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OB Ch. 14
Gestational Conditions
| Question | Answer |
|---|---|
| what is the most common medical complication of preg | HTN |
| what is 2nd cause of morbidity/mortality in US | preeclampsia which usually happens after 2nd trimester(after 20wks) |
| what is eclampsia | seizures from cerebral effects of preeclampsia |
| what is gestational HTN | onset of HTN during pregor in 1st 24 hrs after birth. BP returns to normal w/in 6wks of birth |
| what BP is considered mild/severe preeclampsia? HTN BP? Chronic HTN? | 140/90, 160/110, plus proteinuria map: >105 2x, 4hrs apart Chronic: HTN present b4 preg or b4 20 wks |
| s/s of severe preeclampsia | oliguria, altered lvl of consc, confusion, HA, blurred vision, epigastric pain |
| Preeclampsia is seen more in which pregnancy | primigravida |
| Name some risk factors for preeclampsia | nulliparity, obesity, multifetal gestation, chronic htn, renal disease, DM |
| Tx to prevent preeclampsia | high protein, low salt diet, Ca, Mg, Zinc, fish, diuretics, aspirin, heparin, Vit E/C |
| During preg, what occurs with CO? Peripheral resistance? Blood vol? O2 consumption? clotting factors? albumin lvls? renal flow? hormones? | incr: vol, co, o2, clotting factors, hormones decr: peripheral resistance, MAP, albumin |
| what is the HELLP Syndrome? | severe preeclampsia H-hemolysis EL- elev. liver enzymes(elevated) LP-low platelets (must b <100,000) |
| what is dependent edema? Pitting edema? | lowest/most dependent parts of body where hydrostatic pressure is greatest. +1(2mm), +2(4), +3(6), +4(8) |
| what is sign of mg toxicity | absence of DTRs(deep tendon reflexes), N, warmth, flush, muscle weakness, slurred speech Score: 0-4+ with 2+expected result Abnormal: positive clonus(tapping) |
| Assessing preeclampsia, when should report immediately? | incr BP, protein in urine, wt gain, decr fetal mvmt |
| In HELLP/Severe preeclampsia, which birth is safer? | vaginal and induced 32-36 wks |
| how soon should corticosteroids be given to promote fetal lung maturation | <34 wks |
| Why is mg sulfate drug of choice for preeclampsia | prevent convulsions given as IVPB. Initial loading dose 4-6g diluted in 100ml fluid, infused over 15-30min. Mg. lvl: 4-7.5 or 5-7 |
| what is antidote for mg sulfate | Ca gluconate, slow IV push over 3 min |
| what is anti-htn drug of choice for htn | IV hydralazine. but depends on woman's response |
| what is immediate care for eclamptic seizure? | patent airway noting time/duration description of seizure and any urinary/fecal incontinence, watch for aspiration |
| what is ultimate cure for eclampsia | delivery of baby |
| Mg Sulfate in postpart. can create what in the woman? | boggy uterus/lg lochia |
| Ergotrate and Methergine are contraindicated with preeclampsia, why? | They incr BP |
| With chronic htn, what is goal of therapy? What is drug of choice? | BP 150-160/100-110Hg Drug: Methyldopa or hydralazine |
| what is hyperemesis gravidarum? | vomiting when preg to wt loss of 5% or prepreg wt. See dehydration, electrolyte imbal, ketosis, acetonuria |
| Antepartal hemorrhage is leading cause of maternal death including? | ectopic preg rupture, uterine rupture, abruptio placentae |
| what is definition of miscarriage(spontaneous abortion)? | ends w/o medical/surgical b4 20 wks or 500g wt |
| An early/late miscarriage occurs when? What are possible causes of early miscarriage? | b4 12/12-20 wks Causes: endocrine imbal, immunological factors, inf, systemic disorders(lupus), genetic factors |
| what are 5 types of miscarriages | Threatened: uterine bleeding/pain Inevitable:ROM, dilation, passing Incomplete: pass fetus, not placenta Complete: all fetal tissue passed Missed: fetus dies in utero |
| What is a D&C (dilation and curettage)? | surgical where cervix is dilated adn curette inserted to scrape uterine walls adn remove contents |
| Misoprostol is used for what? | 1st trimester preg loss or expulsion |
| what is an incompetent cervix? | painless dilation w/o labor/contractions tx: bed rest, hydration, tocolysis, cervical cerclage(sew cervix shut) usually at 11-15 wks |
| what is an ectopic preg? It's the leading casue of what? | fertilized ovum is implanted outside uterine cavity, mostly fallopian tube on ampullar. Others: ovary, abd cavity, cervix. It's the leading cause of infertility |
| what are s/s of ruptured ectopic preg? | referred shoulder pain, tenderness, so methotrexate(used to abort) can mask signs of rupture |
| What is gestational Trophoblastic Disease (GTD)? | arise from placental trophoblast including: hydatidiform mole, invasive mole, choriocarcinoma |
| what is hydatidiform mole or molar preg? | early teens or over 40 2 types: complete(classic)-nucleus of fertilized egg lost. Looks like bunch of white grapes Partial mole: two sperm fertilizing ovum. Have various parts. Look like snow storm on doplar |
| what is standard to assess for placenta previa | ultrasound, if vag exam, prepare for c-section. |
| what is placenta previa? | placenta is implanted in lower uterine segment. Compete/Total/Central: internal os entirely covered by placenta Partial: imcomplete coverage Marginal: only an edge extends to internal os Low-lying: placenta implanted in lower uterine seg, not near os |
| what are risks for placenta previa | multiple gestation, multiparity, >35yrs, Af/Asian, smoking |
| If bleeding after 20wks, what should be suspected | placenta previa adn it's painless bleeding |
| what are best signs of acute blood loss more than VS? | urinary output |
| what is abruptio placentae? | premature separation of placenta, detachment of all/part. Greatest risk after vehicle crash with preg woman |
| what is major risk factor for abruption | maternal htn then cocaine use, blunt abd trauma, smoking |
| s/s of abruption will show? | sudden onset of intense localized uterine pain w/ or w/o bleeding. tx: fluids, UO of 30ml, Hct >30% |
| placenta accreta? increta? secreta | hemorrhaging accreta: trophoblastic invasion extends beyond normal endometrial barrier increta: extends into myometrium secreta: beyond uterine serosa |
| Rare placental anomalies: Velamentous insertion of cord? Vasa Previa? | Vela: umbilical vessels branch at membranes and into placenta Vasa: umbilical vessels x cervical os below presenting part |
| what is Battledore(marginal) insertion of cord? | increases risk of fetal hemorrhage after battledore |
| what is succenturiate placenta? | placenta divided into two or more separate lobes |
| s/s of appendicitis | RLQ pain, N/V, loss of appetite |
| what is second most common nonobstetric abd emergency in preg? | intestinal obstruction from women wtih laparotomy scar |
| When is best time for C-section after maternal death? | fetal survival best b4 20 min after maternal death |
Created by:
palmerag
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