Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
107 Cards in this Set
- Front
- Back
What age women are considered High Risk Pregnancy
|
less then 20 years of age or older then 35
|
|
Risk factors for high risk pregnancy
|
biophysical
psychosocial socio-demographic environmental |
|
Blood pressure needed to diagnose Chronic Hypertension
|
systolic blood pressure greater then or equal to 140
or diastolic blood pressure greater then or equal to 90 that was known to exist before pregnancy or before 20 weeks two readings at least 6 hours apart |
|
Gestational Hypertension is
|
hypertension in pregnancy with onset after 20 weeks of pregnancy
|
|
to diagnose gestational hypertension you need
|
systolic blood pressure greater then or equal to 140
or diastolic blood pressure greater then or equal to 90 two reading at least 6 hours apart |
|
An alternative criteria for gestational hypertension is
|
systolic going up from baseline by 30 and diastolic by 15
|
|
Does proteinuria occur in gestational hypertension?
|
no
if yes ( scant or trace) |
|
Pre-eclampsia is diagnosed with
|
systolic blood pressure greater then or equal to 140
or diastolic blood pressure greater then or equal to 90 proteinuria greater or equal to 1+ |
|
Pre-eclampsia can occurs up to
|
48 hours postpartum
|
|
triad of symptoms for pre-eclampsia
|
HTN
proteinuria Edema |
|
Pre-eclampsia occurs after the
|
1st trimester
|
|
pre-eclampsia is the leading cause of
|
peri-natal death
|
|
What is a common occurrence in infants
|
IUGR
|
|
With pre-eclampsia women can have ____ weight gain per week
|
2kg (4.5lbs)
|
|
pre-eclampsia occurs predominantly in
|
prinips
|
|
Signs and Symptoms of pre-eclampsia
|
headache
visual change epigastric pain elevated BP sudden excessive weight gain hand and face edema proteinuria |
|
Which liver enzymes are elevated with pre-eclampsia
|
AST
|
|
Signs of mild pre-eclampsia
|
SBP greater or equal to 140 but less then or equal to 160
DBP greater or equal to 90 but less then or equal to 110 +1 protein moderate puffiness DTRs WNL |
|
Signs of severe pre-eclampsia
|
SBP greater or equal to160
DBP greater or equal 110 3+ protein or higher generalized edema and noticeable puffiness hyperreflexive oliguria |
|
anasarca
|
generalized edema
|
|
oliguria
|
urine output less then 30cc per hour
500cc over 24 hours |
|
Management of mild pre-eclampsia
|
BR in LLP periodically
BP Q2H Daily urine dip and daily weights FMC |
|
management of severe pre-eclampsia
|
hospital and bed rest
decreased environmental stimulation seizure precautions I and O Fetal Assessment Magnesium Sulfate |
|
Normal Magnesium is
|
4-8mg
|
|
Eclampsia
|
pre-eclampsia with convulsions
|
|
What is the cure for eclampsia?
|
Birth
|
|
What is the therapy for eclampsia?
|
Magnesium Sulfate
|
|
What is the dose for Magnesium sulfate with eclampsia?
|
IVBP with initial loading dose of 4-6 grams in 100-250cc over 15-30min
|
|
What is the maintenance dose for Magnesium Sulfate with eclampsia?
|
40g/1000 LR via pump at 2grams per hour
|
|
Main goal with eclampsia
|
prevention or control of convulsions
|
|
HELLP Syndrome
|
hemolysis
elevated liver low platelets |
|
HELLP syndrome is
|
life threatening
|
|
With HELLP syndrome coagulation factor
|
coagulation factor is normal but abnormal clotting factor
|
|
The treatment for HELLP syndrom is
|
birth
|
|
Risk factors for HELLP syndrome
|
chronic renal disease
chronic HTN family h/o PIH Primigravida maternal age > 40 diabetes obesity twin gestation |
|
Bleeding Complications of Pregnancy
|
spontaneous abortion (SAB)
molar pregnancy incompetent cervix ectopic pregnancy implantation spotting |
|
Spontaneous abortion is
|
when pregnancy ends before 20 weeks
|
|
early SAB is
|
prior to 12 weeks
|
|
late SAB is
|
12-20 weeks
|
|
a Complete SAB is
|
all products of conception are expelled
cervix is closed |
|
an incomplete SAB is
|
some but not all POC are expelled
bleeding is major manifestation cervix is open (could be an SAB in progress) |
|
a threatened SAB
|
vaginal bleeding occurs but the POC are not expelled
|
|
an inevitable SAB is
|
an abortion that cannot be stopped when their is ROM and dilation of the cervix
|
|
a missed SAB
|
the fetus dies but the POC are not expelled
|
|
a recurrent SAB
|
three or more consecutive pregnancies that end in SAB
|
|
Of all clinical pregnancies how many end in SAB
|
10-15%
|
|
Risk Factors for SAB
|
endocrine embalance
infection maternal structural problems immunological factors systemic disorders drug use inadequate nutriton |
|
incompetent cervix
|
passive and painless dilation of the cervix in the 2nd trimester
|
|
Risk factors for an incompetent cervix
|
H/O of previous cervical laceration
excessive cervical dilation congenital short cervix cervical uterine abnormalities |
|
Management of an incompetent cervix
|
cerclage
|
|
What is cerclage
|
pull the cervix closed by putting a tie around it
|
|
For women with H/O an incompetent cervix a cerclage can be done at
|
10-14 weeks
|
|
Cerclage is removed at
|
37 weeks
|
|
After a cerclage patient should NOT
|
stand for 90 minute
NPV |
|
a cerclage is rarely performed after
|
25 weeks
|
|
ectopic pregnancy
|
fertilized ovum implanted outside the uterine cavity
|
|
a sign associated with an ectopic pregnancy is
|
referred shoulder pain with L lower quadrant pain
|
|
Signs of an ectopic pregnancy
|
pregnancy
vaginal bleeding or spotting further along = more pain low or slow to rise HCG |
|
normal HCG levels
|
double every day
|
|
adnexal
|
outside the uterine cavity
|
|
Clinical Findings with an ectopic pregnancy
|
low or slow rising HCG levels
Adnexal tenderness and fullness on exam Referred shoulder pain |
|
Molar Pregnancy also known as
|
gestational trophoblastic disease
|
|
Gestational trophoblastic disease
|
an abnormal growth of trophoblastic cells that attach the fertilized ovum to the uterine wall
the proliferating trophoblasts fill the uterus with vesicles that resemble a cluster of grapes |
|
the cause of GTD is
|
unknown
|
|
molar pregnancy can be
|
cancerous
|
|
Molar Pregnancy: Complete
|
believed that this occurs when the ovum is fertilized by a sperm and then duplicates its own chromosomes while the chromosomes of the ovum are inactivated
|
|
Molar Pregnancy: Partial
|
fetal tissue or membranes are present
chromosome contribution is present nonviable fetus |
|
Signs and Symptoms of Molar Pregnancy
|
Vaginal Bleeding
Severe NV Uterus is large for dates No fetal heart tones or activity HCG levels high and rising rapidly |
|
Management of Molar Pregnancy
|
immediate vacuum evacuation
identify tissue to identify malignant or benign cytology Weekly measurement of HCG Monitoring for up to one year Avoid pregnancy for 1 year |
|
Placenta Previa
|
placenta completely or partially covers the internal os
painless |
|
placenta abruption
|
painful
premature separation of placenta from the uterine wall |
|
Risk factors for placenta previa
|
previous previa
previous c-section elective TOP multiple gestation closely placed pregnancies AMA smoking cocaine |
|
Management of previa
|
bed rest
NPV evaluate fetal well being NEVER do a vaginal exam C-section |
|
Signs of Placenta Abruption
|
vaginal bleeding ( may be concealed)
abdominal pain with contractions greater then expected uterine tenderness board like abdomen fetal tachy |
|
Risk factors of placenta abruption
|
PIH
Cocaine Use Trauma Smoking Poor Nutriton |
|
Gestational Diabetes
|
physiological glucose intolerance in pregnancy
|
|
typical onset of gestational diabetes is
|
at 24 weeks
starts to go up between 18-24 weeks |
|
50% of mother with gestational diabetes will
|
develop glucose intolerance later in life
|
|
GDM Risk Factors
|
maternal age >30
obesity family history of IDDM previous baby weighing > 4000g polyhydramnios previous unexplained stillbirth SAB congenital anomalies signs and symptoms of diabetes recurrent glucosuria note on dip stick |
|
polyhydramnios
|
increase in amniotic fluid
|
|
glucose challange test (GCT)
|
screen for glucose
24-28 weeks |
|
Glucose Tolerance Test (GTT)
|
f/u to elevated GCT
diagnostic |
|
Value of GCT that is indicative of a positive test
|
>200
|
|
2 abnl values on GTT
|
fasting > 105
1 hour > 190 2 hour > 165 3 hour > 145 |
|
Treatment of gestational diabetes
|
goal is glucose control
fasting level < 105 2 hours postprandial <120 goal 60 and 100 diet and exercise |
|
postprandial
|
after eating
|
|
Dietary Guidelines for gestational diabetes
|
standard diabetic diet
small frequent meals high fiber foods lower fat intake avoid sugar and concentrated sweets |
|
IUGR
|
pathological process
decreased O2 and nutritional availability symmetrical or unsymmetrical |
|
symmetric IUGR
|
represents chronic/long term insult
small in all parameters including head development |
|
asymmetric IUGR
|
late occuring
short term deprivation head sparing small body and large head |
|
Risk factors for IUGR
|
poor nutriton and maternal weight gain
maternal vascular disease pre-eclampsia multiples smoking genetic disease drug and alcohol abuse anemia |
|
anemia
|
reduced oxygen carrying capacity because decreased heme
|
|
SGA
|
nonpathalogical
constitutionally small fetus |
|
Oligohydramnios
|
Abnormally small amount of fluid
AFI <5cm associate with marked perinatal mortality |
|
normal AFI
|
5-20cm
|
|
factors a/w oligohydramnios
|
congenital anomalies
IUGR early rupture of membrane post-maturity |
|
Management of oligohydramnios
|
bed rest
hydration encourage good nutrition assess fetal well being induction and delivery if severe |
|
LGA
|
macrosomia
multifetal pregnancy fibroid uterus polyhydraminos |
|
polyhydraminos
|
excessive amount of amniotic fluid
difficult ascultating and palpating fetus unstable fetal lie rule out GDM and ABO/RH disease |
|
risk factors polyhydraminos
|
multiples
uncontrolled GDM Fetal malformation chromosomal abnormalities |
|
Complications of polyhydraminos
|
fetal malpresenation
placental abruption uterine dysfunction during labor PP Hemorrhage cord prolapse preterm labor |
|
post-term pregnancy
|
pregnancy that extends past 42 weeks of gestation
|
|
cause of post-term pregnancy
|
unknown
|
|
clinical manifestations of post-term pregnancy
|
maternal weigh loss
decreased uterine size meconium fluid advanced bone maturation of the fetal skeleton with a hard skull |
|
maternal risk of post-term pregnancy
|
dysfunctional labor
perineal trauma PPH infection interventions emotional stress |
|
Fetal risks with post term pregnancy
|
macrosomia
birth trauma distress hypoxia/ asphyxia |
|
Management of post term pregnancy
|
BPP, NST, FMC
cervical assessment for ripeness induction |