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
Fill in: Loss of pregnancy before fetus is viable is < __a__ weeks gestation. Or < __b__ gms.
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.
List 4 complications of Spontaneous abortion
3. RH factors
4. DIC (disseminated intravascular coagulation)
What are the six subgroups of Spontaneous abortions?
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
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
What are the diagnostic tests for ectopic pregnancy?
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)?
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
These conditions in a women can all increase the risk factor for what?
- prior c-sec
- prior D&C
- smoking and cocaine use
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
This term is the separation of the placenta before fetus is born
List steps if a mom is suspected of Abruptio Placentae. If stable? Unstable?
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
List 3 management interventions for severe Pre-eclampsia