Obstetrics Quiz: Placental Issues and RhoGAM

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Questions and Answers

What is the primary cause of maternal vessels tearing away from the placenta during the 2nd and 3rd trimester?

Infection in the uterus

Placenta previa

Placental abruption (correct)

Maternal hypertension

Which of the following is a classic manifestation of placental abruption?

Shooting lower back pain

Heavy fatigue with no other symptoms

Shortness of breath

Sharp abdominal pain (correct)

What maternal risk is associated with complications from placental abruption?

Thyroid dysfunction

Chronic hypotension

Obstetrical hemorrhage (correct)

Increased risk of gestational diabetes

What is the primary goal of therapeutic management for placental abruption?

Control and restore blood loss Signup and view all the answers

What defines preeclampsia/eclampsia in a pregnant individual?

New onset of hypertension with proteinuria Signup and view all the answers

What is the primary purpose of administering RhoGAM to a pregnant woman?

To help destroy any fetal cells in the maternal circulation Signup and view all the answers

When is RhoGAM indicated during pregnancy?

Between 28 - 32 weeks gestation and within 72 hours after delivery Signup and view all the answers

What does a positive indirect Coombs test indicate for a pregnant woman?

Isoimmunization has occurred, making RhoGAM ineffective Signup and view all the answers

Which of the following conditions would not typically indicate the use of RhoGAM?

Maternal hypertension Signup and view all the answers

Polyhydramnios is characterized by excessive amniotic fluid levels exceeding what volume?

2000 mL Signup and view all the answers

Which pathological change is characterized by a lower than normal number of platelets?

Thrombocytopenia Signup and view all the answers

What is one of the two events leading to pathological changes associated with impaired blood flow?

Vasospasm Signup and view all the answers

Which management strategy is recommended for improving uteroplacental blood flow?

Lateral recumbent position Signup and view all the answers

Which dietary recommendation is advised for women with elevated blood pressure issues?

Encourage drinking 6-8 glasses of water daily Signup and view all the answers

What therapeutic management should be prioritized for addressing complications?

Delivery of the placenta Signup and view all the answers

Which is NOT a risk factor identified for preeclampsia?

Advanced age Signup and view all the answers

What symptom is associated with hypoperfusion caused by high blood pressure?

Nausea and vomiting Signup and view all the answers

Which laboratory tests are recommended to monitor complications in women at risk?

CBC, clotting studies, liver enzymes Signup and view all the answers

What is a common therapeutic management option for impaired swallowing in fetuses with chromosomal abnormalities?

Frequent prenatal visits Signup and view all the answers

What is oligohydramnios and its primary effect on the fetus?

A decrease in amniotic fluid putting the fetus at risk for cord compression Signup and view all the answers

Which medication is used to manage oligohydramnios by decreasing amniotic fluid?

Indomethacin Signup and view all the answers

What potential risk does reduced amniotic fluid create for the fetus?

Increased risk of intrapartal hypoxia Signup and view all the answers

What characterizes gestational diabetes?

It includes glucose intolerance that begins during pregnancy. Signup and view all the answers

Which of the following is a maternal complication of diabetes during pregnancy?

Preeclampsia Signup and view all the answers

What role do serial ultrasounds and fetal surveillance play in managing oligohydramnios?

To assess fetal heart rate patterns and well-being Signup and view all the answers

What is the primary pathophysiology of diabetes during pregnancy?

Higher fat deposition followed by insulin resistance Signup and view all the answers

Which is NOT included in the care plan for a gestational diabetic mother?

Regular lung function tests Signup and view all the answers

What is a common neonatal complication associated with gestational diabetes?

Cord prolapse Signup and view all the answers

How does insulin resistance impact pregnancy?

It leads to complications if not managed Signup and view all the answers

What is the purpose of tracking fetal kick counts in gestational diabetes?

To detect any decrease in fetal activity Signup and view all the answers

What is a potential outcome of amnioinfusion during oligohydramnios?

Improvement in fetal heart rate patterns Signup and view all the answers

Which diagnostic test evaluates the kidney function in gestational diabetes patients?

Urine check for protein Signup and view all the answers

Which symptom is NOT associated with glucose intolerance?

Nausea Signup and view all the answers

What lifestyle measure is essential for preventing complications in gestational diabetes?

Monitoring blood glucose levels regularly Signup and view all the answers

What is the primary medical emergency associated with ectopic pregnancy?

Maternal organ rupture Signup and view all the answers

Which of the following is a common site for ectopic implantation?

Fallopian tube Signup and view all the answers

What is a hallmark symptom of ectopic pregnancy?

Abdominal pain with spotting Signup and view all the answers

Which organism is known to cause scarring that may lead to ectopic pregnancy?

Neisseria gonorrhea Signup and view all the answers

What is one method used for the non-ruptured ectopic pregnancy management?

IM Methotrexate Signup and view all the answers

Which of the following is NOT a cause of blockage leading to ectopic pregnancy?

Increased exercise Signup and view all the answers

What is the goal of surgical intervention in cases of ectopic pregnancy?

Preventing hemorrhage Signup and view all the answers

What should be monitored to assess the condition of a patient with ectopic pregnancy?

Beta-hCG level Signup and view all the answers

Study Notes

Care of Childbearing Women

Placenta Previa: A condition where the placenta is wholly or partially implanted in the lower uterine segment, potentially covering the cervical opening.
Impaired Placental Implantation (Early Detection): Ultrasound and Doppler technologies are used.
Causes of Impaired Implantation: Uterine scarring/damage in the upper segment can cause placental growth in the unscarred lower segment. Uteroplacental under perfusion can also cause placental encroachment.
Therapeutic Management (Placenta Previa): Management depends on bleeding extent and fetal development. Factors like closeness of placenta to cervical os and fetal viability influence treatment options.

Abruptio Placenta

Abruptio Placenta: Early separation of a normally implanted placenta, occurring after 20 weeks of gestation. Bleeding occurs between decidua and the placenta.
Pathophysiology: Maternal vessels tear away from the placenta causing bleeding between the uterine lining and the maternal side of the placenta.
Classic Manifestations: Painful abdominal pain (knife-like), dark red vaginal bleeding, uterine tenderness and contractions, a decrease in fetal movement.
Maternal Risks: Obstetrical hemorrhage, blood transfusions, potentially needing a hysterectomy; disseminated intravascular coagulation (DIC).
Perinatal Consequences: Low birth weight, preterm birth, asphyxia, stillbirth, and perinatal death.
Therapeutic Management: Controlling and restoring blood loss, preventing coagulation disorders (DIC), anticoagulation, blood transfusions, and Cesarean Section (C-section) if fetal distress is imminent.

Preeclampsia/Eclampsia

Pathological Changes: Pulmonary edema, oliguria, seizures, thrombocytopenia (low platelet count). Abnormal liver functions can also occur.
Two-stage events: Vasospasm leading to injury to endothelium of blood vessels, thus leading to fibrin deposition and schistocyte formation. Decreased blood flow to vital organs, especially the brain, liver, kidneys, and placenta.
Risk Factors: Multifetal pregnancy, previous preeclampsia, renal disease, diabetes, chronic hypertension, autoimmune disorders.
Management: Bed rest (lateral recumbent position), monitoring blood pressure, monitoring fetal movement, diet modifications (low sodium, increase water intake, balance protein), delivery of the placenta, potential hospital admission.

HELLP Syndrome

HELLP Syndrome: Blood disorder associated with severe preeclampsia, characterized by hemolysis (destruction of red blood cells), elevated liver enzymes, and low platelet count.
Risk Factors: Severe preeclampsia features.
Complications: Increased risk of cerebral hemorrhage and retinal detachment.

ABO Incompatibility

Incidence: A pregnancy where the mother is blood type O and the fetus has a different blood type (A, B, or AB). Mother's serum contains naturally occurring antibodies (anti-A and anti-B) that can cross the placenta and hemolyze (destroy) fetal red blood cells.
Nursing Assessment: Prenatal blood type and Rh factor determination, indirect Coombs test to determine if the mother has formed antibodies against the fetus's red blood cells.

Polyhydramnios

Polyhydramnios: Excessive amniotic fluid (> 2000 mL) surrounding the fetus.
Risks: Diabetes or other maternal conditions, fetal abnormalities such as upper gastrointestinal obstruction.
Therapeutic Management: Monitoring, possible amniocentesis to reduce fluid buildup, and maternal medication if appropriate.

Oligohydramnios

Oligohydramnios: Insufficient amniotic fluid (< 500 mL).
Risks: Increased risk of perinatal morbidity and mortality, potentially leading to fetal death. Cord compression is a potential concern.
Managements: Fetal monitoring, and potential interventions if risk factors are identified.

Diabetes

Gestational Diabetes: Glucose intolerance diagnosed during pregnancy.
Pregestational Diabetes: Preexisting condition, type 1 or type 2.
Complications: Macrosomia in the fetus, hypoglycemia, birth trauma.

Ectopic Pregnancy

Ectopic Pregnancy: Fertilized egg implants outside the uterine cavity.
Risks: Rupture and hemorrhage, medical emergency.
Causes of blockage: Pelvic inflammatory disease (PID) scarring, uterine fibroids, intrauterine contraceptive devices, previous ectopic pregnancies, endometriosis, etc.
S/S: Abdominal pain, vaginal bleeding, amenorrhea (missed menstrual period)

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Description

Test your knowledge on critical topics related to placental health during pregnancy, including placental abruption, preeclampsia, and RhoGAM administration. This quiz covers key complications, their manifestations, and management strategies. Perfect for medical students and healthcare professionals looking to reinforce their understanding of obstetric care.