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OB Ch. 14

Gestational Conditions

QuestionAnswer
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