Ob Ch 28

Front 1

Fetal risk from maternal hemorrhage

Back 1

1. Blood loss

2. Hypoxemia

3. Hypoxia

4. Anoxia

5. Pre term birth

Hint 1

5

Front 2

Highest incidences of maternal mortality

Back 2

Ruptured Etopic pregnancy

Abduction placente

Hint 2

2

Front 3

Miscarriage (spontaneous abortion)

Back 3

1. Pregnancy that ends as a result of natural causes before 20 weeks gestation

2. Severe cramping after 12 weeks

Front 4

Threatened miscarriage

Back 4

Amount of bleeding: Slight, spotting

Uterine cramping: Mild

Passage of tissue: No

Cervical dilation: No

Management: Bed rest, ultrasound and hCG test

Hint 4

Amount of bleeding:Uterine cramping:Passage of tissue:Cervical dilation:Management:

Front 5

Inevitable miscarriage

Back 5

Amount of bleeding: Moderate

Uterine cramping: Mild to Severe

Passage of tissue: No

Cervical dilation: Yes 4mm

Management: If ROM, pain, bleeding, or infection present terminate pregnancy by D/C

Hint 5

Amount of bleeding:Uterine cramping:Passage of tissue:Cervical dilation:Management:

Front 6

Incomplete miscarriage

Back 6

Amount of bleeding: Heavy, profuse

Uterine cramping: Severe

Passage of tissue: Yes

Cervical dilation: Yes with cervix tissue

Management: May require additional cervical dilation before curettage

Hint 6

Amount of bleeding:Uterine cramping:Passage of tissue:Cervical dilation:Management:

Front 7

Complete miscarriage

Back 7

Amount of bleeding: Slight

Uterine cramping: Mild

Passage of tissue: Yes

Cervical dilation: No (cervix has already closed after tissue passed)

Management: No further intervention if uterine contractions adequate

Hint 7

Amount of bleeding:

Uterine cramping:

Passage of tissue:

Cervical dilation:

Management:

Front 8

Missed miscarriage

Back 8

Amount of bleeding: No

Uterine cramping: None

Passage of tissue: No

Cervical dilation: No

Management: Blood clotting factors are watched

Hint 8

Amount of bleeding:Uterine cramping:Passage of tissue:Cervical dilation:Management:

Front 9

Recurrent miscarriage

Back 9

3 or more abortions before 20 weeks

Front 10

Miscarriage initial care

Back 10

1. Transvaginal US and hCG levels to see if fetus alive

2. If cervix dilates, miscarriage is inevitable- suction curettage

3. Misoprostol (Cytotec)

4. D/C with Methergine or Hemabate

Hint 10

4

Front 11

Discharge teaching for Woman after Early miscarriage

Back 11

1. Clean perineum after each voiding or BM

2. No tub baths for 2 weeks

3. No vaginal intercourse for 2 weeks

4. High iron supplementation and protein

Hint 11

4

Front 12

Cervical insufficiency

Back 12

Etiology: Passive and painless dilation of the cervix during second trimester: May be acquired or congenital

Diagnosis: Speculum/digital pelvic exam and transvaginal US that reveals cervical funneling

Hint 12

Etiology and diagnoses

Front 13

Cervical insufficiency care management

Back 13

1. Cerclage

2. Prophylactic 12-14 weeks

3. Therapeutic 14-23 weeks

4. Removed by 36 weeks of geststion

Front 14

Ectopic Pregnancy

Back 14

Leading cause of infetility

CM: Occur 6-8 weeks after the last normal menstrual period

1. Ab pain

2. Delayed menes

3. Abnormal vaginal bleeding (spotting) dark red or brown

Hint 14

CM and 3

Front 15

Diagnosis of Ectopic pregnancy

Back 15

1. Beta hCG levels are greater than 1500 to 2000 IU/mL

AND

2. Transvaginal US shows nothing. Redraw hCG every 48 hours

Hint 15

2

Front 16

Tubal pregnancy management

Back 16

1. Methotrexate- dissolves tubal pregnancy

2. Explain urine contains levels of drug metabolite that could be toxic for 72 hours peak hours being first 8 hours

3. Teach about not getting urine on toilet start and double flush

Hint 16

3

Front 17

Hydatidiform mole (molar pregnancy)

Back 17

Benign proliferative growth of the placental trophoblast in which the chorionic villi develop into avascular vesicles that hang like grape like clusters

Front 18

Types of Hydatidiform mole

Back 18

Complete: no embryonic or fetal parts

Partial: often have embryonic or fetal parts and an amniotic sac

Hint 18

2

Front 19

CM of Hydatidiform mole

Back 19

1. Anemia from blood loss

2. Hyperemesis gravidarum

3. Ab cramps

Hint 19

3

Front 20

Diagnosis of Hydatidiform mole

Back 20

1. Transvaginal US that shows snowstorm pattern.

2. Serum hCG

Front 21

Placenta previa

Back 21

Placenta implanted in lower uterine segment near or over internal cervical os

Complete

Marginal

Low-lying

Front 22

Complete placenta previa

Back 22

Placenta totally covers internal cervical os

Front 23

Marginal placenta priva

Back 23

Edges of the placenta is seen to be 2.5 cm or closer to internal cervical

Front 24

Low lying placenta previa

Back 24

Happens in the second trimester

Front 25

Risk factors for Placenta previa

Back 25

1. Hx of c section, suction curettage

Front 26

CM of placenta previa

Back 26

Painless bright red vaginal bleeding

Front 27

Outcomes of placental priva

Back 27

1. Major complication is hemorrhage

2. Fetal death

3. Still birth

4. IUGR

5. Fetal anemia

Hint 27

5

Front 28

Diagnosis of placental previa

Back 28

Transabdominal US

Front 29

Care management of Placenta previa

Back 29

1. If < 36 weeks and & not in labor bedrest and observation

2. Labor-hospitalized IV, NST, BPP

3.Excessive bleeding = immediate birth

4. C/S if 2 cm from cervical os

Hint 29

4

Front 30

Abruptio placentae

Back 30

1. Detachment of part or all of placenta from implantation site after 20 weeks of gestation

2. HTN, cocaine use and trauma are risk factors

Hint 30

2

Front 31

CM of abruptio placentae

Back 31

1. Vaginal bleeding

2. Uterine tenderness and contractions

3. Boardlike abdomen

4. Couvelaire uterus (purple/blue uterus

Hint 31

4

Front 32

Outcomes of abruptio placentae

Back 32

1. Maternal- hemorrhage, hypovolemic shock, hypofibrinogenemia, thrombocytopenia

2. Fetus: IUGR, prematurity, neurologic defects, CP, SIDs threat greater

Hint 32

Maternal

Fetus

Front 33

Diagnosis of abruptio placentae

Back 33

1. Confirmed by birth by visual inspection of placenta

2. Suspected with sudden onset of intense uterine pain

Hint 33

2

Front 34

Vasa previa

Back 34

1. Fetal vessels lie over cervical os, and vessels are implanted into the fetal membranes instead of the placenta so it's not protected by Wharton's jelly

2. Risk for rupture

Hint 34

2

Front 35

Risk factors for vasa previa

Back 35

1. Low lying placenta

2. Multiple gestations

Hint 35

2

Front 36

Velamentous insertion of the cord

Back 36

Cord vessel branch at membranes and then onto placenta

Front 37

Succenturiate placenta

Back 37

Placenta has divided into two or more lobes

Front 38

Battledore (marginal) insertion of the cord

Back 38

Increases Risk of fetal hemorrhage

Front 39

Disseminated intravascular coagulation (DIC)

Back 39

Form of diffuse clotting that consumes large amounts of clotting factors, causing widespread external bleeding, internal bleeding or both

Never a primary diagnosis; there's an underlying cause either Abruption, severe preeclampsia, or HELLP

Front 40

NI for DIC

Back 40

1. Volume expansion

2. Rapid replacement of blood products & clotting factors

3. Oxygenation

Front 41

Placental abruptio Grades: Coagulopathy

Back 41

Grade 1: Rare

Grade 2: occasional DIC

Grade 3: frequent DIC

PP: None

Front 42

Placental abruptio Grades: uterine tonicity

Back 42

Grade 1: Normal

Grade 2: increased may be localized to one region or diffuse over uterus. Uterus fails to relax between contractions

Grade 3: tetanic persistent uterine contractions board like uterus

PP: normal