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 |