RNC-OB complications with pregnancy
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| Preterm Labor | ctx resulting in cervical change. Can be caused by infection, stress, hemorrhage/abruption, mechanical stretch of uterus. screened by cervical length or FFN. Managed by bedrest, pelvic rest, tocolytics, hydration, progesterone.
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| FFN | glycoprotein produced by fetal membranes present on if disrution of membrane-uterine junction. Indicates high risk of labor in next 7 days. Contraindicated if sex or SVE in last 24 hours, >3cm dilated, ROM, cerlage, or vaginal bleeding
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| Placenta Accreta | Placenta attached deep into uterine wall, but not into muscle. Most commone type of abnormal implantation. Risk factors: previous c/s or myomectomy, >35 years old, smoker.
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| Placenta Increta | placenta penetrates into uterine muscle (myometrium)
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| Placenta Percreta | placenta penetrates through uterine muscle (myometrium and serosa) and possibly to other organs.
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| Placenta Previa | placenta completely covering (complete), partially covering (partial), or lying at the edge of (marginal) the cervix. Associated with previous uterine surgery, multiple gestation, multip, or >35 years old. Deliver via low segment vertical c/s
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| Placenta Abrution | Premature seperation of placenta.S/S: uterine tenderness, sharp abdominal pain, 'port wine' stained fluid, "board like" abdomen, uterine irritability, frequent ctx, tachycardia, nonreassureing FHTs. Associated with cocaine use, smoking, CHTN, and pre-e
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| (Poly) Hydramnios | >/= 2L, AFI >20
assocaited with cepahlic abnormalities, cleft palate, esophageal atresia, Down's syndrome, hydrops fetalis, maternal diabetes, multiple gestation, abnoramlly large, glistening, tight abdomen. Treated with meds, amnioreduction, or deliver
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| Oligohydramnios | <500cc, AFI<5. Assocaited with chromosomal & congenital abnormalities, >42 wk gest, ROM, IUGR, defects of fetal urinary tract. Risks: cord compression, birth defects, miscarriage, still birth, MSF, PTL. Treatment: amnioinfusion, bedrest, rehydration
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| Anaphylactoid Syndrome (Amniotic Fluid Embolism) | Entrance of amniotic fluid & debris into maternal circulation. Triggers vasoscpasms and vasoconstriction, pulm HTN and hypoxia, heart failure with acute resp. distress. Initiation of clotting cascade leads to hemorrhage and DIC.
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| Prolapsed Cord | Umbilical cord lies beside or below presenting part. Associated with malpresentation, non engagement, AROM, Amnioinfusion, External version, and internal monitors. Risk factors: low lying placenta, preterm, multiple gestation, polyhydramnios.
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| Vasa Previa | Fetal vessels run, unsupported by tissue or cord, in membranes through lower uterine segment below presenting part. Painless vaginal bleeding at ROM. Risk factors: IVF, placental malformation. Requires c/s delivery. APT test determines source of blood.
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| Shoulder Dystocia | H-Help
E-evaluate for episiotomy
L-legs into McRoberts - thighs on abdomen
P-pressure suprapubic
E-enter maneuvers
R-remove posterior arm
R-roll to all fours (Gaskin's maneuver)
last resort = cephalic replacement, sympiotomy, or deliberate fracture
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| Hemorrhage | >1000cc vaginally; >1500cc C/S
Tone - assess fundus r/o uterine atony
Tissue - r/o retained placenta
Trauma - r/o cervical or vaginal laceration or hematomas
Thrombin - check labs
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| Mo/Mo Twins | least common, highest risk
one placenta, one sac
risks: cord entanglement, compression
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| Mo/Di Twins | one placenta, two sacs
at risk for TTTs
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| Twin to Twin Transfusion Syndrome (TTTs) | blood and nutrients from one twin to the other.
Donor = small, anemic, oligo
Recipient = large, polycythemic, poly, plethora
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| Di/Di Twins | most common, lowest risk
2 placentas, 2 sacs
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| Gestational HTN (PIH) | HTN first diagnosed during pregnancy after 20 wks that does not progress to preeclampsia and resolves by 12 wks postpartum. Retrospective diagnosis: close observation and overdiagnosis of preeclampsia preferrable. Not associated with poor birth outcomes.
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| Mild Preeclampsia | Pregnancy specific syndrome of decreased organ perfusion defined as HTN >140/90 x2, 4hrs apart + proteinuria >300 mg or 1+. Associated with young age, primip, new paternity, african american, CHTN, multiple gestation.
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| Severe Preeclampsia | Diagnosis of preeclampsia + one of the following: BP >160/110, proteinuria >5g or 3+, creatinine >1.2, platelets <100,000, elevated liver enzymes, persistent symptoms, oliguria, pulmonary edema, seizures
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| Eclampsia | 1-2 min seizures with alternating muscle ctx of hands and facial muscles, intermittent respirations, & coma in women diagnosed with preeclampsia. protect airway, prevent aspiration, supplemental O2, minimize risk of recurrent seizure, expedite delivery!
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| Superimposed preeclampsia | new onset of proteinuria or sudden increase in BP in previously well controlled HTN. prognosis worse for mom and baby. Increased risk for placental abruption and IUGR than with preeclampsia or CHTN alone.
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| HELLP | microvascular endothelial damage leads to intravascular platelet activation. Often presen tiwth nonspecific symptomes. Associated with spontaneous hemorrhage, DIC, abruption, renal failure, pulmonary edema, hepatic rupture, severe IUGR
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| Ketoacidosis (DKA) | more common with Type I IDDM
insuline definciency, hyperglycemia, ketosis, acidosis, dehydration
caused by polyuria, N/V
Treated by correction of fluid & electrolyte imbalance, IV hydration, insulin, correct acidosis
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| Gestational Diabetes | Develops second trimester due to increased hormones causing increased resistance to insulin action.
Increased risk of Type II IDDM
Risk for macrosomia and metabolic consequences
Treated with nutritional therapy, exercise, insulin, or glyburide.
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| Type I/II IDDM | Insulin requirements increase in 2nd-3rd trimesters.
Increased risk of maternal HTN and preeclampsia, IUGR, and placenta abruption.
Risks to infant depend on glucose control throughout pregnancy.
insuline requirements decrease rapidly after delivery.
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| Appendicitis | Most common, acute, abdominal condition requiring surgery during pregnancy. S/S: anorexia, N/V, RLQ pain
risk of perforation increases with gestation leading to increased risk of PTL
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| Systemic Lupus Erythematosus (SLE) | Autoimmune disorder characterized by photosensitive rash, inflammation of lungs, heart and abdominal organs, raynauds, glomerulonephritis, hematologic abnormalities. Increased risk of flares in pregnancy. Fetus at risk for congenital heart block
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| Hyperthyroid Dysfunction | Typically caused by Graves Disease. Immune system makes antibodies that mimic TSH. Can go into remission 2nd-3rd trimesters due to immune system depression. Can cause CHF, preeclampsia, thyroid storm, miscarriage, PTL, low birth weight
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| Hypothyroid Dysfunction | Typically caused by Hashimoto's disease. Immune system attacks thyroid. decreased levels of thyroid hormone in 1st trimester can effect growth and brain development. Can lead to preeclampsia, anemia, miscarriage, low birth weight, and stillbirth
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| DIC | Inflammatory response releases clotting cascade leading to microclots forming in capillaries decresing clotting factors and causing excessive bleeding. Treat with replacement of pRBCs, FFP, Cryoprecipitate, and platelets.
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| Hemolytic Disease (of Newborn) | Rh+ infant RBC's attacked by antibodies from Rh- mom that form against fetal-D antigen (anti-D) that cross placenta. Sensitization occurs with first pregnancy, miscarriage, or prenatal bleeding. Treat with Rhogam at 28 weeks and after delivery
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| Immune Thrombocytopenic Purpera (ITP) | Antiplatelet antibodies (IgG) coat platelets which are destroyed by spleen. Antibodies cross placenta and can cause bleeding disorders in newborn. Treat with steroids, IV immune Globulins, splenectomy, Rhogam, platelet transfusion.
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| Iron Deficiency Anemia | Most common. decreased Iron = decreased HGB (can't carry enough O2). Treat with 300-325mg Iron supplement daily
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| Folate Deficiency Anemia | decreased folic acid = decreased RBCs.
can lead to other types of birth defects
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| Vitamin B12 Deficiency | decreased Vit. B12 = decreased RBCs.
can lead to birth defects
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| Anemia | mild physiologic anemia normal due to increased blood volume. S/S tired & weak. Risks: PTL, low birthweight, pp depression, increased risk of defects, blood transfusions. Risk factors: multiple gestation, close pregnancies, heavy periods, teen pregnancy
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| Cocaine Use with Pregnancy | associated with: SAB, PROM, PTL, IUGR, Abruption, congenital anomalies, transient increased CNS and autonomic systems, LBW, and decreased length & head circumference
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| Domestic Violence and Pregnancy | Increased risk for violence &/or frequency
effects: IUFD, abruption, fractures, rupture, hemorrhage, inadequate PNC, poor weight gain, anxiety, LBW, miscarriage, exacerbation of chronic illness
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