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High Risk
Bleeding
| Term | Definition |
|---|---|
| Threatened abortion findings | Mild cramping, little spotting, NOT PASSING TISSUE, cervix NOT dilated |
| Threatened abortion management | Put her on bedrest. If 1st Tri, won't stop it because can't. Have her labs checked (progest/HCGs) and US for fetal heartbeat. |
| Inevitable abortion findings | MODERATE bleeding, cramping, cervix IS dilating, has NOT passed tissue but may start |
| Inevitable abortion management | Watch how much POC (products of conception) is there. If POC expelled, does bleeding ease or cont? If POC expelled, do a D&Curettage |
| Incomplete abortion findings | HEAVY/PROFUSE bleeding, dilation yes, NOT everything has passed... but most |
| Incomplete abortion management | First Tri: EMERGENT D&C, d/t risk of bleeding out. Second Tri: Dilation & Evacuation |
| Complete abortion findings | UTERUS EMPTY, bleeding will go down, pain will resolve |
| Complete abortion management | No further interventions unless cont. to bleed |
| Missed abortion findings | Fetus has expired, NO SIGNS OF MISCARRIAGE, during prenatal visit NO fetal HR, "stone baby", risk for D.I.C. |
| Missed abortion management | 1st Tri: D&C 2nd/3rd Tri: Induce labor to allow body to empty uterus Good pain control If SEPTIC --> D&Evacuation + antibiotics |
| Habitual abortion findings | Has 3+ recurring miscarriages; unable to maintain pg |
| Habitual abortion management | Check her progesterone levels. If cervix dilates too quickly then cerelage (suture) cervix closed, release during 3rd Tri. |
| Placenta previa findings | BRIGHT red vaginal bleeding; PAINLESS; can partially or completely block cervical oss |
| Placenta previa low-lying management | Observe for bleeding, BEDREST to decrease risk of bleed; observe fetal well-being. If not much bleeding, will try v-birth |
| Placenta previa complete management | Bedrest last wks of pg, C-S necessary |
| Mild abruption findings | None to minimal bleeding, usu absent pain, uterus acts normal, baby generally not impacted |
| Mild abruption management | Monitor; may not have known there was abruption until expelled |
| Moderate abruption findings | May or may not be concealed vs. partial. Absent to moderate DARK RED bleeding (1000-1500), pain present, uterus fails to relax btwn cx and is firm |
| Moderate abruption management | V-birth until baby/mom tells otherwise (showing distress/bleeding) |
| Severe/complete (concealed) abruption findings | Dark red bleeding (>1500cc), rigid painful abd/uterus, tetanic/persistent uterine cx |
| Severe/complete (concealed) abruption management | C-Section; need to get baby out since no O2, no heart tones, variability. |
| Methotrexate is used to Tx ______ | Unruptured ectopic pg |
| ______ is one of the leading causes of maternal death. 2nd leading cause is _____ | Hemorrhage #1; HTNsive disorders #2 |
| Maternal exsanguiation can occur in less than ___ minutes | 10 |
| Missed abortion is defined as ______ | Nonviable embyro remaining in uterus for AT LEAST 6 weeks |
| Retained expired fetus is a risk factor for __ | DIC |
| What is the difference between D&C (dilation and curettage) and D&E (dilation and evacuation) | D&C is a procedure where cervix is widened (dilated) uterine lining is scraped to remove tissue after abortion. D&E refers to dilation of cervix and |
| What is a cerclage? | Suturing close cervix around 11-15 weeks |
| Management of cerclage | Bedrest, progesterone, anti-inflammatory drugs, antibiotics |
| When should cerclage be removed? | At 37-39 weeks or when labor begins. Depends on cervix. |
| Define an ectopic pregnancy | Fertilized ovum implanted OUTSIDE uterine cavity |
| 95% of ectopic pregnancies occur in the outer __ of the ___ | 1/3 (ampullar) of fallopian tube |
| Leading cause of infertility is _____ | Ectopic pregnancies |
| Clinical manifestations of ectopic pregnancies include (list 5) | 1) Dull to acute abd (often lower quadrant) pain, 2) delayed menses, 3) abnormal vaginal bleeding, 4) referred shoulder pain, 5) signs of shock |
| Management of ectopic pg: | Salpingostomy/salpingectomy, methotrexate, contraception, discussion of future fertility (d/t high rate of reoccurrence) |
| ________ is a sign of ruptured ectopic pregnancy | Referred shoulder pain |
| Methotrexate will cause _____ to shrink and should be given if mother presents with ____ shock | Embyro/fetus; no |
| Molar pregnancy is also known as ______ ______ | Hydatidiform mole |
| Molar pg is defined as | Spectrum of pg-related trophoblastic disorders without a viable fetus |
| Complete molar pg is defined as | Fertilization of egg with lost/inactivated nucleus. NO fetus/placenta/amniotic membrane |
| Partial mole pg is defined as | Result of 2 sperm fertilizing a normal ovum. Embyronic parts present and an amniotic sac. |
| Sx of molar pg | Severe hyperemesis, excessive abd/uterus growth, + pg test, NO FETAL HEARTBEAT HEARD, bright red/brown vaginal bleeding |
| True or false: molar pregnancies will show false negatives on pg test | False. Will show + pg test |
| True or false: in early stages, molar pg will present with abnormal sx | False. Early stages may look like normal pg |
| Management of molar pg | Most pass spontaneously. Suction curettage is safe. If unattended, could rupture uterus. Monitor 1 year afterword since high risk of choriocarcinoma (complication of molar pg) |
| Best place for a placenta to attach is ___ to the ___ | Close to the fundus |
| True or false: right shoulder pain and possible fetal changes are common sx of abruption | True |
| Greater than ___ of abruption-related bleeding is of high concern. | 500 |
| If large partial/concealed abruption, management is to... | DELIVER |
| 4Ts (causes) of intrapartum bleeding | Tone (uterine atony), tissue (retained placental tissue), trauma (uterine/cervical/vaginal lacerations), thrombin (coag disorders) |
| PP hemorrhage plan of care: | 1) ASSESS FUNDUS, 2) massage boggy fundus, 3) Trendelenburg/supine position, 4) O2 non-breather 10-12 L/min, 5) LOC/O2 sat, 6) meds, 7) VS/blood loss, 8) breath sounds before fluid bolus |
| For PP hemorrhage, you will give medications in this order | 1) Pitocin, 2) methergine, 3) hemabate, 4) Cytotec |
| Methergine is contraindicated in ____ | HTN |
| Cytotec is contraindicated in ____ | Moderate-severe asthma |
Created by:
lapio-obgyn
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