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Maternity Exam 4
Terms in this set (51)
What is spontaneous abortion (SAB)?
termination of a pregnancy before the fetus is viable (less than 20 weeks gestation and less than 500 grams)
What are some causes of spontaneous abortion?
chromosomal abnormalities, maternal infections, endocrine disorders, immunologic factors
What is threatened spontaneous abortion?
spotting, slight bleeding, cervical os closed, no dilation of cervix
What is inevitable spontaneous abortion?
moderate to heavy bleeding with opened cervical os
What is incomplete spontaneous abortion?
moderate to heavy bleeding with opened cervical os, not all products of conception are expelled
What is complete spontaneous abortion?
all products of conception are expelled from the uterus
What is missed spontaneous abortion?
fetus dies and remains in uterus with placenta
What is recurrent SABs (three or more) the result of?
genetic or chromosomal abnormalities; anomalies of the reproductive tract such as bicornuate uterus, incompetent cervix
What is bicornuate uterus?
having 2 horns with indentation at the top
What is incompetent cervix?
unable to support weight of the fetus; placement of cerclage suture early in pregnancy with removal at 36 weeks gestation
How do you diagnose spontaneous abortions?
hormone levels, ultrasound
What is the management of threatened spontaneous abortions?
bedrest, pelvic rest
What is the management of inevitable spontaneous abortions?
it's going to happen, no way to prevent it, just allow them to deliver, and maybe do D&C
What is the management of incomplete spontaneous abortions?
stabilize the mom
What is the management of complete spontaneous abortions?
everything has come out, teach her to observe for infection or bleeding
What is the management of missed spontaneous abortions?
What are complications for spontaneous abortions?
infection (avoid intercourse until after next menses), anemia (blood loss, iron replacement may be needed), Rh negative mom (RhoGam, no matter what baby is)
What is DIC?
disseminated intravascular coagulation; problem with missed spontaneous abortion after 12th week; initiation of clotting mechanisms with consumption of clotting factors; circulating blood is deficient in clotting factors resulting in bleeding from vulnerable sites
What are risk factors for DIC?
abruption placenta, IUFD (intrauterine fetal death), eclampsia (convulsions), amniotic fluid embolism (rare, amniotic fluid enters mother's blood stream during delivery), hemorrhage
What are symptoms of DIC?
bleeding from every orifice, abnormal clotting factors, shock (restlessness, tachycardia)
What is the management of DIC?
deliver fetus and placenta promptly to remove precipitating factors, replace intravascular fluid volume with PRBC's and crystalloid solutions, and administer fresh frozen plasma along with platelet concentrates
What is a complication of DIC?
death if hypofibrinogenemia is not reversed
What is ectopic pregnancy?
the implantation of the fertilized ovum occurs outside the uterine cavity
What are causes of ectopic pregnancy?
pelvic inflammatory disease scarring, failed tubal ligation, multiple induced abortions, STD's, IUD, hormonal issues (delayed or premature ovulation)
What type of ectopic pregnancies are there?
tubal (95%), abdominal (3-4%), ovarian (1%), cervical (1%)
What is the diagnosis of ectopic pregnancies?
differential diagnosis involves consideration of numerous disorders that share many signs and symptoms (appendicitis, salpingitis, ruptured ovarian cyst, miscarriage), use laboratory analysis or ultrasound
What are signs and symptoms of ectopic pregnancies?
pain (may be dull, increasing to severe if tube ruptures), nausea and vomiting (occasionally before, frequently after rupture), missed period followed by abnormal vaginal bleeding (50-80%), signs of shock related to bleeding in abdominal cavity
How do you manage ectopic pregnancies?
laparotomy to remove tube if rupture has occurred, salpingostomy to incise tube and remove fetus before rupture, methotrexate (medication given to inhibit the rapidly dividing cells)
What are complications from ectopic pregnancies?
maternal mortality from hemorrhage, infertility
What is the cause of 10% of all maternal mortality (the leading cause)?
What is the infertility from ectopic pregnancy from?
damage to tubes or destruction of tube
What is hydatidiform mole (molar pregnancy)?
gestational trophoblastic disease, with development of the placenta but not the fetus and resulting in proliferation and edema of the chorionic villi
What are the chorionic villi?
grape like clusters of tissue that rapidly grow and fill the uterus to the size of an advanced pregnancy
What is the cause of hydatidiform mole?
What are the types of hydatidiform moles?
complete and partial
What is complete hydatidiform moles?
ovum is fertilized by sperm that duplicates its own chromosomes while the maternal chromosomes in the ovum are inactivated; grape like cluster appearance
What is partial hydatidiform moles?
maternal contribution is present, but paternal contribution doubles; appearance of some fetal tissue or membranes
How do you diagnose hydatidiform moles?
excessive nausea and vomiting, uterus larger than expected for dates, vaginal bleeding which may be bright red or brown, no fetal heart tones or movement, hCG level greater than normal; use ultrasound
How do you manage hydatidiform moles?
evacuation of trophoblastic tissue of mole (can become cancer), follow up to detect any malignant changes of any remaining trophoblastic tissue
What are complications of hydatidiform moles?
bleeding, infection, risk of choriocarcinoma
What is placenta previa?
implantation of the placenta in the lower uterus
What are risk factors of placenta previa?
previous placenta previa, previous cesarean birth, previous induced abortion, fibroids, advanced maternal age (>35 years), multiparity, multiple gestation
What are fibroids?
benign fibroid tissue tumors in the muscle layer of the uterus
What are the different types of placenta previa?
marginal, partial, total
What is marginal placenta previa?
doesn't cover cervical os (low lying)
What is partial placenta previa?
partially covers cervical os
What is total placenta previa?
completely covers cervical os
What are s/s of placenta previa?
painless vaginal bleeding, use ultrasound to diagnose
How do you manage placenta previa?
c/s if heavy bleeding or total placenta previa, bed rest if bleeding stops and baby not term gestation
What should nurses not do in the case of vaginal bleeding?
a vaginal exam, may cause additional placental separation or tear the placenta itself, causing severe hemorrhage and extreme risk to the fetus
What are complications of placenta previa?
preterm ROM, preterm birth, hemorrhage (postpartum leading to hysterectomy)
This set is often in folders with...
Postpartum Quiz Pt. 2
Care of the Newborn
Maternity Exam 1
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