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[BIOETHICS]ABORTION
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Equine Abortion
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Denominational switching:  People who move from one sect of Christianity to another  “spiritual supermarket syndrome” “pew hoppers” or “switchers” -> name calling - Growing trend in western world towards denominational switching - People no longer making lifelong commitments to one church but more likely to swap based on where they feel comfortable and are catered for o Contrast to historic patterns where individuals and families traditionally remained affiliated with one denomination for generations - Reflection of modern consumer society - Reason for increase: mobility o Growth in car ownership since 1945 makes it easier to travel to favoured church rather than local parish church - Main losers of switching are older, mainstream, traditional denominations o Lutherans, uniting church, presbyterian, Anglicans NOTE: number of Catholics switching is very low - Pentecostal churches -> reason for switch is charismatic leaders in Pentecostal churches preach with great authority and services include rock bands Interdenominational switching: - Pentecostal churches have been greatest beneficiaries of “switchers” due to: o Aggressive evgelization o Focus on personal salvation o “up-tempo” gospel services o Attractive services to under 40’s in particular o Less focus on social, ethical or moral issues o Personal following of preachers - Revolving door syndrome -> Pentecostal churches loose membership as fast as they are gained Who switches and why? - Under 40s less likely to view lifetime loyalty to particular type of church as important (15%), compared to 60+ (38%) - People with active Christian faiths more likely to switch to seek stronger Christian community and exclusively provided - Family breakdown was another factor -> children of divorce 64% more likely to cease identifying with family faith than those of non-divorced parents o Catholics 1.7x more likely to switch to a moderate protestant (methodist) denomination and 2.6x more likely to switch to conservative protestant (Baptist, evangelical) denomination Denominational dissatisfaction: - Most people who stop attending church regularly don’t stop attending completely -> they continue to be searchers - Found services to be boring - Looking for openness to different views of religious matters and broad approach to worship catering for different spiritualities - Former adherents baulk at ‘hard-line’ moral and ethical stances on contentious issues e.g. abortion Rise of new age religions:  Extremely diverse in nature with focus on fostering individual fulfillment in regard to happiness, health and meaning in life (individualism)  New age religions can be followed instead of traditional religious practices or can be practised alongside traditional religions - Popular bc traditional religions fail to resonate with modern people - New age religions have been growing since 1970s and now include: o Feng shui o Tarot cards o Astrology o Meditation o Scientology o Spiritualism o Philosophy - New age religions tend to reject monotheism, but may except polytheism, worship of nature (pantheism), goddesses, or monism (belief that everything is one) - New age religions often adopt elements of eastern religions, and may incorporate elements of numerology, astrology, yoga, tai chi, paganism and feng shui - Part of appeal is they provide freedom for adherents to pick and choose what they believe fulfills them in spiritual manner - From 1996-2001 140% growth in new age religions in census Reasons for growth include: - Disillusionment with traditional religion and traditional worship - Frustration with slowness of change - Desire for personal fulfillment - Desire to find new ways of seeking inner peace and health - Response to globalisation and de-centring of western ‘truths’ - Ease of travel - Lessening of commitment to traditional structures such as churches Links to religious traditions: - Trend towards new age religions introduced number of Hindu concepts into language and practice of many people who may not necessarily consider themselves religious - Practices include meditation, yoga and concepts such as reincarnation and karma Secularism:  Movement/concept which rejects religious belief or adherence  Belief that religion should not interfere with or be integrated into the public affairs of a society - Significant number of Australians are not religious, and number is still growing - Trend could be result of greater levels of technological and scientific knowledge + perseverance of many religions in antiquated and conservative attitudes - Some perceive to be hypocrisy that religions still try hold themselves to be moral authorities Promotes idea that society would be better off by not being controlled by religion for reasons including: - Pluralism: diversity of beliefs and cultures - Individualism, materialism and scepticism towards supernatural as result of scientific progress - Disillusionment with traditional religions Reasons for reduced membership of religious or attendance at church are varied but include: - Church practices that are boring or unfulfilling - Disagreement with church theology or stance on moral and social issues - Alternative practices that meet same needs as church e.g. social groups - No time for church - Personal dislike of religion - Technology and scientific advances that conflict with church Effects of secularism: - Loss of religious value - Lack of religious church practice e.g. civil marriages, non-religious funerals - Seeking alternative “religions” or “forms of spirituality” - Greater trust in science and belief in supernatural is contradictory to what many believe to be empirically true - Rise of new age religions which focus on personal satisfaction, self-help groups, happiness, mind and spirit exhibitions - Until 1973, australians only had two options for where + how they could get married (church or registry office) o Today 80%+ wedding ceremonies now performed by civil celebrants (up from 50% in 2021) Ecumenical movements within Christianity: - Increasingly secularised society - Involvement in issues of peace and social justice to renew relevance - Multifaith society requires ongoing dialogue with those who have different beliefs and practices - In australia today, relationships between Christian churches (ecumenism) and relations between various religious traditions (interfaith dialogue) are characterised by mutual tolerance and respect Ecumenism: - Movement among Christian churches to promote the restoration of unity among all Christians -> “collective movement” - Aims to bring branches (denominations) of church back to single community of faith or ‘body of Christ’ Sectarianism = Conflict between two groups of a particular faith - Sectarianism found in other countries is less vigorous in Australia Ecumenism is recent philosophical approach in life of church and australians have supported ecumenical ideas - Uniting Church in Australia - National Council of Churches - NSW Ecumenical Council Uniting church: - Formed 22nd June 1977 - Result of union of three individual churches o Congregational union of australia o Methodist church of australia o Presbyterian church of australia - “most significant ecumenical event in Australia’s history” (Francis Rush – Catholic Archbishop of Brisbane) - Particularly known for social justice approach and support for marginalised sections of society National council of churches in Australia: - Umbrella organisation bringing many of Australia’s churches together - Happens in both practical and organisational cooperation and discussion on faith-bade issues - Officially became NCCA in 1994 with inclusion of Catholic Church NSW Ecumenical Council: - Founded in 1982 - Encourages social justice and operates on an ecumenical level to achieve this - Central bond is that they’re all followers of Christ, so there’s unity amongst adherents o Rather than competing against each other, they come together in accordance with sense of Christian duty - Gives churches shared voice when following religious beliefs and undertakings - Involved in community projects such as helping settle refugees and providing accommodation to poor - Christmas Bowl initiative -> local church projects that aid people with needs - Local + international initiatives allow churches to have more significant impact o If they were separated there wouldn’t be as much impact - Domestic violence project -> raises awareness about how to respond to domestic violence and how to support survivors - Commission on middle east -> international initiative where member churches come together to advocate for Christians, minority groups and asylum seekers in Middle East Interfaith Dialogue:  Move to greater cooperation and harmony between people of different religious traditions  Involves positive communication and cooperation resulting from discussion between different faiths  Often involves discussing matters of societal + faith concern  Often led by ecumenical groups within a religion Example: NCCA (est. 1994) has ongoing dialogue with Australian Federation of Islamic Councils and Executive Council of Australian Jewry - Important to include all sectors of each religion “No World Peace without peace between the religions” Importance of interfaith dialogue: - Topics impact everyday Australian life - Discussing impacts of belief or behaviour reduces tension and misunderstanding - Some topics of community concern are important not only to religious community but also wider secular society of Australia and the world * Building understanding, goodwill and sense of community * Consider issues as a whole community * Encourages and allows individuals to learn about each other and different faiths * Encourages activities and projects of commonality within and between faiths * Importance for young people -> idealism and enthusiasm of youth Recent interfaith initiatives: 1991: Australian Council of Christians and Jews - Goal is to recognise common heritage and promote understanding 2004: The Columban Centre for Christian-Muslim Dialogue - Located in Turramurra -> focuses on dialogue between Christians and Muslims particularly among women 2007: one of largest groups to attend the Dalai Lama’s visit to Canberra was the Association for Studies of Religion Presently: as recognised by Cambridge text, the provision of Studies of Religion in the NSW HSC is, in itself, an example of interfaith dialogue 2023: last world parliament of religions in Chicago (where all faiths come together) Atomi Notes (need to fix): Current religious landscape in Australia: Christianity as major religious tradition: Immigration: - Most immigration from Britain 1945: migration brought Christianity into Australia (mainly Catholicism) - Was mainly impacted by new variety of ethnic backgrounds 1945-60: jews arrive from Europe 1960: drastic moves to restrict racial diversity in Australia 1973: white australia policy abandoned - Planned program for asian immigration 1975: asian immigration dramatically increased following Vietnam War - Australia accepted 120,000 refugees from Indochina Post 1975: spike in total Muslim population in Australia Denominational switching: People moving between sects of Christianity - Only comes from people who attend church - Source of information is from National Church Life Survey o Only 8% of people attend church - Christianity not further defined was biggest growing Christian response in 2016+2021 Rise of new age religions: Alternative spiritualities that aim to foster personal happiness, health and meaning in life - Popular bc traditional religions fail to resonate with modern people Mind, body, spirit festival -> Secularism: Belief religion should not interfere with or be integrated into public affairs of society - Promotes ideas that society would be better off by not being controlled by religion o Pluralism: diversity of beliefs and cultures o Individualism, materialism and scepticism towards supernatural as result of scientific progression o Disillusionment Ecumenism: • Impact of movements within australia (syllabus dot point) - Movement for dialogue and mutual understanding between Christian Churches o Response to immigration post 1945 National council of churches australia (NCCA): - Formed 1944 and consists of 18 member Churches across Australia - Runs programs o Act for peace o Safe church awareness o Australian churches refugee taskforce  Aims to apply Christian moral voice to suffering of refugees and asylum seekers  Gives combined Christian churches political voice in scheme of australia’s secularism  Combined power of churches means they have bigger impact on this social issue o Christmas bowl mission  Sends aid assistance to countries throughout Africa, asia, middle east and pacific NSW ecumenical council: - Formed 1982 with 18 member churches - Runs many initiatives o Domestic violence project  Allows church to have greater impact together rather than being separate o Commission on middle east  International initiative where member churches come together to advocate Christians, minority groups and asylum seekers in middle east How to answer a 5 marker: - Combine content with census data dot point - Always refer to stimulus explicitly o Look for dates, change in denomination, changed services offered 1) Intro -> Identify changes in australia’s religious landscape a. Denominational switching b. Immigration c. Secularisation 2) Explanation -> go through each change, referencing the syllabus Extra class notes: - Salvation army is a Christian denomination Examine the relationship between aboriginal spiritualities and religious traditions in the process of Reconciliation Reconciliation: - Process which changes relationship between individuals or groups for the better - Mainly used in Australia to describe way of improving relationships between Indigenous and non-Indigenous Australians - Involves acknowledgement of injustices of past and dispossession, willingness + commitment to rectify these wrongs where possible, to improve the position of Aboriginal peoples in the future Key events: 1991 -> Land rights movement Dec 10, 1992 -> Redfern speech (PM Paul Keating) May 28, 2000 -> Sorry Day Sydney Harbour Bridge walk - More than 250 000 people walked across bridge to press Federal Government to apologise Feb 13, 2008 -> Federal Government apology - PM Rudd apologised on behalf of the Parliament and Government of Australia for past injustices - Stated apology was to “Remove a stain from the soul of Australia” and “It was time for all Australians, to come together, truly reconcile and together build a truly great nation” Kanyani video notes: - Country is family for Indigenous people o They live in + amongst nature e.g. walking around in natural state, no houses (huts) and sleep under the stars on the earth o All animals living with them are family - Born from Mother Earth and supported by her o “she looks after us with meat, bush tucker as well as water” - Trained to look after ceremonies, land and each other -> main importance - Never take more than you need and don’t destroy to the level where it cannot produce again o Duty to the land and caring for it - Each person is given totem animals o Not allowed to ever kill that animal - Spirit, psyche, mental, physical are all connected with every form - Oneness + completeness of oneness for everything - Every inch of land + waterways is sacred Aboriginal Spirituality Dreaming: - Definition: The Dreaming is infinite and links the past with the present to determine the future. It encapsulates the stories of creation and life in Aboriginal culture. - The Dreaming is the central and deepest reality of the Aboriginal world. - It is the spiritual dimension of reality that has existed from the beginning and continues to be present in all aspects of life. o The Dreaming is inextricably linked with the land Characteristics and features of the Dreaming - Dreaming is experiences through songs, stories, rituals and symbols. - Dreaming establishes the lore linking the relationship between Aboriginal people, the land, and all things associated with Aboriginal life. - This is evident through: o Kinship structures of society o Rules and obligations for social behaviours o Ceremonies performed to maintain the life of the land. - Quote: “The Dreaming refers to all that is known and all that is understood. It is the way Aboriginal people explain life and how their world came to being.” – 2024 Aboriginal Art and Culture, Alice Springs Australia. Kinship: - Kinship systems define where a person fits into the community, binding people together in relationships of sharing and obligation to one another and the land. - Connection to Dreaming: o Kinship binds culture, Country, family and community together it is a way of being. o Kinship systems assign the responsibility to transmit the knowledge of the Dreaming from Elders to the younger generation - Quote: “All people with the same skin grouping as my mother’s… They have the right, the same as my mother, to watch over me, to control what I’m doing, to make sure I do the right thing. It’s an extended family thing… It’s a wonderful secure system.” – Wadjularbinna Doomadgee Gungalidda leader, Gulf of Carpentaria, 1996 Ceremonial life: - The spirituality of Aboriginal people comes from their belief and understanding of the Dreaming, and how this has been taught to them throughout generations. - Ceremonial life is an essential expression of the Dreaming, connecting individuals with their ancestors, the land, and each other. Connections between ceremonial life and the Dreaming (STAR) - Stories from the Dreaming describe Aboriginal law and lifestyle, teaching about the way of life - Totems represent the individual as they existed in the Dreaming and carry ceremonial responsibilities (the embodiment of each individual in their primordial state) - Art communicated the Dreaming and the multiple layers of meaning - Rituals form the Dreaming and is a way to relive activities of ancestor spirits Obligations to the land and people - In Aboriginal society, people do not own the land it is a part of them, and it is part of their duty to respect and look after Mother Earth - Land has significance for all First Nations people as the sacred places provide a sense of identity and connection - Relationships within kinship groups connect people to places and define their obligations to each other - The land is an important aspect of Dreaming stories, particularly those associated with the time of Creation. - Custodianship o Custodianship of the land is a sacred duty bestowed upon Aboriginal people by the Dreaming - Sacred Sites o Specific locations are considered sacred because of the physical manifestations of the Dreaming. o These sites require special care and are often the focus of rituals - Sustainability Practices o Dreaming stories often includes teachings on how to care for the land o Practices such as controlled burning and seasonal hunting aim to ensure the land remains healthy for future generations. Aboriginal people believe they are related to, and custodians of natural world - This relationship provides advantages of survival and life and also imposes responsibilities of preservation and education In the land, aboriginal people see evidence of Dreaming and creation Dreaming stories which describe ancestors or Creation are set in land and describe actual land where people live Aboriginal people believe the Dreaming ancestor became the land Aboriginal people describe themselves as being descendants of particular ancestral beings Therefore have continuous and living relationship with features of the land Inseparable from the land and so believe if they are removed from the land then they will die (spiritually not literally) Ceremonial life: - By performing ceremonies, the Dreaming and its giving power loves on through human beings and animals - Ceremonies highlight the connection to the Dreaming, the importance of land, and relationships between people - Examples: initiation ceremony, men’s law and women’s law, funeral ceremonies, celebration ceremonies Purpose of aboriginal ceremonies: Rites of passage Inform all of the new status of the individual e.g. initiations and funerals Information Transfer from elder to younger generation Changes the social custodians of history Personal Support personal friendships Support personal or group activities e.g. intertribal or totemic group trade or cultural meetings Spiritual Maintain the link and connect people with the spiritual world or the Dreaming Types of aboriginal ceremonies: Ceremony Description Initiation ceremony Teaches young people bout the law and the spiritual beliefs Allows them to take their place as an elder in the community Men’s law and women’s law Each tribe has gender-specific roles and ceremonies Respect for individuals and the whole family is shown by accepting men’s and women’s law Funeral ceremonies Rite of passage from the living world to the spirit world Activities can include sprinkling of water, smoking of (bark) coffin, flowers, memory celebration Restriction of naming deceased person Celebration ceremonies Celebrate the telling of a Dreaming story Dancing and artwork happy and joyous The cause of continuation of life itself Ceremonies have changed over recent time bc of the impact of external religious beliefs (mainly Christian) and other social factors which have removed young people from their land and tribal support In some cases aboriginal spiritual beliefs have combined with Christianity in a form of syncretism (syncretism = combing of; coming together of …) Removal from land, kinship, and community has meant important ceremonial connections are becoming less effective Corroboree indicates a ceremony driven by settlers’ vernacular however they took that from one of the aboriginal torres strait islander peoples words for rituals which is ?keraberre? These ceremonies often centre on retelling of Dreaming stories -> singing, dancing, music and mime -> often body of actor is decorated to represent a spirit he/she is portraying Activities for rite of passage -> testing of strength, revelation of knowledge, the removal of the child from the biological mother, seclusion (learn to live of the land), giving of new name/sacred object Burial ceremonies -> death is time where spirit leaves body and returns to ancestor spirits -> certain ceremonies are used to encourage spirit on its journey
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Trends in Abortion
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Abortion
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1. Hyperemesis Gravidarum/ Pernicious Vomiting Definition: Excessive nausea and vomiting during pregnancy, extending beyond week 12 or causing dehydration, ketonuria, and significant weight loss within the first 12 weeks. Incidence: 1 in 200-300 women Cause: Unknown, but may be associated with increased thyroid function and Helicobacter pylori infection. Signs and Symptoms: • Decreased urine output • Weight loss • Ketonuria • Dry mucous membranes • Poor skin turgor • Elevated hematocrit • Decreased sodium, potassium, and chloride levels • Polyneuritis (in some cases) Assessment: • Hemoglobin: Elevated hematocrit concentration (hemoconcentration) due to inability to retain fluids. • Electrolytes: Decreased sodium, potassium, and chloride levels due to low intake. • Acid-base Balance: Hypokalemic alkalosis (severe vomiting, prolonged period). • Neurological Examination: Polyneuritis due to B vitamin deficiency. Effects (if left untreated): • Intrauterine Growth Restriction (IUGR): Dehydration and inability to provide nutrients for fetal growth. • Preterm birth: Due to complications caused by the condition. • Prolonged hospitalization/home care: Resulting in social isolation. Therapeutic Management: • Fluid and Electrolyte Management: Monitor input and output, blood chemistry to prevent dehydration. • Nutritional Support: Withhold oral food and fluids (usually) and administer total parenteral nutrition (TPN). • Intravenous Fluid Replacement: 3000 ml Ringer's lactate with added vitamin B to increase hydration. • Antiemetic Medication: Metoclopramide (Reglan) to control vomiting. 2. Ectopic Pregnancy Definition: Implantation of a fertilized egg outside the uterine cavity (ovary, cervix, fallopian tube - most common). Incidence: Second most frequent cause of bleeding during the first trimester. Causes: • Obstruction of the fallopian tube: ◦ Adhesions (from previous infection like chronic salpingitis or pelvic inflammatory disease). ◦ Congenital malformations. ◦ Scars from tubal surgery. ◦ Uterine tumor pressing on the proximal end of the tube. ◦ Current use of an intrauterine device (IUD). Signs and Symptoms: • Missed period/amenorrhea. • Positive hCG test. • Sharp, stabbing pain in the lower abdominal quadrants and pelvic pain (at time of rupture). • Scant vaginal spotting/bleeding. • Rigid abdomen (from peritoneal irritation). • Leukocytosis (increased WBC count due to trauma). • Decreased blood pressure and increased pulse rate (signs of shock). • Cullen's sign (bluish tinge around the umbilicus). • Tender mass palpable in the cul-de-sac of Douglas (vaginal exam). • Falling hCG or serum progesterone level (suggesting the pregnancy has ended). • No gestational sac on ultrasound. Therapeutic Management: • Non-ruptured Ectopic Pregnancy: Oral administration of methotrexate followed by leucovorin. • Ruptured Ectopic Pregnancy (emergency): Laparoscopy to ligate bleeding vessels and remove or repair the damaged fallopian tube. 3. Hydatidiform Mole (H-mole)/ Gestational Trophoblastic Disease/ Molar Pregnancy Definition: A gestational anomaly of the placenta consisting of a bunch of clear vesicles resembling grapes. This neoplasm is formed from the swelling of the chorionic villi, resulting from a fertilized egg whose nucleus is lost, and the sperm nucleus duplicates, producing a diploid number 46XX. Incidence: Approximately 1 in every 1500 pregnancies. Risk Factors: • Low socioeconomic group (decreased protein intake). • Women under 18 or over 35 years old. • Women of Asian heritage. • Receiving clomiphene citrate (Clomid) for induced ovulation. Types of Molar Growth: • Complete/Classic H-mole: All trophoblastic villi swell and become cystic. No embryonic or fetal tissue present. High risk for malignancy. • Partial/Incomplete H-mole: Some of the villi form normally. Presence of fetal or embryonic tissue. Low risk for malignancy. Signs and Symptoms: • Uterus expands faster than normal. • No fetal heart sounds heard. • Serum or urine test for hCG strongly positive. • Early signs of preeclampsia. • Vaginal bleeding (dark-brown spotting or profuse fresh flow). • Discharge of fluid-filled vesicles. Diagnosis: • Ultrasound. • Chest x-ray (lung metastasis). • Amniocentesis (no fluid). • Hysteroscopy (via cervix). Management: • Evacuation of the mole: Dilation and curettage (D&C). • Blood transfusion. • Hysterectomy (in some cases). • Monitoring hCG levels: Every 2 weeks until normal. • Contraception: Reliable method for 12 months to prevent confusion with a new pregnancy. 4. Premature Cervical Dilatation/ Incompetent Cervix Definition: Premature dilation of the cervix, usually occurring around week 20, when the fetus is too immature to survive. Incidence: About 1% of pregnancies. Causes: • Increased maternal age. • Congenital structural defects. • Trauma to the cervix (cone biopsy, repeated D&C). Signs and Symptoms: • Painless dilation of the cervix. • Pink-stained vaginal discharge. • Increased pelvic pressure. • Rupture of membranes and discharge of amniotic fluid. Therapeutic Management: • Cervical cerclage: Surgical procedure to prevent loss of the child due to premature dilation. • Bed rest: After cerclage surgery, to decrease pressure on the sutures. 5. Abortion Definition: Termination of pregnancy before the fetus is viable (400-500 grams or 20-24 weeks gestation). Types of Abortion: • Spontaneous Abortion: Pregnancy interruption due to natural causes. ◦ Threatened: Mild cramping, vaginal spotting. ◦ Inevitable/Imminent: Profuse bleeding, uterine contractions, cervical dilation. ◦ Complete: All products of conception expelled spontaneously. ◦ Incomplete: Part of the conceptus expelled, some retained in the uterus. ◦ Missed: Fetus dies in utero but is not expelled. ◦ Habitual: 3 or more consecutive spontaneous abortions. • Induced Abortion: Deliberate termination of pregnancy in a controlled setting. Complications of Abortion: • Hemorrhage. • Infection (endometritis, parametritis, peritonitis, thrombophlebitis, septicemia). Management: • Bed rest. • Emotional support. • Sedation. • D&C: Surgical removal of retained products of conception. • Antibiotics. • Blood transfusion. 6. Placenta Previa Definition: The placenta is implanted in the lower uterine segment, covering the cervical os, obstructing the birth canal. Incidence: 5 per 1000 pregnancies. Signs and Symptoms: • Abrupt, painless vaginal bleeding (bright red). • Bleeding may stop or slow after the initial hemorrhage, but continue as spotting. Types: • Total: Placenta completely obstructs the cervical os. • Partial: Placenta partially obstructs the cervical os. • Marginal: Placenta edge approaches the cervical os. • Low-lying: Placenta implanted in the lower rather than the upper portion of the uterus. Therapeutic Management: • Immediate Care: Bed rest in a side-lying position. • Assessment: Monitor vital signs, bleeding, and fetal heart sounds. • Intravenous Therapy: Fluid replacement with large gauge catheter. • Delivery: Vaginal birth (safe for infant if previa is less than 30%). Cesarean section (safest for both mother and infant if previa is over 30%). 7. Abruptio Placenta/ Premature Separation of Placenta/ Accidental Hemorrhage/ Placental Abruption Definition: Separation of a normally implanted placenta after the 20th week of pregnancy, before birth of the fetus. Incidence: Most frequent cause of perinatal death. Causes: • Unknown. • Predisposing Factors: ◦ High parity. ◦ Advanced maternal age. ◦ Short umbilical cord. ◦ Chronic hypertensive disease. ◦ PIH. ◦ Trauma (automobile accident, intimate partner abuse). ◦ Cocaine or cigarette use. ◦ Thrombophilitic conditions (autoimmune antibodies). Classification: • Total/Complete: Concealed hemorrhage. • Partial: Concealed or apparent hemorrhage. Signs and Symptoms: • Sharp, stabbing pain in the uterine fundus. • Contractions accompanied by pain. • Uterine tenderness on palpation. • Heavy vaginal bleeding (may be concealed). • Signs of shock. • Tense, rigid uterus. • Disseminated Intravascular Coagulation (DIC). Therapeutic Management: • Fluid Replacement: IV fluids. • Oxygen: Limit fetal hypoxia. • Fetal Monitoring: External fetal heart rate monitoring. • Fibrinogen Determination: IV fibrinogen or cryoprecipitate. • Lateral Position: Prevent pressure on the vena cava. • Delivery: CS is the method of choice if birth is not imminent. 8. Premature Rupture of Membranes Definition: Rupture of the fetal membranes with loss of amniotic fluid during pregnancy before 37 weeks. Incidence: 5%-10% of pregnancies. Causes: • Unknown. • Associated with: Infection of the membranes (chorioamnionitis), vaginal infections (gonorrhea, streptococcus B, Chlamydia). Signs and Symptoms: • Sudden gush of clear fluid from the vagina with continued minimal leakage. • Nitrazine paper test: Amniotic fluid turns the paper blue (alkaline), urine remains yellow (acidic). • Microscopic examination: Amniotic fluid shows ferning, urine does not. • Ultrasound: Assess amniotic fluid index. • Signs of infection (increased WBC count, C-reactive protein, temperature, tenderness, odorous vaginal discharge). Therapeutic Management: • Bed Rest: To prevent further leakage and risk of infection. • Corticosteroids: To hasten fetal lung maturity. • Prophylactic Antibiotics: To reduce risk of infection. • Intravenous Penicillin/Ampicillin: If (+) for streptococcus B. • Induction of Labor: If fetus is mature and labor does not begin within 24 hours. 9. Pregnancy-Induced Hypertension (PIH)/ Toxemia Definition: Vasospasm occurring in both small and large arteries during pregnancy, causing elevated blood pressure, proteinuria, and edema. Incidence: Rarely occurs before 20 weeks of pregnancy. Risk Factors: • Multiple pregnancy. • Primiparas younger than 20 or older than 40. • Low socioeconomic background. • Five or more pregnancies. • Hydramnios. • Underlying diseases (heart disease, diabetes). • Rh incompatibility. • History of H-mole. Categories: • Gestational Hypertension: Blood pressure 140/90 or greater, without proteinuria or edema. • Preeclampsia: Blood pressure 140/90 or greater, with proteinuria and edema. • Eclampsia: Seizures or coma accompanied by preeclampsia. Therapeutic Management: • Preeclampsia: Bed rest, balanced diet, left lateral position. • Severe Preeclampsia: Hospitalization, diazepam, hydralazine, magnesium sulfate. • Eclampsia: Magnesium sulfate, diazepam, oxygen therapy, left lateral position
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