30 mmHg or diastolic >15 mmHg above baseline on at least 2 occasions, w/ readings 6 hours apart |
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Term
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Definition
| PIH + proteinuria + generalized edema AFTER 20 WEEKS GESTATION |
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Term
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Definition
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Term
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Definition
Hemolysis
Elevated
Liver enzymes
and a
Low
Platelet count |
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Term
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Definition
1. Pre-existing hypertension, renal, cardiovascular disease -NUMBER ONE INDICATOR
2. Diabetes
3. Lupus, autoimmune disorders
4. Multiple gestation
5. Primigravida
6. Personal or FH of PIH, preeclampsia
7. Maternal age - young or old (14 or 35) |
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Term
| PIH: management and testing |
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Definition
- NST after 32 to 34 weeks or PRN
- Rest at home: if it worsens, bed rest in left lateral recumbent position
- fetal surveillance: NST, ultrasound, and kick counts for fetal activity at home |
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Term
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Definition
1. sudden weight gain - can't get rings off/shoes on
2. Progresses from peripheral to generalized edema
3. Frontal or occipital headaches
4. Visual disturbances as it worsens |
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Term
| Preeclampsia: physical exam (5) |
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Definition
1. HTN
2. Proteinuria (Trace to 1+ on a voided sample, progresses to 2+)
3. Edema - nondependent> 1+ progressing to pretibial edema > 3 to 4+
worsening facial and generalized edema
4. Weight gain - 2 lbs/week or 6 lbs in one month
lagging fundal height
5. |
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Term
| Preeclampsia: Testing (5) |
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Definition
- BP monitor
- Urine testing Q visit; repeat 24 hour PRN
- Baseline if not established w/ coag studies
- NST weekly; BPP w/ amniotic fluid index
- ultrasound - monitor fetus and placenta |
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Term
| Preeclampsia: Management (6) |
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Definition
- Refer
- Strict bed rest w/ left lateral recumbent position
- Fetal surveillance: NST, BPP, ultrasound
- kick counts at home
- weekly steroid injections (betamethasone) for fetal lung maturity if <34 weeks gestation
- hospitalization and MgSO4 therapy to stabilize if severe , then delivery if maturity is assured (>34 weeks or 2 doses betamethasone) |
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Term
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Definition
PIH + preeclampsia + seizure
- BAD headache
- epigastric pain that worsens
- visual disturbances (spotty vision, blurriness, blindness)
- HIGH BP (160/100)
- seizures
- oliguria to anuria
- fetal distress in utero |
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Term
| Eclampsia: Testing and management |
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Definition
- CBC, LFTs w/ full chem profile, Coag profile, 24 hr urine, creatinine, uric acid, fetal surveillance
- REFER
- MgSO4 to break seizure or valium if ineffective; then IV drip to stabilize
- DELIVER |
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Term
|
Definition
- going into liver failure and may bleed
- those of preeclampsia, plus:
- nausea w/ or w/o vomiting
- jaundice
- extreme fatigue
- hepatomegaly
- tenderness in RUQ extending to epigastric area
- possible ascites |
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Term
| HELLP: Tests and management (6) |
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Definition
- preeclampsia
- ASSESS FOR:
- Thrombocytopenia (below 50,000)
- clotting factors reduced
- severe hemoconcentration
- very elevated LFTs - IN THE HUNDREDS
- Proteinuria consistent w/ severe preeclampsia
- REFER AND DELIVER |
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Term
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Definition
- Mal-implantation of the placenta in the lower uterine segment
- Cervical os may be completely, partially, or marginally covered |
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Term
| Placenta previa and abruptio placentae occur when? |
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Definition
| late 2nd/early 3rd trimester |
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Term
| Placenta Previa: risk factors (4) |
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Definition
1. Previous c-section/uterine surgery
2. Multiparity
3. Malpresentation (breech or transverse lie)
4. History of previous previa |
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Term
| Placenta Previa: s/sx (5) |
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Definition
1. PainLESS bleeding
2. Usually put something in vagina like intercourse
3. No contractions
4. No tenderness
5. Little to no fetal compromise unless bleeding is severe |
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Term
| Placenta Previa: tests (3) |
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Definition
1. Ultrasound for localiztion
2. EFM to exclude fetal distress
3. CBC if bleeding is severe or continuous |
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Term
| Placenta Previa: Management (5) |
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Definition
1. NO BIMANUAL EXAM: speculum only to determine extent of bleeding
2. Hospitalization
3. NST/BPP while in hospital and weekly
4. Vaginal rest: NOTHING in the vagina
5. Anticipate delivery if fetus is mature |
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Term
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Definition
- Separation of the placenta from the uterine wall, completely or partially
- EMERGENCY - fetal death is very likely unless already hospitalized at the time
- hemorrhage is life-threatening to mother |
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Term
| Abruptio Placentae: risk factors (6) |
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Definition
- previous abruptio
- trauma
- PIH domino
- cocaine use
- alcohol, cigarette use
- uterine tumor or structural abnormality |
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Term
| Abruptio Placentae: s/sx (6) |
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Definition
1. Severe abdominal pain
2. Bright red bleeding heavy if unconcealed
3. minimal to moderate bleeding of abruption is UNconcealed
4. rigid uterus in concealed abruption
5. Shock
6. Fetal distress/absent FHTs |
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Term
| Abruptio placentae: Tests and management |
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Definition
- same as previa but w/ Rh for transfusion and coag profiles
- refer, immediate delivery |
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Term
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Definition
- contractions after 20 weeks but before 37 weeks gestation which result in dilation and effacement of the os
- contractions may not even be perceived |
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Term
| Premature labor: risk factors (9) |
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Definition
1. hx or preterm
2. Genital and/or UTI
3. Multiple gestations
4. Low-income
5. Poor weight gain, poor nutrition
6. Drug use, especially cocaine; smoking
7. Uterine structural abnormalities
8. Cervical trauma
9. Young or old (14 or 35) |
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Term
|
Definition
1. Uterine cramping - intermittent and constant
2. Lower back pain which may be constant, intermittent, and rhythmic
3. contractions w/ frequency 10-12 minutes (5/hr)
4. May experience vaginal spotting or change in d/c
5. Cervical effacement/shortening and/or dilitation |
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Term
| Premature labor: Management (6) |
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Definition
1. hospitalization
2. tocolytic therapy if cervical changes occur (terbutaline)
3. If less than 34 weeks and successfully tocolyzed, give B-methasone injections twice weekly for lungs until 34 weeks
4. Bed rest
5. Vaginal rest and bed rest at home
6. weekly cervical checks |
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