What are the 3 primary causes of vaginal bleeding in the first trimester pregnancies?
1. Spontaneous abortion
2. Ectopic Pregnancy
3. Gestational Trophoblastic disease
This is is a group of conditions in which tumors grow inside a woman's uterus (womb). The abnormal cells start in the tissue that would normally become the placenta. The placenta is the organ that develops during pregnancy to feed the fetus
B.
Fill in: Loss of pregnancy before fetus is viable is < __a__ weeks gestation. Or < __b__ gms.
a. 20
b. 500
This term occurs when chromosome pairs do not separate during gamete formation or when two sperm fertilize an ovum simultaneously. (an embryo with one or more extra sets of chromosomes.)
T or F: It usually results in early spontaneous abortion.
Polyploidy: True
List 4 complications of Spontaneous abortion
1. hemorrhage
2. infection
3. RH factors
4. DIC (disseminated intravascular coagulation)
What are the six subgroups of Spontaneous abortions?
Complete
Recurrent
Inevitable
Incomplete
Threatened (50% will succeed)
Missed (no cramps/brownish discharge)
What is considered an "early" and "late" abortion?
Early: abortion before 12 wk gestation
Late: abortion between 12-20 wk gestation
Match abortion type definitions:
1. All of the products (tissue) of conception leave the body.
2. Only some of the products of conception leave the body
3. The pregnancy is lost and the products of conception do not leave the body
a. Inevitable
b. Complete
c. Incomplete
1. b
2. c
3. a
For therapeutic management of spontaneous abortions list interventions that will cover each:
T or F: IUD is a form of birth control that can increase the risk for PID (Pelvic Inflammatory Disease).
True: it can also increase risk for spontaneous abortion
A women who is pregnant shows with these s/s:
- vaginal spotting (or bleeding)
- abdominal, pelvic and R shoulder pain
- Elevated hCG but lower than normal pregnancy
- Breast tenderness
- Sudden severe pain in the R or LLQ
Ectopic pregnancy
What are the diagnostic tests for ectopic pregnancy?
Transvaginal ultrasound
Serum hCG
Will a surgical procedure (Salpingectomy) be done for an ectopic pregnancy if the fallopian tube is not intact?
A fallopian tube segment is removed. The remaining healthy fallopian tube may be reconnected. Salpingectomy is needed when the fallopian tube is being stretched by the pregnancy and may rupture or when it has already ruptured or is very damaged.
How is Methotrexate used during an ectopic pregnancy?
The drug interferes with DNA synthesis and disrupts cell multiplication
If a woman is on Methotrexate tx for an ectopic pregnancy, what will be needed for you to monitor?
Look for a drop in hCG level, showing that the pregnancy is ending
This disease is a group of conditions in which tumors grow inside a woman's uterus, and the abnormal cells start in the tissue that would normally become the placenta.
A baby may or may not develop.
How will hCG levels look compared to other normal pregnancies?
Gestational trophoblastic disease: hCG extremely elevated d/t large amounts of chorionic villi multiplying
What could these s/s indicate:
- Red brownish discharge at 16th week
- Uterus larger than expected
- Elevated BP before 24 week gestation (early dev. of PIH)
- Extremely elevated hCG (as high as 1-2 million IU; 300k normally)
Gestational trophoblastic Disease
What will be the diagnostic and tx for Molar Pregnancy (GTD)?
Diag.: Ultrasound
Tx: chest x-ray
- Metabolic and blood chem
- hCG tests
- CBC, blood type and clotting factors
- treat htn
- possible evauation of mole by vacuum aspiration
- follow up
This term is a condition in which the placenta partially of fully blocks the uterus for normal delivery
Placenta Previa
These conditions in a women can all increase the risk factor for what?
- multiparas
- prior c-sec
- prior D&C
- smoking and cocaine use
Placenta Previa
What do you want to avoid with a patient who has Placenta Previa?
Avoid cervical exams
Avoid administration of oxytocin or prostaglandins
This term is a rare but serious complication in which the pacenta grows so deeply in the uterine wall that it is unable to detach after childbirth.
Morbidly Adherent Placenta
Match the type of MAP:
1. Placenta grows in the uterine lining
2. Placenta grows into the muscular wall of the uterus
3. Placenta grows through the wall of the uterus and in some cases into adjacent organs
a. Increta
b. Accreta
c. Percreta
1. b
2. a
3. c
This term is the separation of the placenta before fetus is born
Placental Abruption
List steps if a mom is suspected of Abruptio Placentae. If stable? Unstable?
Hospitalization
Stable: bed rest, steroids for fetus
Unstable: Immediate delivery by c-sec
Replace fluid and blood PRN
This is a rare condition that causes blood clots reducing blood flow and can block blood from reaching bodily organs. As condition progresses, platelets and clotting factors in the blood are used up and you will experience excessive bleeding.
Disseminated Intravascular Coagulation
What are 2 possible tx of DIC?
1. Delivery of fetus and placenta
2. Blood product replacement
How can pre-eclampsia effect the placenta? 4
- infarctions increase risk of abruption and DIC
- Premature aging (IUGR) or delayed growth
- Thrombosis
- Calcifications
List 3 management interventions for severe Pre-eclampsia
What is HELLP stand for and which condition is it used for?
Severe Pre-Eclampsia
Hemolysis
Elevated Liver enzyme
Low Platelet count
90% of patients with severe pre-eclampsia experience this
65% of these patients experience this
31% experience this
Malaise: (general feeling of discomfort, illness, or uneasiness whose exact cause is difficult to ID)
Pain in the RUQ, lower chest or epigastric area
HA
What are the 2 diagnostic tests for HELLP?
CBC and LFT
What are tx for HELLP?
Seizure precautions
Keeping BP <160/110
If close to term, deliver ASAP
Transfusion PRN
Corticosteroids for fetus PRN
What seizure meds will be given for HELLP syndrome and why?
Magnesium sulfate to lower CNS irritability
What will be given if the baby is Rh+ and the mother is Rh-? When is it given?
RhoGAM to prevent antibody formation: given at 28 weeks gestation and after birth if baby is Rh+
Which increased human placental hormones in later pregnancy cause increased resistance to insulin and decreased glucose tolerance?
Lactogen
Prolacctin
Cortisol and glycogen levels also
How is the Glucose screening done?
Glucose challenge test @24-28 weeks: 50 gram load - test 1 hour
If >140, schedule 3 hour oral glucose tolerance test
- GTT: take BG after fasting, and then at 1, 2, and 3 hours after ingestion of a 100g oral glucose.
State whether insulin requrements will increase or decrease in the stage of pregnancy:
1. Early pregnancy
2. Second Trimester
3. End of Pregnancy
1. decreased
2. Increased
3. May double or quadruple
T or F: Insulin does not cross the placental barrier
True: Fetus starts producing insulin at 10 weeks.
Fill in:
The fetus starts producing insulin at ___ weeks.
10
What happens to the fetus if it is exposed to high levels of glucose?
It produces excessive insulin which acts as a growth hormone: Macrosomia
List the risks of pregnancy with diabetes
Hydramnios (10-20%) with PROM
Pre-eclampsia
UTI & vaginitis
Labor dystocia (difficult or slow labor)
Birth injury to maternal tissue
List 4 screening and assessment for a fetus/neonate
1. Glucose challenge test @24-28 weeks
2. Oral glucose tolerance test
3. Urine dip
4. Obtain baseline; ECG and opthalmic exam
What is the most common complication of pregnancy that is associated with preterm labor and low birth weight in extreme cases?
Iron deficiency anemia
What is iron deficiency anemia defined as in a pregnancy (lab value)
Hgb <11g/dL
List complications of anemia in pregnancy
1. More susceptible to infections
2. Delayed healing of wounds
3. Fatigue
4. PP hemorrhage
5. Pre-eclampsia
6. LBW
What is the supplement dose for anemia to start?
30mg/day: give wth OJ
Folate supplements as high as 1mg/day
What are adolescent pregnant moms have a higher risk for?
Preterm
LBW
Pre-eclampsia
Iron deficiency anemia
CPD (when baby's head or body is too large to fit through mom's pelvis)
Will Hydatidiform mole (Molar pregnancy) have high or low hCG levels?
Extremely high (1-2 million IU; normal = 300k)
What can a sudden onset of painless uterine bleeding in the latter of pregnancy indicate?
Placenta Previa
Fill in: What do you want to avoid doing with a placenta previa? (2)
Avoid cervical exams
Avoid admin of oxytocin or prostaglandins
What are the different types of MAP? (morbidly adherent placentas)
Accreta: invasion of trophoblastic cells into superficial layers of uterus
Increta: invasion into the myometrium
Percreta: involves invasion beyond uterine serosa
T or F: Placenta abruption is painful, and placenta previa is painless
True
T or F: Placenta abruptions can lead to rapid labors
True
What can these s/s indicate:
bleeding
abdominal and back pain
frequent contractions
non-reassuring FHR
Abruptio Placentae
Define: anticoagulation and procoagulation factors are stimulated at the same time. This results in a decrease in clotting factors and an increase in anticoagulants, leaving the mom unable to clot
DIC: dessiminated intravascular coagulation
What a risk of doing a c-sec on a mom who has a deceased fetus?
DIC: best to induce mom and deliver fetus and placenta vaginally
Pre-eclampsia is defined as...
>140/90 after 20 weeks
Proteinuria
What is the difference between pre-eclamp vs. gestational hypertension
No proteinuria AFTER 20 WEEKS
What is IUGR (intrauterine growth restriction) associated with?