Obstetrics Quiz: Eclampsia and HELLP Syndrome

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Questions and Answers

What is the first sign of shoulder dystocia during labor?

Rapid descent of the fetus

Excessive bleeding

Turtle sign (correct)

Persistent fetal heart rate deceleration

Which condition can result from tachysystole during labor?

Increased fetal heart rate

Decreased uterine contractions

Hypoxemia (correct)

Excessive uterine relaxation

Which of the following is NOT a risk factor for shoulder dystocia?

Maternal diabetes

Fetal macrosomia

History of cervical lacerations (correct)

Prolonged labor

What nursing action is recommended for managing tachysystole?

Change maternal position Signup and view all the answers

What is a possible consequence of tachysystole besides hypoxemia?

Uterine rupture Signup and view all the answers

What is the definition of PROM?

Premature rupture of membranes prior to the onset of true labor Signup and view all the answers

Which statement correctly describes PPROM?

It is defined as spontaneous rupture of membranes between 20 and 37 weeks of gestation. Signup and view all the answers

What is a characteristic of preterm labor?

Uterine contractions and cervical changes between 20 and 36 weeks of gestation Signup and view all the answers

What defines gestational diabetes?

An impaired glucose tolerance recognized during pregnancy Signup and view all the answers

What characterizes hyperemesis gravidarum?

Excessive nausea/vomiting causing significant weight loss and dehydration Signup and view all the answers

What are common warning signs that may precede eclampsia?

Headache and severe epigastric pain Signup and view all the answers

Which component is NOT part of the diagnosis for HELLP syndrome?

Elevated blood glucose Signup and view all the answers

What type of placenta previa occurs when the cervical os is completely covered by the placenta?

Complete placenta previa Signup and view all the answers

Which symptom is associated with ectopic pregnancy?

Unilateral stabbing pain Signup and view all the answers

What is a typical finding in a case of placenta abruptia?

Sharp abdominal pain Signup and view all the answers

Which test is important for diagnosing placenta previa?

Pelvic ultrasound Signup and view all the answers

What does the acronym HELLP stand for in HELLP syndrome?

Hemolysis, Elevated Liver enzymes, Low Platelets Signup and view all the answers

What is a common risk factor for developing placenta previa?

Maternal age greater than 35 years Signup and view all the answers

What is the typical laboratory test used to assess hemolysis in HELLP syndrome?

Hematocrit and hemoglobin levels Signup and view all the answers

What does the first letter of the labor position label indicate?

The maternal pelvis side Signup and view all the answers

Which of the following is a characteristic sign of intrahepatic cholestasis?

Itching and jaundice Signup and view all the answers

Which station indicates that the fetal head is aligned with the ischial spines?

0 station Signup and view all the answers

How should a laboring woman be encouraged to position herself?

Frequent position changes are encouraged for comfort. Signup and view all the answers

What is indicated by an APGAR score of 5?

Moderate difficulty Signup and view all the answers

Which factor can impair the progress of labor due to psychological effects?

Maternal stress and anxiety Signup and view all the answers

What does a score of 0-3 on the APGAR scale signify?

Severe distress Signup and view all the answers

In the event of shoulder dystocia, what is necessary during delivery?

Additional maneuvers to relieve shoulder impaction Signup and view all the answers

The third letter in the labor position label signifies what aspect?

The part of the maternal pelvis Signup and view all the answers

What is the condition characterized by generalized itching in late pregnancy that affects about 1% of pregnancies in the United States?

Cholestasis Signup and view all the answers

Which of the following describes the greatest risk associated with multigestational pregnancies?

Twin-to-twin transfusion syndrome Signup and view all the answers

What acronym stands for a group of teratogenic infections that can affect pregnancy?

TORCH Signup and view all the answers

Which bacterial infection is the most common during pregnancy that can also increase risks for mother and fetus?

Group B Streptococcus Signup and view all the answers

What is characterized by transitory, abrupt slowing of fetal heart rate (FHR) at least 15 seconds below baseline?

Variable decelerations Signup and view all the answers

In fetal heart rate tracings, what is the defining characteristic of Category I patterns?

Moderate baseline FHR variability Signup and view all the answers

Which of the following factors is considered a primary power during labor?

Uterine contractions Signup and view all the answers

What is a common intervention for late decelerations in fetal heart rate?

Increasing fluids Signup and view all the answers

What is a potential consequence of untreated urinary tract infections during pregnancy?

Pyelonephritis Signup and view all the answers

What nursing intervention is unnecessary for managing early decelerations of fetal heart rate?

Discontinue oxytocin Signup and view all the answers

Study Notes

Eclampsia

Preceded by headache, severe epigastric pain, hyperreflexia, and hemoconcentrations, which signal possible convulsions.

HELLP Syndrome

Variant of gestational hypertension (GH) with hematologic conditions and severe preeclampsia involving hepatic dysfunction.
Diagnosed through lab tests, not clinically.
H: Hemolysis causing anemia and jaundice.
EL: Elevated liver enzymes (ALT or AST), leading to epigastric pain, nausea, and vomiting.
LP: Low platelets (<100,000/mm3), resulting in thrombocytopenia, abnormal bleeding and clotting, bleeding gums, petechiae, and potential disseminated intravascular coagulation (DIC).

Placenta Previa

Abnormal placental implantation in the lower uterine segment near or over the cervical os.
Three classifications:
- Complete/Total: Cervical os completely covered by placenta.
- Incomplete/Partial: Cervical os partially covered by placenta.
- Marginal: Placenta attached in the lower uterine segment, but doesn't reach the cervical os.
- Low-lying: Exact relationship of placenta to internal os undetermined.
Risk factors: Previous placenta previa, uterine scarring, maternal age >35, multifetal gestation, multiple gestations, and smoking.

Placenta Abruptia

Partial or complete placental detachment before delivery, causing bleeding at the decidual-placental interface.
Symptoms: Vaginal bleeding, sharp abdominal pain, and a tender, rigid uterus.

Ectopic Pregnancy

Abnormal implantation of a fertilized ovum outside the uterine cavity, often in the fallopian tube.
Can lead to tubal rupture and fatal hemorrhage.
Second most frequent cause of bleeding in early pregnancy and a leading cause of infertility.

Intrahepatic Cholestasis

Most common pregnancy-specific liver disease, reversible and hormonally influenced.
Develops in late pregnancy in genetically predisposed individuals.
Characterized by generalized itching, especially on palms and soles of the feet.

Multigestational/Twins

Monoamniotic/Monozygotic: Shared amniotic sac, higher risk of twin-to-twin transfusion and cord entanglement.
Diamniotic/Dizygotic: Separate amniotic sacs, reduced risk of twin-to-twin transfusion.

TORCH Infections

Acronym for Toxoplasmosis, Other (hepatitis B), Rubella, Cytomegalovirus, and HSV.
Teratogenic, causing developmental abnormalities in the fetus.

UTI/Pyelonephritis

Most common bacterial infections during pregnancy.
Risks for both mother and fetus, can contribute to preterm labor/preterm birth, low birth weight, and increased risk of perinatal mortality.
Can be symptomatic or asymptomatic.

Group B Strep (GBS)

Bacterial infection passed to a fetus during labor and delivery.
Complications: Preterm labor/preterm birth, UTI, intrauterine infection, endometriosis after delivery.
Can cause pneumonia, respiratory distress syndrome (RDS), sepsis, and meningitis in the baby.
Cultures performed at 36 0/7 and up to 37 6/7 weeks of gestation.
Treatment: Intravenous (IV) loading dose (bolus) followed by intermittent IV bolus every 4 hours; typically Pen G or ampicillin.

VEAL CHOP

Mnemonic for fetal heart rate (FHR) patterns.
Variable decelerations Cord compression
Early decelerations Head compression
Accelerations OK, reassuring
Late decelerations Placental insufficiency

Prolonged Decelerations

FHR slowing lasting longer than 2 minutes.
Represents significant fetal distress.

Category I FHR Tracing

Reassuring FHR pattern.
Includes:
- Baseline FHR 110-160 bpm.
- Moderate variability.
- Accelerations present or absent.
- Early decelerations present or absent.
- Variable or late decelerations absent.

Stages of Labor

First Stage: Onset of regular contractions to full cervical dilation (10 cm).
Second Stage: Full cervical dilation to delivery of the baby.
Third Stage: Delivery of the baby to delivery of the placenta.
Fourth Stage: Postpartum period, first 4 hours after delivery.

5 P's of Labor

Powers: Uterine contractions and maternal pushing efforts.
Passageway: Birth canal, including bony pelvis, cervix, pelvic floor, vagina, and introitus.
Passenger: Fetus, including size, presentation, position, and attitude.
Position: Maternal position during labor, promotes comfort, fatigue relief, and circulation.
Psychological: Maternal stress, tension, and anxiety can affect labor progress.

Premature/Prelabor Rupture of Membranes (PROM/PPROM)

PROM: Spontaneous rupture of amniotic membranes before onset of true labor.
PPROM: Spontaneous rupture of amniotic membranes after 20 weeks of gestation and before 37 weeks.

Preterm Labor (PTL)

Uterine contractions and cervical changes between 20 and 36 weeks and 6 days of gestation.
Categorized as:
- Very preterm: Less than 32 weeks.
- Moderately preterm: 32 to 34 weeks.
- Late preterm: 34 to 36 weeks.
Symptoms: Bloody discharge, regular uterine contractions, cervical dilation and effacement.

Diabetes: Pre-gestational/Gestational

Pre-gestational Diabetes: Blood glucose levels above normal, but below the cutoff for overt diabetes in non-pregnant women.
Gestational Diabetes: Impaired glucose tolerance with onset during pregnancy.
Ideal blood glucose levels during pregnancy: 60-99 mg/dL fasting and ≤120 mg/dL 2 hours after meals.

Hyperemesis Gravidarum

Excessive nausea and vomiting, often related to elevated hCG levels.
Prolonged past 16 weeks gestation or causing weight loss, dehydration, nutritional deficiencies, electrolyte imbalances, and ketonuria.

Gestational Trophoblastic Disease/Molar Pregnancy/Hydatidiform Mole

Proliferation and degeneration of trophoblastic villi, resulting in swollen, fluid-filled, grape-like clusters in the placenta.

APGAR Score

Rapid assessment of newborn's extrauterine adaptation at 1 and 5 minutes of life.
Scores:
- 0-3: Severe distress.
- 4-6: Moderate difficulty.
- 7-10: Minimal/no difficulty.

Shoulder Dystocia

Birth complication where the fetal shoulder gets stuck, requiring additional maneuvers to relieve impaction.
Risks: Fetal macrosomia, maternal diabetes, previous shoulder dystocia, prolonged labor, excessive weight gain.
First sign: Retraction of fetal head against maternal perineum (turtle sign).
Delay in shoulder delivery after head delivery.

Tachysystole

Uterine contractions lasting longer than 90 seconds, or 5 or more contractions in 10 minutes.
Can cause fetal hypoxemia and abnormal FHR.
Risk of abruptio placenta or uterine rupture (rare).
Causes: Cervical ripening medications, induced or augmented labor, dehydration, preeclampsia, drug use.

Postpartum Hemorrhage

Excessive blood loss after delivery.
Classified by severity based on blood loss volume.
Leading cause of maternal mortality.
Causes: Uterine atony, retained placenta, lacerations, or hematomas.
Risk factors: Prolonged labor, grand multiparity, previous postpartum hemorrhage, and operative delivery.

Fetal Presentation

The part of the fetus that enters the pelvic inlet first.
Cephalic: Head first, most common.
Breech: Buttocks or feet first.
Shoulder: Shoulder first.

Fetal Position

Relationship of the landmark of the presenting part to the maternal pelvis.
Identified with three letters:
- Right (R) or Left (L): Side of the maternal pelvis.
- Occiput (O), Sacrum (S), Mentum (M), or Scapula (Sc): Presenting fetal part.
- Anterior (A), Posterior (P), or Transverse (T): Part of the maternal pelvis.

Fetal Station

Measurement of fetal descent in centimeters, with station 0 at the level of the ischial spines.
Minus stations: Superior to the ischial spines.
Plus stations: Inferior to the ischial spines.

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Description

Test your knowledge on critical obstetric conditions such as Eclampsia, HELLP Syndrome, and Placenta Previa. This quiz covers symptoms, diagnosis, and classifications associated with these conditions. Enhance your understanding of maternal-fetal health.