High-Risk Pregnancy and Obstetric Complications

Comprehensive practice flashcards covering high-risk pregnancy conditions, including bleeding disorders, hypertensive states, and amniotic fluid imbalances based on the lecture notes.

How is a high-risk pregnancy defined?

A pregnancy in which a condition exists that jeopardizes the health of the mother, her fetus, or both.

According to Nagtalon-Ramos (2014), what is the ratio of pregnant women considered to be at high risk or diagnosed with complications?

Approximately one in four pregnant women.

What are the four broad categories used to group pregnancy risks?

Biophysical, psychosocial, sociodemographic, and environmental.

At what point in the gestational period is a pregnancy loss classified as a stillbirth rather than a miscarriage?

After the $20^{th}$ week of development.

What is the most common cause for first-trimester spontaneous abortions?

Fetal genetic abnormalities, usually unrelated to the mother.

Which category of abortion is characterized by slight vaginal bleeding, a closed cervical os, and no passage of fetal tissue?

Threatened abortion.

Where does the word 'ectopic' originate, and what does it mean?

It is derived from the Greek word 'ektopos', meaning 'out of place'.

What is the classic clinical triad of symptoms for an ectopic pregnancy?

Abdominal pain, amenorrhea, and vaginal bleeding.

What are the eligibility criteria for medical treatment of an ectopic pregnancy using methotrexate?

The client must be hemodynamically stable, have no signs of active intraperitoneal bleeding, beta-hCG levels less than $5,000\,mIU/mL$, and a mass measuring less than $4\,cm$.

What is characterized by an 'empty egg' fertilized by a normal sperm, resulting in $46$ all-paternal chromosomes?

A complete hydatidiform mole.

What is the primary follow-up requirement for a woman after the evacuation of a molar pregnancy to detect choriocarcinoma?

Serial quantitative hCG levels monitored weekly until undetectable for $3$ consecutive weeks, then monthly for $1$ year.

How is cervical insufficiency (premature dilation of the cervix) defined?

A weak, structurally defective cervix that spontaneously dilates in the absence of uterine contractions in the second or early third trimester.

What measurement of cervical length between $16$ and $24$ weeks' gestation is considered abnormal and indicative of a risk for preterm labor?

Less than $25\,mm$.

What are the four classifications of placenta previa based on the degree of coverage of the internal os?

Total, partial, marginal, and low-lying placenta previa.

Why are vaginal examinations contraindicated in women with known or suspected placenta previa?

They may disrupt the placenta and cause massive hemorrhage.

What clinical manifestations differentiate abruptio placentae from placenta previa?

Abruptio placentae is characterized by painful, dark-red vaginal bleeding and uterine rigidity, whereas placenta previa involves painless, bright-red bleeding and a soft uterus.

How is Disseminated Intravascular Coagulation (DIC) described in terms of blood clotting balance?

A loss of balance between the clot-forming activity of thrombin and the clot-lysing activity of plasmin.

What are the common subcategories of placenta accreta based on the depth of myometrial invasion?

Placenta accreta (attaches too deeply), placenta increta (invades the myometrium), and placenta percreta (penetrates through the myometrium and uterine serosa).

What weight loss threshold is used to diagnose Hyperemesis Gravidarum?

Weight loss of more than $5\%$ of prepregnancy body weight.

What are the five categories of hypertensive disorders in pregnancy?

1. Chronic hypertension, 2. Gestational hypertension, 3. Preeclampsia, 4. Eclampsia, 5. Chronic hypertension with superimposed preeclampsia.

What are the two underlying mechanisms involved in the two-stage event of preeclampsia pathophysiology?

Vasospasm and hypoperfusion.

What is the recommended loading dose and maintenance dose for intravenous magnesium sulfate in preeclampsia management?

A loading dose of $4$ to $6\,g$ over $15$ to $20$ minutes, followed by a maintenance dose of $2\,g/hr$.

What are the signs of magnesium toxicity that a nurse must monitor for?

A respiratory rate less than $12\,breaths/min$, absence of deep tendon reflexes (DTRs), and a decrease in urinary output less than $30\,mL/hr$.

On the scale for grading Deep Tendon Reflexes (DTRs), what does a grade of $4+$ indicate?

Very brisk, hyperactive, with clonus (indicative of pathology).

What does the acronym HELLP syndrome stand for?

Hemolysis, Elevated Liver enzymes, and Low Platelets.

When is RhoGAM administered to an Rh-negative nonimmunized woman?

Between $28$ and $32$ weeks’ gestation and again within $72$ hours after giving birth if the newborn is Rh positive.

What volume of amniotic fluid defines polyhydramnios?

More than $2,000\,mL$ of amniotic fluid between $32$ and $36$ weeks.

What volume of amniotic fluid defines oligohydramnios?

Less than $500\,mL$ of amniotic fluid between $32$ and $36$ weeks.

What is the difference between monozygotic and dizygotic twins?

Monozygotic twins develop from a single fertilized ovum that splits (identical), while dizygotic twins result from two sperm fertilizing two separate ova (fraternal).

How is Preterm Premature Rupture of Membranes (PPROM) defined?

Rupture of membranes prior to the onset of labor in a woman who is less than $37$ weeks’ gestation.

What three tests are commonly used to confirm the diagnosis of PROM?

Nitrazine test (pH indicator), Fern test (microscopic crystallization), and ultrasound (to detect oligohydramnios).