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antepartum

types of abortion

QuestionAnswer
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