Ch 14 Pregnancy At Risk: Gestational Conditions

Front 1

A systolic BP >140, diastolic >90, or a MAP >105 recorded on 2 separate occasions at least 4 hours apart.

Back 1

Hypertension

Front 2

Onset of hypertension during pregnancy or in the first 24 hours after birth without other signs or symptoms of preeclampsia and without preexisting hypertension

Back 2

Gestational Hypertension

Front 3

A Pregnancy specific syndrome in which hypertension develops after 20 weeks of gestation in a previously normotensive woman. It is a multisystem, vasospastic disease process of reduced organ perfusion characterized by the presence of ____ and ____ with a clinical continuum from mild to severe.

Back 3

Preeclampsia; hypertension; proteinuria

Front 4

Presence of a systolic BP of greater than 160 or diastolic BP of at least 110 and 5g or more of protien in a 24 hour urine specimen.

Back 4

Severe preeclampsia

Front 5

Onset of seizure activity or coma in the woman diagnosed with preeclampsia, with no history of preexisting pathology that can result in seizure activity.

Back 5

Eclampsia

Front 6

Hypertension present before pregnancy or diagnosed before 20 weeks of gestation.

Back 6

chronic hypertension

Front 7

Laboratory diagnosis for a variant of severe preeclampsia that involves hepatic dysfunction; it is characterized by _______, _______, and ________

Back 7

HELLP syndrome; hemolysis, elevated liver enzymes, low platelets.

Front 8

Protein concentration of 30 mg/dl or more in at least 2 random urine specimens collected at least 6 hours apart.

Back 8

Proteinuria

Front 9

Increased amount of urine produced to reduce fluid retention

Back 9

diuresis

Front 10

Excessive vomiting during pregnancy that leads to excessive weight loss of at least 5% of prepregnancy weight and is accompanied by dehydration, electrolyte imbalance, ketosis and acetonuria.

Back 10

Hyperemesis gravidarum

Front 11

What is the treatment for mild preeclampsia?

Back 11

Bed rest on left side.
Monitor BP/reflexes, antihypertensives (hydralazine)
Check urine for protein
Diet with moderate to high protein and moderate salt.

Front 12

What's a classic sign of preeclampsia?

Back 12

Epigastric pain (near liver)

Front 13

You check your pt reflex and it is a 1+. Why would it be 1+ and what should you have prepared?

Back 13

1+ would indicated that reflexes are a little slow and possibly getting close to a magnesium toxicity. Have Ca+ Gluconate (antidote for MG) at bedside in syringe.

Front 14

What's the treatment of preeclampsia?

Back 14

birth!! sedative to encourage quiet bed rest. MG sulfate IV drug of choice.

Front 15

Recurrent Premature Dilation of the Cervix (incompetent cervix)

Back 15

Conservative management of bed rest, progesterone, antiinflammatory drugs, antibiotics.
-Shirodkar or McDonald procedure
-Prophylactic cerclage is placed at 12 to 15 weeks.

Front 16

What is cerciage?

Back 16

Correction of recurrent premature dilation of cervix. Purse string sutures around cervix.

Front 17

Ectopic Pregnancy

Back 17

Fertilized ovum implanted outside uterine cavity.
95% occur in uterine (fallopian) tube.
Most located on ampullar.

Front 18

Why is methotrexate given during ectopic pregnancy?

Back 18

it prevents body from using folate. It prevents pregnancy from growing/ progressing.

Front 19

Causative factors of Ectopic pregnancy?

Back 19

PID Previous tubal surgery
Endometriosis IUD DES
Cigarettes Menstrual reflux

Front 20

Clinical manifestations of ectopic pregnancy

Back 20

missed period
adnexal fullness
dark red or brown vaginal bleeding

Front 21

What would happen if mom didn't abort pregnancy?

Back 21

the tubes would burst and mom would bleed into the abdominal cavity.

Front 22

Mom is complaining of sharp, one-sided pain, syncope, referred shoulder pain. What's going on?

Back 22

She most likely is having an ectopic pregnancy. hCG levels would be decreased. Check ultrasound. TX: surgery or methotrexate.

Front 23

Hydatidiform mole (molar pregnancy). What are the 2 types?

Back 23

Complete (classic): mole results from fertilization of egg with lost or inactivated nucleus

Partial mole: result of 2 sperm fertilizing a normal ovum.

Front 24

Medical management of molar pregnancy?

Back 24

suction curettage is safe, rapid, and effective if necessary.

induction of labor with oxytocin or prostaglandins is not recommended.

Front 25

Following a molar pregnancy how long does mom have to wait to get pregnant?

Back 25

1 year!! this overgrowth of tissue can sometimes result in cancer. Tumors classified as nonmetastic, metatstic low risk and metatastic high risk 50% occur after molar pregnancy. Pregnancy masks cancer symptoms

Front 26

What is molar pregnancy?

What are some classic signs?

Back 26

degenerative process in chorionic villi. Multiple cysts (grapelike clusters) & rapid growth of the uterus with hemorrhage.

Front 27

What is placenta previa?

Back 27

The placenta is implanted in lower uterine segment near or over internal cervical os.

Front 28

Mom has brownish bleeding larger than expected uterus & hyperemesis gravidarum

What has most likely occured?

Back 28

Molar pregnancy. There would also be No FHT or fetal movement.

Front 29

How is placenta previa managed?

Back 29

C-Section!! and of course observation and bed rest.

Front 30

Mom comes to the hospital with painless, bright red vaginal bleeding. You notice she has a soft & relaxed uterus. What has most likely occured?

Back 30

Placenta previa. It is "quiet and sneaky" and in the last 1/2 of pregnancy.

Front 31

How is placenta previa managed if fetus is premature?

Back 31

Nothing in Vagina!! (no exams) transfusions, FHT VS
bed rest

Front 32

How is placenta previa managed if fetus is term, labor started or bleeding heavy?

Back 32

IV blood to combat shock
O2
Prepare for C section
Check NB for anemia

Front 33

What is premature separation of the placenta from uterine surface prior to delivery called?

What are the grades?

Back 33

Placental abruption (abruptio placentae)

> w/ hypertension & cocaine abuse (vasoconstriction

1 (mild) 2 (moderate) 3 (severe)

Front 34

Mom comes to the hospital with severe and steady pain with uterine tenderness. Uterine irritability, frequent low intensity contractons, increased resting tones, what is going on?

Back 34

Abruptio Placentae. "sudden & stormy" Fetal decline is also noted.

Front 35

What is the management of abruptio placentae?

Back 35

Emergency situation! c-section
Observe for shock and DIC
Mild separation: induce labor
Moderate to severe: severe hemorrhage or fetal distress.

Front 36

DIC

Back 36

Pathologic form of diffuse clotting causing widespread external and internal bleeding.

Clotting in the microcirculation results in deficiency of clotting factors.

Front 37

von Willebrand's disease

Back 37

type of hemophilia that can affect women.

Front 38

What are the risks of DIC?

Back 38

Hypovolemic shock
CVA
Ischemia to vital organs leading to necrosis & failure

Front 39

What's a problem with diagnosing appendicitis with pregnancy?

Back 39

it has similar symptoms of pregnancy. nausea vomiting and increased WBC. Pregnancy actually pushes the appendix up, pregnant womens appendix burst 2-3 more times than non pregnant

Front 40

a mom has right lower quadrant pain, nausea vomiting, and loss of appetite. moving the uterus increases the pain. Temperature is mildly increased. what's going on?

Back 40

Appendicitis (most common nongynecologic cause of actue surgery of abdomen during pregnancy). If it ruptures, preterm labor will usually result and necessitate the use of tocolytic agents.

Front 41

Mom comes to the hospital with constipation, persistent cramplike, abdominal pain; vomiting, ausculatory rushes within the abdomen and "laddering" of the intestinal shadows on x ray, what's going on?

Back 41

Intestinal obstruction. immediate surgical intervention is required. Pregnancy is rarely affected.

Front 42

What are the most common causes of trauma in pregnancy?

Back 42

motor vehicle 49%
falls 25%
assaults 18%
gunshot 4%
burns 1%
50% of fetal deaths are associated with maternal trauma.

Front 43

Miscarriage (spontaneous abortion)

Back 43

termination of pregnancy that ends without medical or surgical method before 20 weeks of gestation or 500g birthweight

Front 44

early miscarriage

Back 44

termination of pregnancy that ends without medical or surgical method before 12 weeks of gestation

Front 45

Late miscarriage

Back 45

termination of pregnancy that ends without medical or surgical method between 12 and 20 weeks of gestation

Front 46

Missed miscarriage

Back 46

Pregnancy in which the fetus has died but the products of conception are retained in utero for up to several weeks.

Front 47

Habitual miscarriage (recurrent spontaneous abortion)

Back 47

3 or more consecutive pregnancy losses before 20 weeks of gestation.

Front 48

Cullen sign

Back 48

Ecchymotic blueness around the umbilicus that indicates hematoperitoneum as a result of an undiagnosed ruptured intraabdominal pregnancy.

Front 49

At 30 weeks of gestation, Angela's MAP was 108. her urinalysis indicated a protein level of 32 on dipstick. biceps and patellar reflexes are 2+
a. Eclampsia b. Chronic hypertension c. gestational hypertension d. HELLP syndrome e. preeclampsia

Back 49

Preeclampsia

Front 50

At 24 weeks, Mary's BP rose froma prepregnant baseline of 120/70 to 150/92. No other problematic signs and symptoms including proteinuria were noted. a. Eclampsia b. Chronic hypertension c. gestational hypertension d. HELLP syndrome e. preeclampsia

Back 50

Gestational Hypertension

Front 51

Susan, 34 pregnant woman, has had a consistently high BP ranging from 148/92 to 160/98 since she was 28. her weight gain has followed normal patterns, and urinalysis remains normal as well. a. Eclampsia b. Chronic hypertension c. gestational hypertension d. HELLP syndrome e. preeclampsia

Back 51

Chronic Hypertension

Front 52

At 32 weeks, Maria, with hypertension since 28 weeks, hyperactive DTRs with clonus, and preteinuria of 4+ has a convulsiona. Eclampsia b. Chronic hypertension c. gestational hypertension d. HELLP syndrome e. preeclampsia

Back 52

Eclampsia

Front 53

Dawn has been hypertensive since her 24 week. urinalysis indicates a protein content of 3+. She has a platelet count of 95,000. she has begun to experience nausea with some vomiting and epigastric pain a. Eclampsia b. Chronic hypertension c. gestational hypertension d. HELLP syndrome e. preeclampsia

Back 53

HELLP syndrome.

Front 54

drug of choice in the prevention and treatment of convulsions caused by preeclampsia or eclampsia

Back 54

magnesium sulfate

Front 55

IV antihypertensive agent of choice for the treatment of hypertension that occurs with severe preeclampsia.

Back 55

hydralazine

Front 56

Antihypertensive agent of choice for the treatment of chronic hypertension during pregnancy.

Back 56

methyldopa

Front 57

Antiemetic med commonly used to treat hyperemesis gravidarum

Back 57

metoclopramide

Front 58

antimetabolite and folic acid antagonist that is used to destroy rapidly dividing cells; it is used for the medical management of an unruptured ectopic pregnancy

Back 58

Methotrexate

Front 59

Protein readings

Back 59

0 negative
trace - trace
1+ 30mg/dl
2+ 100 mg/dl
3+300 mg/dl
4+ more than 1000mg (1g)/dl

Front 60

What must the platelet count be below to have a diagnosis of HELLP syndrome?

Back 60

100,000/mm

Front 61

signs of Magnesium toxicity

Back 61

loss of patellar reflexes, oliguria, decreased LOC, respiratory and muscular depression.