OB Exam 3

Miscarriage is pregnancy loss due to __________ causes before _____ ________

natural, 20 weeks

What are the 4 kinds of miscarriages?

threatened, inevitable, incomplete, and complete

Threatened Miscarriage

• _______ bleeding

• _______ cramps

• ________ cervix

• pregnancy may __________; fetus is _________

slight, mild, closed, continue, living

Threatened Miscarriage Treatment (3)

ultrasound, serial hCG, and Monitoring

Inevitable Miscarriage

• ___________ bleeding

• ______ to _______ cramps

• __________ cervix

• expulsion ______ be __________

moderate, mild, severe, dilated, can’t, prevented

Inevitable Miscarriage Treatment (2)

cytotec and possible D and C

Incomplete Miscarriage

• _________ bleeding

• __________ cervix

• ________ tissue passed,

• placenta tissue ________

heavy, dilated, some, retained

Incomplete Miscarriage Treatment (2)

stabilize, D and C

Complete Miscarriage

• bleeding and cramping ________ after passage

• cervix may _______ after passage

• ______ tissues passed

decreased, close, all

Treatment for Complete Miscarriage (2)

pain management, emotional support

Nurse Priorities for Miscarriage

• determine _____/___ status

• administer __________ _________ when indicated for Rh Neg pt

• provide support

• anticipate __________, ______, ____ _______, and possible ____ and ___.

ABO, Rh, Rhimmune globulin, ultrasound, hCG, IV fluids, D, C

What are 4 Nursing Assessments for Miscarriage?

bleeding, pain, VS, gestational age

Ectopic Pregnancy is when fertilized egg implants _________ uterine cavity (usually in the ______)

outside, tubes

Symptoms of Ectopic Pregnancy

• ____________ lower abd. pain

• mild dark ____/______ bleeding

• _________ pain

unilateral, red, brown, shoulder

Symptoms of Ectopic Pregnancy Rupture

• ________, sharp, severe abd. pain

sudden

Symptoms of Ectopic Pregnancy Shock

• ______ ___________

• __________

• __________

• ______

Int. Hemorrhage, tachycardia, hypotension, pallor

What are 4 Risk factors for Ectopic Pregnancy?

PID/STDs, tubal surgery, abd. surgery, previous ectopic

Treatment for Ectopic Pregnancy includes… (3)

Methotrexate, Laparoscopy, or Laparotomy

Methotrexate for Ectopic Pregnancy

• _________ rapidly dividing _____________ tissue

• used in ______, __________ cases

destroys, trophoblastic, stable, unruptured

Laparoscopy/Laparotomy for Ectopic Pregnancy

• ________ the ectopic pregnancy

• used in cases where there is ___________ and __________

removes, rupture, instability

Nursing Priorities for Ectopic Pregnancy

• establish ___ for ______ and _______ products

• prepare for ________ (if ruptured)

• Monitor _____ and signs of _____. ___________

IV, fluids, blood, surgery, VS, int. bleeding

Nursing Priorities for Methotrexate

• monitor _____ until it resolves

• teach pt to follow __________, and ________-____.

hCG, restrictions, follow up

Hydatidiform Mole (Molar Pregnancy) is an abnormal growth of _____________ tissue in the uterus.

trophoblastic

Symptoms of Molar Pregnancy

• _________ bleeding (from abnormal growth)

• Uterus is _______ than expected

• Severe ___/____ (elevated _____)

• unusually early ____________

• ____________ ( elevated hCG stimulates _______ receptors)

• grape clusters on ultrasound

vaginal, larger, N, V, hCG, hypertension, hyperthyroidism, thyroid

Treatment for Molar Pregnancy

• ____ and ____

• serial _____ monitoring

• avoid _____________ during hCG _______________

D, C, hCG, pregnancy, surveillence

Molar pregnancy can become…

malignant

Painless Bleeding during pregnancy is associated with…

placenta previa

Painful bleeding during pregnancy can be associated with…

Placental abruption

Placenta Previa

• placenta is ______ / _________ cervical opening

• bleeding is ________ _____

• uterus is _____, _______, and ____-________

• Contractions? _______

• fetal status is _____________ _____________

near, covering, bright red, soft, relaxed, non-tender, maybe, initially reassuring

What are 3 risks of Placenta Previa?

anemia, shock, hemorrhage

What are 4 risk factors that make Placenta Previa more likely?

previous C-section, previa, smoking, mult. parity

What does delivery look like for a pt with Placenta Previa?

C-section if previa persists/worsens

Nurse Care for Placenta Previa

• never perform ____________ _______

• (can disrupt ________ and cause ______________)

vaginal exam, placenta, hemorrhage

4 Nursing Assessments for Placenta Previa

bleeding, VS, FHR, contractions

What 4 things should the nurse obtain for a pt with Placenta Previa?

CBC, blood type/Rh, coag studies, type/crossmatch

What should a nurse monitor for a pt with Placenta Previa?

• _____________ and ____________ labs

• ____ patency

Hemoglobin, hematocrit, ultrasound

In a pt with Placenta Previa the nurse anticipates…

• ________ rest/ ____________ in activity as ordered

• ____________ to locate placenta

• ___-__________ if placenta keeps covering OS

• ___________ (If PRE-TERM delivery)

pelvic, restrictions, ultrasound, c section, betamethasone

What is it called when the placenta separates prematurely from the uterine wall?

placental abruption

Placental Abruption

• bleeding is ____ red

• uterus is _______ and _______

• contractions are ___________ or there is ___________ __________

• fetal status is frequently _________________

dark, tender, firm, frequent, uterine tetany, nonreassuring

What are 3 risks associated with Placental Abruption?

hemorrhage, shock, DIC

What are 4 Risk Factors that can contribute to placental abruption?

cocaine, HTN, abd. trauma, and smoking

Delivery should occur in a pt with Placental Abruption if…(2)

severe, mat/fetal instability

Nursing Care for Placental Abruption

• when placenta separates from uterine wall the baby doesn’t get ____ or ___________

• this is an…

O2, nutrients, emergency

Nursing Intv. for Placental Abruption

• ______ _______ ____ (16-18 gauge)

• ________ _______ to measure urine output (>/= 30 mL/hr)

• prepare for blood and fluid ___________

• _________ if severe or instable

large bore IV, foley catheter, replacement, delivery

For pts with Placental Abruption, the nurse should Monitor…

• maternal ____________ and ___________

• _____

• uterine _____

• ____________

tachycardia, hypotension, FHR, tone, contractions

Complications of Placental Abruption

• maternal ___________

• _____________ ________

• fetal __________ and _______

• _____

• ___________ uterus

hemorrhage, hypovolemic shock, hypoxia, death, DIC, convelaire

Couvelaire Uterus

• ______ infiltrates uterine _________ tissue

• causes purple __________ and impaired _______________

blood, muscle, bruising, contractility

Common Obstetric causes of DIC

• placental ___________

• amniotic fluid ___________

• ______

• intrauterine _______ _______

• ___________

• severe _____________

abruption, embolism, sepsis, fetal death, preeclampsia, hemorrhage

What 2 labs are LOW in DIC?

platelets and fibrinogen

What 3 labs are HIGH in DIC?

PT, aPTT, D-dimer

Nursing Priorities for DIC

• identify and treat ___________ ______

• administer _________ ___________ as ordered

• Administer _____ as needed

underlying cause, blood products, O2

What 4 things should the nurse monitor in DIC?

VS, bleeding, renal fucntion, and urine output

DIC can cause widespread _________ and severe __________ simultaneously.

clotting, hemorrhage

Preterm Labor

• ___________ contractions with progressive cervical _______________ and _______________.

regular, effacement, dilation

Preterm Birth

• birth between ____ 0/7, and ___ 6/7 weeks.

20, 36

Late Preterm Birth

• birth between ___ 0/7 and ___ 6/7 weeks

34, 36

PROM

• rupture of membranes before ____ weeks and before ________ _______

37, labor begins

Cervical Insufficiency

• ____________ cervical ____________

• during ______ trimester w/o _______________

painless, dilation, 2nd, contraction

Do contractions confirm preterm labor?

no

Demographic Risk Factors for Preterm Labor

• ________

• low __________________ status

• _______ prenatal care

black, socioeconomic, late

Lifestyle Risk Factors for Preterm Labor

• __________, ____________ use

• high or low ______

smoking, substance, BMI

Medical Risk Factors for Preterm Labor

• _____________ disease

• genital tract infections

• cervical _____________

periodontal, instrumentation

OB hx Risk Factors for Preterm Labor

• previous spontaneous ________ _____

• unexplained _________ during pregnancy

preterm birth, instrumentation

Pregnancy Related Risk factors for Preterm Labor

• _____-______ pregnancy

• uterine _______________

• _____

multi fetal, abnormalities, IVF

Indicated Preterm Delivery

• delivery is medically ________ due to maternal of fetal ____________

necessary, complication,

Spontaneous Preterm Labor

• labor begins on it’s own

• __________ contractions and cervical changes

regular

Possible reasons for Spontaneous Preterm Labor

• previous __________ _______

• _____________

• _______-_______ pregnancy

• cervical _________________

preterm birth, infection, multi fetal, insufficiency

Possible reasons for Preterm Delivery

• ____________

• uncontrolled ________, _____

• Fetal compromise or _________ __________

• placental ____________ or __________

preeclampsia, diabetes, HTN, growth restriction, abruption, previa

What is the cause of cervical insufficiency?

weak or structurally compromised uterus

What is the main symptom of Cervical Insufficiency?

painless cervical dilation

Risk Factors for Cervical Insufficiency

• cervical _________

• _____________

• __ and __

• congenital _______ cervix

surgery, lacerations, D, C, short

Diagnostic Criteria for Cervical Insufficiency

• ___________ showing cervical length </= ___cm or _____________

ultrasound, 2.5, funneling

What is the treatment for Cervical Insufficiency?

cerclage

suture placed around the cervix to keep it closed

cerclage

Cerclage can be ________ or ______________ at around ___-___ weeks

rescue, prophylactic, 11, 15

When is cerclage removed?

36-37 weeks or earlier

What are 2 screening predictors of Preterm Labor?

cervical length ultrasound, and fetal fibronectin

Fetal Fibronectin (fFN)

• measures _______________ that acts like _____ between fetal membranes and uterine lining

glycoprotein, glue

What fFN result is reassuring?

negative

fFN is more useful for ________ _____ imminent preterm labor

ruling out

Prevention of Preterm Labor

• early _________ ______

• ____________ counseling

• prenatal ___________

• appropriate ________ ______

• __________ __________

• ____________

prenatal care, preconception, vitamins, weight gain, smoking cessation, progesterone

Signs and Symptoms of Preterm Labor

• regular/frequent _____________ (often painless)

• __________-like cramping

• pelvic __________

• inc. ________ ___________

• inc. ___________, (changes in color and amount)

• membrane fluid __________ or ________

contractions, menstrual, pressure, urinary frequency, discharge, leakage, rupture

Nursing Priority for Preterm Labor

• assess ____________, _________ changes, _______ _______, and possible ______.

contractions, cervical, fetal status, ROM

Tocolytic Meds ___________ ______/_____ contractions, ______________ DELIVERY

temporarily slow, stop, delaying

Tocolytic Meds only work _____________, long enough to administer _________________ or ____________ pt to facility w/higher level neonatal care.

temporarily, corticosteroids, transfer

Mag. Sulfate

• CNS ___________

• __________ __________ __________

depressant, relaxes smooth muscles

Side Effects of Mag. Sulfate

• ________, sweat

• nausea

• weakness

• ______. _________

flush, resp depression

Mag Sulfate Considerations

• Monitor _____’s, _____, ______, urine _______, and _______ levels

DTR, RR, LOC, output, mag

Nifedipine (Procardia)

• _____

• relaxes __________ _________

CCB, uterine muscles

Nifedipine Side Effects

• _____

• __________ and dizziness

• __________

HTN, headache, flushing

Nifedipine Monitor

• ____

• maternal ____

• ____________

• _____

BP, VS, contractions, FHR

Terbutaline (Berthine)

• _____-___ _________

• relaxes uterine