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What is the term used to describe any interruption of a pregnancy before the fetus is viable?
What is the term used to describe any interruption of a pregnancy before the fetus is viable?
Abortion
Which of the following is considered a potential cause of spontaneous abortion? (Select all that apply)
Which of the following is considered a potential cause of spontaneous abortion? (Select all that apply)
Threatened miscarriage is characterized by bright red vaginal bleeding, slight cramping, and cervical dilatation.
Threatened miscarriage is characterized by bright red vaginal bleeding, slight cramping, and cervical dilatation.
False
Which type of miscarriage involves the expulsion of the fetus but the retention of the membranes or placenta?
Which type of miscarriage involves the expulsion of the fetus but the retention of the membranes or placenta?
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A missed miscarriage is a type of early pregnancy failure where the fetus dies in the uterus but is not expelled.
A missed miscarriage is a type of early pregnancy failure where the fetus dies in the uterus but is not expelled.
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What is the medical term for bleeding during pregnancy?
What is the medical term for bleeding during pregnancy?
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What is the name of the hormone that is drawn at the start of bleeding, and then again after 48 hours, to help evaluate the viability of the fetus?
What is the name of the hormone that is drawn at the start of bleeding, and then again after 48 hours, to help evaluate the viability of the fetus?
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In the context of pregnancy, what does the term 'bed rest' typically mean?
In the context of pregnancy, what does the term 'bed rest' typically mean?
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During a complete miscarriage, the entire products of conception are expelled spontaneously without any assistance.
During a complete miscarriage, the entire products of conception are expelled spontaneously without any assistance.
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What is one common symptom that may be present in the event of a threatened miscarriage?
What is one common symptom that may be present in the event of a threatened miscarriage?
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What is the term for infections that may occur during or after pregnancy?
What is the term for infections that may occur during or after pregnancy?
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Which procedure is used to remove the remainder of pregnancy from the uterus in the event of an incomplete miscarriage?
Which procedure is used to remove the remainder of pregnancy from the uterus in the event of an incomplete miscarriage?
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Isoimmunization occurs when the mother is Rh-negative and the fetus is Rh-positive.
Isoimmunization occurs when the mother is Rh-negative and the fetus is Rh-positive.
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What is the primary purpose of administering RhoGAM to Rh-negative mothers?
What is the primary purpose of administering RhoGAM to Rh-negative mothers?
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An ectopic pregnancy is defined as a pregnancy in which implantation occurs outside the uterine cavity.
An ectopic pregnancy is defined as a pregnancy in which implantation occurs outside the uterine cavity.
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What is the medical term for hydatidiform mole, a proliferation and degeneration of the trophoblastic villi resulting in grapelike clusters of vesicles?
What is the medical term for hydatidiform mole, a proliferation and degeneration of the trophoblastic villi resulting in grapelike clusters of vesicles?
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Molar pregnancy refers to both complete mole and partial mole, both involving abnormal growth of the trophoblasts.
Molar pregnancy refers to both complete mole and partial mole, both involving abnormal growth of the trophoblasts.
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Which of the following is NOT a potential cause of molar pregnancy?
Which of the following is NOT a potential cause of molar pregnancy?
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The primary management for a molar pregnancy involves a suction curettage to evacuate the mole.
The primary management for a molar pregnancy involves a suction curettage to evacuate the mole.
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What does the term 'incompetent cervix' refer to, and what is it now more commonly known as?
What does the term 'incompetent cervix' refer to, and what is it now more commonly known as?
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Which of the following is considered a risk factor for premature cervical dilatation? (Select all that apply)
Which of the following is considered a risk factor for premature cervical dilatation? (Select all that apply)
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What is the term used to describe the surgical procedure that involves suturing the cervix to prevent it from dilating prematurely?
What is the term used to describe the surgical procedure that involves suturing the cervix to prevent it from dilating prematurely?
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A low-lying placenta implants near the internal os with its margin located about 2-5 cm from the os.
A low-lying placenta implants near the internal os with its margin located about 2-5 cm from the os.
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Which of the following is considered a risk factor for placenta previa? (Select all that apply)
Which of the following is considered a risk factor for placenta previa? (Select all that apply)
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What is the term for a sudden separation of the normally implanted placenta from the uterine wall, leading to bleeding?
What is the term for a sudden separation of the normally implanted placenta from the uterine wall, leading to bleeding?
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Abruptio placenta typically occurs during the third trimester of pregnancy, but may also occur during the first and second stages of labor.
Abruptio placenta typically occurs during the third trimester of pregnancy, but may also occur during the first and second stages of labor.
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A sharp, stabbing pain in the uterine fundus, often experienced during contractions, is a common manifestation of abruptio placenta.
A sharp, stabbing pain in the uterine fundus, often experienced during contractions, is a common manifestation of abruptio placenta.
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DIC (Disseminated Intravascular Coagulation) is a severe complication of both placenta previa and abruptio placenta, potentially leading to complications for both the mother and the baby.
DIC (Disseminated Intravascular Coagulation) is a severe complication of both placenta previa and abruptio placenta, potentially leading to complications for both the mother and the baby.
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Preterm labor refers to labor that occurs before the end of week 37 of gestation.
Preterm labor refers to labor that occurs before the end of week 37 of gestation.
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What is the term for infection of the fetal membranes and fluids, a common cause of premature labor?
What is the term for infection of the fetal membranes and fluids, a common cause of premature labor?
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Premature rupture of membranes (PROM) occurs when the amniotic sac ruptures before the onset of labor.
Premature rupture of membranes (PROM) occurs when the amniotic sac ruptures before the onset of labor.
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Which of the following is a potential complication associated with premature rupture of membranes? (Select all that apply)
Which of the following is a potential complication associated with premature rupture of membranes? (Select all that apply)
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Pregnancy-induced hypertension (PIH), formerly known as toxemia, is a condition characterized by vasospasm occurring during pregnancy.
Pregnancy-induced hypertension (PIH), formerly known as toxemia, is a condition characterized by vasospasm occurring during pregnancy.
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Gestational hypertension, a subtype of PIH, is characterized by elevated blood pressure without proteinuria or edema.
Gestational hypertension, a subtype of PIH, is characterized by elevated blood pressure without proteinuria or edema.
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Eclampsia, the most severe form of PIH, involves seizures and represents a life-threatening complication for both the mother and the fetus.
Eclampsia, the most severe form of PIH, involves seizures and represents a life-threatening complication for both the mother and the fetus.
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Which of the following is considered to be a classic sign of PIH? (Select all that apply)
Which of the following is considered to be a classic sign of PIH? (Select all that apply)
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What is the acronym for the condition that involves hemolysis, elevated liver enzymes, and low platelet count?
What is the acronym for the condition that involves hemolysis, elevated liver enzymes, and low platelet count?
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Multiple pregnancy refers to the presence of more than one fetus in the uterus, which can be either identical or fraternal twins.
Multiple pregnancy refers to the presence of more than one fetus in the uterus, which can be either identical or fraternal twins.
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Hydramnios, also known as polyhydramnios, is a condition characterized by excessive amniotic fluid formation, often associated with fetal malpresentation.
Hydramnios, also known as polyhydramnios, is a condition characterized by excessive amniotic fluid formation, often associated with fetal malpresentation.
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Hyperemesis gravidarum is a condition of severe and persistent vomiting during pregnancy, often accompanied by dehydration and electrolyte imbalances?
Hyperemesis gravidarum is a condition of severe and persistent vomiting during pregnancy, often accompanied by dehydration and electrolyte imbalances?
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Gestational diabetes is a type of diabetes that develops during pregnancy, often affecting women with pre-existing diabetes or those developing it for the first time.
Gestational diabetes is a type of diabetes that develops during pregnancy, often affecting women with pre-existing diabetes or those developing it for the first time.
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Cardiovascular disease (CVD) during pregnancy can pose significant risks to both the mother and the baby, emphasizing the importance of careful monitoring and management.
Cardiovascular disease (CVD) during pregnancy can pose significant risks to both the mother and the baby, emphasizing the importance of careful monitoring and management.
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TORCH infections are a group of infectious diseases that are known to cause serious harm to the developing embryo or fetus, potentially leading to complications or birth defects.
TORCH infections are a group of infectious diseases that are known to cause serious harm to the developing embryo or fetus, potentially leading to complications or birth defects.
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Toxoplasmosis, a parasitic infection primarily transmitted through eating undercooked meat or contact with cat feces, can lead to complications for the fetus, including stillbirth, miscarriage, or neurological disabilities.
Toxoplasmosis, a parasitic infection primarily transmitted through eating undercooked meat or contact with cat feces, can lead to complications for the fetus, including stillbirth, miscarriage, or neurological disabilities.
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The New York Heart Association classification system for cardiac disease is widely used to assess the severity of heart disease and guide patient management, including during pregnancy.
The New York Heart Association classification system for cardiac disease is widely used to assess the severity of heart disease and guide patient management, including during pregnancy.
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Study Notes
High Risk Pregnancy - Bleeding
- Restoring Blood Volume: IV fluid replacement using a large-gauge angiocath is used for rapid expansion. Obtain hemoglobin and hematocrit levels and secure a blood sample for typing or cross-matching.
- Assess Hypovolemic Shock: Monitor signs of hypovolemic shock, including decreased blood pressure, increased pulse rate and respiratory rate, decreased urine output, and restlessness.
- O2 Administration: Administer supplemental O2 via face mask if respiration is rapid
- Complete Bed Rest: Lateral position to restrict movement and sexual activity
- Ultrasound: Assess the integrity of the sac.
- First-Trimester Bleeding: Includes miscarriage, threatened miscarriage, imminent miscarriage, and incomplete miscarriage.
Spontaneous Abortion
- Causes: Abnormal fetal formation (due to teratogens or chromosomal aberrations), implantation abnormalities (inadequate endometrial formation or inappropriate implantation site), inadequate progesterone production by the corpus luteum, infection (rubella, syphilis, poliomyelitis, cytomegalovirus, toxoplasmosis, UTI), ingestion of teratogenic drugs, or severe maternal malnutrition.
- Presenting Symptoms: Painless vaginal bleeding
Types of Abortion/Miscarriage
- Threatened Miscarriage: Bright red vaginal bleeding (initially scanty), slight cramping, no cervical dilation. Diagnostic procedures are used to assess the situation
- Imminent (Inevitable) Miscarriage: Uterine contractions and cervical dilation. The loss of the products of conception cannot be halted. Diagnostic procedures are ultrasound to determine if the fetus is viable and if the uterus is empty.
- Complete Miscarriage: All products of conception expelled spontaneously without assistance. Bleeding slows within two hours and stops after a few days.
- Incomplete Miscarriage: Part of the conceptus is expelled, but membranes or placenta remain. There is danger of hemorrhage. Management often includes D&C to remove retained products of conception.
- Missed Miscarriage: Fetus dies in utero but is not expelled.
Septic Abortion
- Definition: Abortion complicated by infection. It can happen after spontaneous abortion. It is more common in self-induced abortions.
- Manifestations: Fever, crampy abdominal pain, tender uterus.
Isoimmunization
- Definition: A condition in which a woman's immune system develops antibodies against the fetus's red blood cells. It occurs when a Rh-negative mother carries a Rh-positive fetus.
- Diagnostic Procedure: Rh-negative women have anti-D titers monitored approximately every two weeks.
- Management: Rh immune globulin (RhoGAM) is administered to prevent the buildup of antibodies in case the fetus is Rh positive. This is given in different stages of pregnancy and after birth.
- Ectopic Pregnancy: Implantation outside the uterine cavity; may occur on the surface of the ovary, cervix, or fallopian tube. Possible causes include congenital defects of the reproductive tract or diverticular disease.
Second Trimester Bleeding
- Gestational Trophoblastic Disease: A proliferation and degeneration of trophoblastic villi. May show dense growth with no fetal outline
- Hydatidiform Mole (molar pregnancy): Abnormal pregnancy resulting from abnormal growth of cells surrounding the embryo and placenta. Usually no embryo inside, characterized by a grape-like appearance on ultrasound.
- Diagnosis: Ultrasound and hCG detection (hCG is abnormally high) are used.
- Treatment: Suction curettage to evacuate the molar pregnancy. Monitor hCG levels after removal.
Premature Cervical Dilation
- Definition: Cervical dilation prematurely.
- Risk Factors: Increased maternal age, congenital cervical defects, cervical trauma.
- Management: Cervical cerclage (suturing of the cervix) to prevent premature dilation .
Third Trimester Bleeding
- Placenta Previa: Placenta implants abnormally low within the uterine cavity, potentially covering the internal os of the cervix. Management depends on severity.
- Accreta/increta/percreta: Placenta abnormality where it implants too deeply within the uterine wall. Can have more adverse outcomes
- Risk Factors: Advanced maternal age, past C-sections, past uterine curettage, and multiple gestations.
- Diagnosis: Ultrasound
Preterm Rupture of Membranes
- Causes: Unknown, but associated with infection
- Manifestations: Sudden gush of clear fluid from vagina
- Diagnostics: Nitrazine paper test, ferning, ultrasound.
- Management: Labor does not begin: place patient on bed rest, antibiotic use to avoid infection. If fetus is too young to survive outside womb, administer IV oxytocin.
Pregnancy-Induced Hypertension
- Risk Factors: Primipara <20, primipara >40, low socioeconomic background, multiple pregnancy, hydramnios, underlying disease (heart disease, diabetes, essential hypertension)
- Pathophysiology: Vasospasm, altered vascular tone, reduced placental perfusion, kidney damage. Classic signs: hypertension, proteinuria, edema.
HELLP Syndrome
- Signs/Symptoms: Hemolysis, elevated liver enzymes, low platelets.
- Management: Blood transfusions, delivery
Multiple Pregnancy
- Types: Identical (monozygotic) and fraternal (dizygotic).
- Diagnostic procedures: Ultrasound
Hydramnios
- Definition: Excessive accumulation of amniotic fluid.
- Causes: Fetus's inability to swallow, increased urine production by fetus (if diabetic mother), congenital anomalies.
Hyperemesis Gravidarum
- Definition: Persistent and uncontrolled vomiting during pregnancy.
- Manifestations: Continuous severe nausea and vomiting, dehydration, electrolyte imbalances, jaundice, dry skin, coated tongue, non-elastic skin turgor, and hypokalemia.
Gestational Diabetes
- Definition: Diabetes that develops during pregnancy.
- Risk Factors: Obesity, history of delivering large neonates, age > 35, family history, and previous pregnancies with gestational diabetes/obesity and weight
- Diagnostic: Glucose tolerance test, glycosylated hemoglobin assessment.
- Monitoring: Diet, exercise, blood glucose control measures.
Cardiac Disease
- Classification: Divided by degree of limitation of activity; usually monitored by cardiac specialist
- Management: Medications, and adjustments made as needed by cardiologist
Toxoplasmosis
- Cause: Protozoan infection
- Manifestations: Asymptomatic, myalgia, malaise, rash, and splenomegaly
- Treatment: Antiparasitic drugs (sulfadiazine, pyrimethamine) to prevent complications for fetus. Prevention: avoiding raw or undercooked meat.
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Description
This quiz covers critical aspects of managing high-risk pregnancies, particularly focusing on bleeding incidents. It addresses the importance of assessing hypovolemic shock, appropriate interventions, and understanding the implications of spontaneous abortion. This knowledge is vital for healthcare professionals in maternal health.
