Complications of pregnancy
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| Is vaginal bleeding in the first trimester always abnormal? | No, it could be a result of implantation bleeding (instead of miscarriage, ectopic or molar pregnancy).
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| Is vaginal bleeding in the second and third trimester always abnormal? | Yes
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| Complications associated with bleeding during 1st trimester. | - spontaneous abortion
- ectopic pregnancy
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| Complications associated with bleeding during 2nd trimester. | - gestational trophoblastic disease (molar pregnancy)
- incompetent cervix
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| Complications associated with bleeding during 3rd trimester. | - placenta previa
- abruptio placenta
- preterm labor
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| What is spontaneous abortion? | - pregnancy terminated before 20 weeks, or
- fetal weight < 500 grams
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| What is dilation and curettage (D&C)? | Dilating and scraping the uterine walls to remove contents from inevitable or incomplete abortions.
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| What is dilation and evacuation (D&E)? | Dilating and evacuating uterine contents after 16 weeks gestation.
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| What hormone drug is administered to induce labor and expulse products of a late term or abortion pregnancy? | Prostaglandin
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| What are S/S of incomplete abortion? | - severe cramps
- continuous and severe bleeding
- partial fetal tissue or placenta passed
- cervix dilated with tissue
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| What are S/S of complete abortion? | - no cramps
- minimal bleeding
- complete expulsion of uterine contents
- closed cervix
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| What is ectopic pregnancy? | Abnormal implantation of fertilized ovum outside of uterus.
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| What are risk factors for ectopic pregnancy? | pelvic inflammatory disease, IUD.
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| What are S/S of ectopic pregnancy? | unilateral stabbing pain, scant dark red - brown bleeding, referred shoulder pain
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| What is gestational trophoblastic disease (molar pregnancy)? | Proliferation and degeneration of the trophoblastic villi in the placenta that takes on a grape-like cluster appearance.
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| What hormone is greatly elevated in molar pregnancy? | hCG
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| What are S/S of molar pregnancy? | rapid uterine growth, vaginal bleeding, hyperemesis
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| What is incompetent cervix? | weak cervix that spontaneously dilates around 16 weeks.
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| What is the treatment for incompetent cervix? | Cervical cerclage (rubber-banding)
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| What are nursing interventions for incompetent cervix? | activity restriction; patient refrain from intercourse, prolonged standing (>90 min), heavy lifting
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| What is placenta previa? | abnormal implantation of placenta in lower uterus or over cervical os.
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| What are S/S of placenta previa? | painless bright red vaginal bleeding, relaxed uterus, unusual fetus lie, decrease UOP
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| What is abruptio placenta? | premature separation of placenta from uterus
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| What are S/S of abruptio placenta? | sudden onset of intense localized pain, vaginal bleeding, uterine hypertonicity, fetal distress, symptoms of hypovolemic shock
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| What is hyperemesis gravidarum? | excessive N/V past 12 weeks with 5% weight loss from prepregnancy weight, dehydration, electrolyte imbalance, ketosis, and acetonuria.
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| What is gestational HTN? | - begins after 20 weeks
- Elevated BP >140/90
- no proteinuria or edema
- returns to baseline after 6 wks postpartum
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| What is mild preeclampsia? | GH with 1 to 2+ proteinuria, weight gain, mild edema
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| What is severe preeclampsia? | BP >160/100, 3 to 4+ proteinuria, cerebral or visual disturbances, hyperreflexia, peripheral edema, hepatic dis-fx, epigastric pain
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| What is eclampsia? | severe preeclampsia with seizure or coma.
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| What is HELLP syndrome? | a variant of GH consisting of Hemolysis, ELevated liver enzymes, Low Platelets
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| What risks are associated with gestational HTN? | placental abruption, preterm birth, fetal and maternal death
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| What is prophylactic for gestational hypertensive seizures? | IV magnesium sulfate
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| What are the s/s of magnesium sulfate toxicity? | absent DTR, urine output <30 ml/hr, RR <12, decreased LOC
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| What is antidote to magnesium sulfate toxicity? | calcium gluconate
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| What is TORCH? | an acronym for group of infections that can negatively affect pregnant women. Toxoplasmosis, Other infections, Rubella, Cytomegalovirus, Herpes Simplex.
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| What are risk factors for toxoplasmosis? | consumption of raw/undercooked meat, handling cat feces.
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