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antepartum
types of abortion
| Question | Answer |
|---|---|
| threatened abortion | vaginal bleeding before the 20th wk. w/ or w/out pain, the cervix is closed, spot to moderate no tissue noted |
| inevitable abortion | vaginal bleeding & cramp-like lower abdominal pain. the cervix is frequently partially dilated, attesting to the inevitability of the process |
| incomplete abortion | in addition to vaginal bleeding, cramp-like, & cervical dilation, an incomplete abortion involves the passage of products of conception, often described by the woman as looking like pieces of skin or liver. |
| complete abortion | after passage of products of conception, the uterine contractions & bleeding abate, the cervix closes, & uterus is smaller than the period of amenorrhea would suggest, the symptoms of pregnancy are no longer present, pregnancy test becomes negative |
| missed abortion | when the fetus has died but is retained in the uterus, usually for some weeks. after 16 wks. gestation, dilation & curettage may become a problem. fibrinogen levels should be checked weekly until the fetus and placenta are expelled |
| recurrent abortion | any case in which there have been 3 consecutive spontaneous abortion. possible causes are know to be genetic error, anatomic abnormalities of the genital tract, hormonal abnormalities, infection, immunologic factors, or systemic disease. |
| gestational trophoblastic disease (molar pregnancy) | pain less dark purple bleeding D&C and no pregnancy for a year d/t cancer risk check serial Hcg levels |
| placental previa | bright red painless bleeding as a result of placenta implanting too low in the uterus so that all or part of the cervix is covered - depending on extend may need caesarian birth. |
| apruptio placental/placental abruption | dark red bleeding w/severe pain & rigid abdomen. risk factors: anything that increases BP/vasoconstriction, eg., severe pre-eclampsia, cocaine use |
| vasa previa | fetal blood vessels implant into the amniotic membrane versus the placenta and may cross the cervical os, painless heavy bleeding w/fetal bradycardia |
| placentra accrete, increta, percreta, | placenta attaches itself too deeply into the wall of the uterus creating a major hemorrhage risk and generally requiring surgical intervention. |
| fetal fibronectin | can be detected in vaginal discharge toward the end of pregnancy. positive fibronectin indicates a woman will go to preterm labor in the next 7-10 days negative fibronectin indicates a woman will not go into labor next 7-10 days. |
| management of preterm labor | treat underlying cause tocolytic meds: terbutaline, calcium channel blockers, magnesium sulfate biophysical profile and L:S ration (= or > is good) to assess fetal maturity. IV steroids adm. to mother may accelerate fetal lung development. |
| hypertensive disorders | chronic hypertension present before woman becomes pregnant. gestational HTN develops after 20 wks: ACEIs & ARBs are contraindicated in pregnancy. |
| preeclampsia | S/S: proteinuria, HTN, sudn weight gain, edema, hyper-reflexia, HA, epigastric pain. Eclampsia: seizures. Meds: labetalol (tx HTN), magnesium sulfate IV, mntr: RR & DTRs (reflexive, not hyporeflexive. HELLP synd: liver involvnt& clotting issues (DIC) |
| diabetes | mgmt. will be complicated d/t hormonal & other physiologic changes. blood sugar imbalances can cause problems w?organogenesis, as pregnancy progresses the placenta may not be well-developed or perfused. |
| gestational diabetes (develops during pregnancy) | first choice is diet and activity, but insulin if medication is needed. baby may be LGA and is at high risk of hypoglycemia after cord is cut. |
| heart disease in pregnancy | TX beta blockers, digoxin (.25mg) furosemide 80mg/day. stopping beta blocker suddenly causes malignant HTN. take BP, HR. digoxin hold: 1) GI distress, 2) level >2mg, 3) visual disturbances, 4) HR < 60, 5) potassium <3.5 |
| TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus) | toxoplasmosis - don't eaat raw or undercooked meat or handle cat feces. rubella & CMV stay away from large crowds of kids if non-immune. Herpes Simplex Virus (HSV) in an active outbreak can't delivery vaginally - cont. antiviral therapy |
| HIV positive mothers | early ID decreases perinatal transmission: zidovudine decreases vertical transmission 70%. can deliver vaginally. avoid invasive procedures (amniocentensis or episiotomy if possible). NO BREASTFEEDING |
| group B strep (GBS) | mother must get at least 2 doses of IV antibiotics prior to delivery or infant must stay at least 48 hours in the hospital d/t risk of newborn sepsis |
| chlamydia and gonorrhea | can cause neonatal eye infection, prevented w/application of antibiotic ointment |
| hepatitis B virus | hep B vaccicen and HBIG within 12 hours of birth if born to positive mother |
| varicella zoster | maternal varicella can be transferred to the fetus through the placenta (if non-immune stay away from kids w/chicken pox) |
| parovirus | AKA "fifth disease" can be transferred to the fetus through the placenta |
Created by:
gdimanche
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