Week 3- OB

What is a spontaneous abortion?

Pregnancy loss before 20 weeks gestation when the fetus weighs less than 500 g.

What are the main types of spontaneous abortion?

Threatened, inevitable, incomplete, complete, missed, septic, and recurrent.

What is the most common cause of spontaneous abortion?

Chromosomal abnormalities (about 25%).

What maternal condition increases the risk for spontaneous abortion?

Type 1 diabetes mellitus.

What assessment findings can indicate spontaneous abortion?

Vaginal bleeding, abdominal cramping, cervical dilation, rupture of membranes, fever, and signs of hemorrhage.

Which laboratory values are monitored when blood loss is significant?

Hemoglobin (Hgb) and hematocrit (Hct).

Why are clotting factors monitored in missed abortions?

Risk of disseminated intravascular coagulation (DIC) from retained products of conception.

What diagnostic test determines if a fetus is viable?

Ultrasound.

What procedure scrapes uterine contents from the uterine wall?

Dilation and curettage (D&C).

What procedure evacuates uterine contents using suction?

Dilation and evacuation (D&E).

Which medications stimulate uterine contractions to expel products of conception?

Prostaglandins and oxytocin.

What are the manifestations of a threatened abortion?

Mild cramps, slight spotting, no tissue passed, closed cervix.

What finding distinguishes an inevitable abortion?

Cervical dilation with moderate bleeding and no tissue passed yet.

What findings are expected with an incomplete abortion?

Severe cramps, heavy bleeding, tissue passed, dilated cervix.

What findings indicate a complete abortion?

Tissue expelled, minimal bleeding, mild cramps, cervix closed afterward.

What is a missed abortion?

Fetal death with retention of products of conception.

What findings occur with a missed abortion?

Usually no pain, little or no bleeding, cervix closed.

What finding suggests a septic abortion?

Malodorous vaginal discharge and infection symptoms.

What is the priority nursing action for vaginal bleeding during pregnancy?

Perform a pregnancy assessment and determine the cause.

How should vaginal bleeding be monitored?

Count and assess saturated pads.

Why should vaginal exams be avoided in clients with bleeding during pregnancy?

They may worsen bleeding.

Why should passed tissue be saved?

For examination.

What term should nurses use instead of "abortion" when speaking with clients?

Miscarriage.

What medication is given to Rh-negative clients after pregnancy loss?

Rho(D) immune globulin (RhoGAM).

What discharge instructions should be given after miscarriage?

No intercourse, tampons, or tub baths for 2 weeks.

When should the provider be notified after a miscarriage?

Heavy bright-red bleeding, fever, or foul-smelling discharge.

What is an ectopic pregnancy?

Implantation of a fertilized ovum outside the uterus, usually in the fallopian tube.

Why is an ectopic pregnancy dangerous?

Tubal rupture can cause life-threatening hemorrhage.

What is the classic pain associated with ectopic pregnancy?

Unilateral stabbing lower abdominal pain.

What type of vaginal bleeding occurs with ectopic pregnancy?

Scant dark-red or brown spotting.

Why can shoulder pain occur with a ruptured ectopic pregnancy?

Blood irritates the diaphragm and phrenic nerve.

What signs indicate hemorrhagic shock from a ruptured ectopic pregnancy?

Hypotension, tachycardia, pallor, dizziness.

What ultrasound finding is characteristic of ectopic pregnancy?

Empty uterus.

What medication treats an unruptured ectopic pregnancy?

Methotrexate.

How does methotrexate work?

Inhibits cell division and dissolves the pregnancy.

What surgery preserves the fallopian tube?

Salpingostomy.

What surgery removes the affected tube?

Salpingectomy.

What should clients taking methotrexate avoid?

Folic acid supplements and excessive sun exposure.

Which risk factors increase the likelihood of ectopic pregnancy?

STIs, tubal surgery, assisted reproductive technology, and IUD use.

What is gestational trophoblastic disease (GTD)?

Abnormal proliferation of placental trophoblastic tissue forming grape-like vesicles.

What happens to the embryo in GTD?

It fails to develop normally.

What cancer can develop from GTD?

Choriocarcinoma.

What is found in a complete mole?

No fetus, placenta, amniotic sac, or fluid.

What causes a complete mole?

All genetic material is paternal.

What causes a partial mole?

Fertilization by two sperm or abnormal sperm division.

What findings suggest GTD?

Hyperemesis, rapid uterine growth, dark brown "prune juice" bleeding, high hCG levels.

What pregnancy complication occurring before 24 weeks suggests GTD?

Preeclampsia.

What ultrasound finding occurs with GTD?

Vesicular growth without a fetus.

What procedure removes a molar pregnancy?

Suction curettage.

Why must hCG levels be monitored after treatment?

To detect persistent disease or choriocarcinoma.

How long should hCG levels be followed?

Weekly for 3 weeks, then monthly for 6 months to 1 year.

What contraception teaching is important after a molar pregnancy?

Use reliable contraception and avoid IUDs.

What is placenta previa?

Placenta implants over or near the cervical os.

What is the hallmark sign of placenta previa?

Painless bright-red vaginal bleeding.

During which trimester does placenta previa usually present?

Second or third trimester.

How does the uterus feel with placenta previa?

Soft, relaxed, and nontender.

What fetal positions are commonly associated with placenta previa?

Breech, transverse, or oblique.

What assessment finding may indicate blood loss before vital signs change?

Decreasing urine output.

What diagnostic test confirms placenta previa?

Ultrasound.

What important intervention is contraindicated in placenta previa?

Vaginal examination.

Why is betamethasone administered with placenta previa?

To promote fetal lung maturity if early delivery is anticipated.

What teaching should be given to a client with placenta previa?

Bed rest and nothing in the vagina.

What is abruptio placentae?

Premature separation of the placenta after 20 weeks gestation.

What is the hallmark symptom of abruptio placentae?

Sudden severe abdominal pain.

What type of bleeding occurs with abruptio placentae?

Dark red vaginal bleeding.

How does the uterus feel with abruptio placentae?

Rigid, board-like, and tender.

What fetal finding is common in abruptio placentae?

Fetal distress.

Which coagulation disorder is commonly associated with abruptio placentae?

Disseminated intravascular coagulation (DIC).

What are major risk factors for abruptio placentae?

Hypertension, abdominal trauma, cocaine use, smoking, PROM, multifetal pregnancy.

What is the priority treatment for significant abruptio placentae?

Immediate birth.

What oxygen flow rate is recommended?

8-10 L/min by face mask.

Placenta previa pain?

Painless.

Abruptio placentae pain?

Severe abdominal pain.

Placenta previa bleeding color?

Bright red.

Abruptio placentae bleeding color?

Dark red.

Placenta previa uterine tone?

Soft and relaxed.

Abruptio placentae uterine tone?

Firm, rigid, board-like.

Vaginal exam in placenta previa?

Contraindicated.

Fetal distress is more common in which condition?

Abruptio placentae.

What is vasa previa?

Fetal vessels implant in the membranes instead of the placenta.

What major complication can occur with vasa previa?

Fetal hemorrhage.

How is vasa previa diagnosed?

Ultrasound.

What is the nurse's priority during labor for a client with vasa previa?

Monitor closely for excessive bleeding and fetal distress.

Bright-red painless bleeding in the third trimester indicates what condition?

Placenta previa.

Dark-red bleeding with a rigid painful uterus indicates what condition?

Abruptio placentae.

Unilateral abdominal pain, missed period, and shoulder pain indicate what condition?

Ectopic pregnancy.

Prune-colored discharge, excessive nausea, and uterus larger than expected indicate what condition?

Hydatidiform mole.

What medication treats an unruptured ectopic pregnancy?

Methotrexate.

What medication should Rh-negative clients receive after pregnancy loss?

Rho(D) immune globulin (RhoGAM).