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49 Cards in this Set
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defin spon abortion
*under what wk* |
nonelective termination of preg <20 wks gestational age
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*over what wk* is third trimester bleeding
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after 20 wks
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T or F: SAB is
common cz of 1st tri bleeding |
T
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2 common cz of 3rd tri bleeding
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placental abruption
placenta previa |
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1st tri SAB caused by
maternal or fetal factors, & example |
*fetal (chromosomal abn)*
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2nd tri SAB caused by
maternal or fetal factors, & examples |
maternal
(cervical incompetence, infection, hypercoagable state) |
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Premature Rupture of Memb (PROM) (spon ROM b/4 onset of labor) may be precip by? rf?
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cervical incompt
infection-vag/cervical abn memb physiology RF: low socioeco, young, smoke, STD |
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Preterm labor is b/w 20-37 wks, RF are?
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infection
mult gestation/polyhydramnios PROM uterine abn hx preterm labor placental abruption poor maternal nutrition low socioeconomic status *most pts no ident RF* |
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RF for spon abortion
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AMA, APA
inc gravidity minority hx prior SAB |
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On hx, ask:
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familial genetic abn (most common cz of 1st tri bl)
infection (2nd tri bl) hx of abortions |
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Pt w/ vaginal bl, what to look for in pelvic exam?
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1. vag bl
2. passage of tissue 3. open or closed cervical os |
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7 types of SAB
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1. threatened ab
2. inevitable ab 3. incomplete ab 4. complete ab 5. missed ab 6. septic ab 7. intrauterine fetal demise |
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threatened ab sx
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*min bl, no POC expelled*
pos abd pain |
amt bl, poc expel?
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threatened ab PE (os)/us
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closed internal cervical os
normal us |
os: open or close
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threatened ab tx
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avoid heavy activity;
pelvic and bed rest |
restriction on activity
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inevitable ab sx
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*profuse bl, sev cramp*
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amt bl
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inevitable ab pe (os)
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open internal cervical os
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os: open or close
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inevitable ab tx
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emergent d/c
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incomplete ab sx
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somc poc expel
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incomplete ab pe(os)/us
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open internal cervical os
retained fetal tissue on us |
os: open or closed
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incomplete ab tx
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emergent d/c
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complete ab sx
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min bl/cramp
*all poc expel* |
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complete ab pe(os)/us
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closed internal cervical os
empty uterus on u/s |
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missed ab sx
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no uterine bl
*no poc expel* |
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missed ab pe(os)/us/fetal heart monitor
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os closed
us: retained fetal tissue no fetal cardiac activity |
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missed ab tx
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evacuate uterus
d/c |
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septic ab sx
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f/c
peritoneal signs recent hx of therapeutic ab (maternal mortality 10-50%) |
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septic ab pe
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sx of shock: hypotension,
hypothermia, oliguria, resp distress inc WBC |
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septic ab tx
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evac uterus
d/c IV abx |
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intrauterine fetal demise sx
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mom report absence of fetal movement
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interuterine fetal demise pe/fetal heart monitor/us
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uterus sm for GA
no fetal heart tones or movement on us |
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intrauterine fetal demise tx
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induce labor and evac uterus to avoid d/c
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os open or closed on
threatened, inevitable, incomplete, complete, missed |
open: inevitable, incomplete
closed: threatened, complete, missed |
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which SAB no POC expel
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threatened, missed
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which SAB all POC expel
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complete
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which SAB some POC expel
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incomplete
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which SAB w/ no bl, min bl, sev bl
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no bl: missed
min bl: threatened, complete sev bl: inevitable |
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which SAB has normal us
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threatened
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which SAB has no fetal cardiac activity
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missed ab, intrauterine fetal demise
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DDx of SAB
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post-coital bl (not preg)
vaginal or cervical lesions ectopic preg extrusion of molar preg |
if not preg, if "preg"
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T or F
if signif bl in SAB (which one is sev), must ensure hemodynamic stability |
T
inevitable ab |
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after hemodyn stable, what test to check preg
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beta-hCG
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what labs to eval bl loss and Rh immunization
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CBC
bl type antibody screen |
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what tool to assess fetal viability
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transvaginal us
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T or F
after hemodyn stable and estab preg, estab GA if threatened ab OR check remaining tissue if incomplete, complete |
T
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what shot give after Rh neg woman has SAB
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RhoGAM
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Mech of RhoGAM
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anti-RhIgG destroys Rh-positive cells in maternal circulation and prevents Rh sensitization
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3 situations in prevention of Rh negative moms
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1. father Rh pos
2. father Rh status unknown 3. paternity uncertain |
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typical management of SAB (usu in missed, septic)
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*evacuate uterus*
prev infection |
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