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?

    <p>Change maternal position</p> Signup and view all the answers

    What is a possible consequence of tachysystole besides hypoxemia?

    <p>Uterine rupture</p> Signup and view all the answers

    What is the definition of PROM?

    <p>Premature rupture of membranes prior to the onset of true labor</p> Signup and view all the answers

    Which statement correctly describes PPROM?

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

    What is a characteristic of preterm labor?

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

    What defines gestational diabetes?

    <p>An impaired glucose tolerance recognized during pregnancy</p> Signup and view all the answers

    What characterizes hyperemesis gravidarum?

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

    What are common warning signs that may precede eclampsia?

    <p>Headache and severe epigastric pain</p> Signup and view all the answers

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

    <p>Elevated blood glucose</p> Signup and view all the answers

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

    <p>Complete placenta previa</p> Signup and view all the answers

    Which symptom is associated with ectopic pregnancy?

    <p>Unilateral stabbing pain</p> Signup and view all the answers

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

    <p>Sharp abdominal pain</p> Signup and view all the answers

    Which test is important for diagnosing placenta previa?

    <p>Pelvic ultrasound</p> Signup and view all the answers

    What does the acronym HELLP stand for in HELLP syndrome?

    <p>Hemolysis, Elevated Liver enzymes, Low Platelets</p> Signup and view all the answers

    What is a common risk factor for developing placenta previa?

    <p>Maternal age greater than 35 years</p> Signup and view all the answers

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

    <p>Hematocrit and hemoglobin levels</p> Signup and view all the answers

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

    <p>The maternal pelvis side</p> Signup and view all the answers

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

    <p>Itching and jaundice</p> Signup and view all the answers

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

    <p>0 station</p> Signup and view all the answers

    How should a laboring woman be encouraged to position herself?

    <p>Frequent position changes are encouraged for comfort.</p> Signup and view all the answers

    What is indicated by an APGAR score of 5?

    <p>Moderate difficulty</p> Signup and view all the answers

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

    <p>Maternal stress and anxiety</p> Signup and view all the answers

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

    <p>Severe distress</p> Signup and view all the answers

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

    <p>Additional maneuvers to relieve shoulder impaction</p> Signup and view all the answers

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

    <p>The part of the maternal pelvis</p> 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?

    <p>Cholestasis</p> Signup and view all the answers

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

    <p>Twin-to-twin transfusion syndrome</p> Signup and view all the answers

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

    <p>TORCH</p> Signup and view all the answers

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

    <p>Group B Streptococcus</p> Signup and view all the answers

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

    <p>Variable decelerations</p> Signup and view all the answers

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

    <p>Moderate baseline FHR variability</p> Signup and view all the answers

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

    <p>Uterine contractions</p> Signup and view all the answers

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

    <p>Increasing fluids</p> Signup and view all the answers

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

    <p>Pyelonephritis</p> Signup and view all the answers

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

    <p>Discontinue oxytocin</p> 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.

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