26 Questions
What is the main cause when the corpus luteum fails to produce enough progesterone during pregnancy?
Fetus fails to grow adequately
Which infection can cross the placenta and affect the fetus during pregnancy?
Rubella
What is the term for the emergency condition caused by severe blood loss making the heart unable to pump enough blood to the body?
Hypovolemic Shock
What is the term for the process that involves uterine contraction and cervical dilation leading to endometrial sloughing?
Dilation and Evacuation (D&E)
What is the rule of thumb mentioned for assessing hemorrhage during miscarriage?
No more than one sanitary pad per hour is excessive
What blood pressure measurement is defined as indicative of pre-eclampsia?
140/90
What is a common sign of pre-eclampsia affecting all organs?
Maternal fever
What is the recommended treatment for preterm pregnancy less than 34 weeks in the presence of signs of infection?
Induce labor and administer antibiotics
What is a potential indication of infection in pre-eclampsia?
Foul smelling vaginal discharge
What action is recommended if pre-eclampsia is diagnosed in a term pregnancy?
Spontaneous labor and vaginal delivery
What effect does excess production of thromboxane have on blood vessels during pregnancy?
Increases vasoconstriction
How does gestational hypertension differ from normal pregnancy in terms of vascular responsiveness?
Blood vessels become less responsive to blood pressure changes
What happens to the peripheral resistance during gestational hypertension?
It increases
How does poor placental perfusion in gestational hypertension affect the fetus?
Reduces fetal nutrient and blood supply
What is a consequence of ischemia in the pancreas during gestational hypertension?
Elevated amylase creatinine ratio
What is the purpose of a McDonald cerclage?
To pull the cervix tightly together
What does Placenta Previa refer to?
Placenta implants near or over the cervical os
What is the postprocedure care following a cerclage?
Maintain the patient on bed rest as ordered
What does Shirodkar's procedure involve?
Applying a submucosal band at the level of the internal cervical os
What are some potential complications associated with 3rd trimester high-risk pregnancies?
Preterm Labor
Which of the following is NOT a condition associated with premature labor?
Gestational diabetes
What is a common symptom of preterm labor?
Pelvic pressure
Which intervention aims to halt preterm labor?
Administering tocolytics
What is one goal of interventions for preterm labor?
Maintaining bed rest and a lateral position
Which of the following is associated with an increased risk of preterm labor?
Smoking
What condition may warrant caution against analgesic agents during preterm labor?
>50% effaced cervix, 3-4 cm dilated
Study Notes
Pre-Eclampsia
- Defined as blood pressure higher than 140/90 measured on two separate occasions, more than 6 hours apart, without protein in the urine, and diagnosed after 20 weeks of gestation.
- Affects all organs
- Signs and symptoms:
- Sudden gush of clear fluid from the vagina
- Maternal fever
- Fetal tachycardia
- Foul smelling vaginal discharge (indicating infection)
Treatment of Pre-Eclampsia
- In term pregnancy:
- Spontaneous labor and vaginal delivery
- Induction of labor
- Cesarean delivery
- Preterm pregnancy (less than 34 weeks):
- Hospitalization and observation for signs of infection while waiting for fetal maturation
- Baseline cultures and sensitivity test if clinical status suggests infection
- Induce labor and IV administration of antibiotic if tests confirm infection
Causes of Pre-Eclampsia
- Corpus luteum fails to produce enough progesterone
- Infection: Rubella, syphilis, poliomyelitis, CMV, and Toxoplasmosis
- UTI crosses the placenta, fetus fails to grow, and placental production of estrogen and progesterone fails
Complications of Miscarriage
- Hemorrhage
- Assess amount of bleeding
- Rule of thumb: More than one sanitary pad per hour is excessive
- Monitor vital signs to detect hypovolemic shock
- Massage the uterine fundus to aid contraction
- Dilatation and curettage
- Suction curettage
- Transfusion
Cerclage
- A procedure in which a suture or band is used to close the cervix using a vaginal approach
- Types of cerclage:
- McDonald cerclage: sutures placed horizontally and vertically high up on the cervix to pull it tightly together
- Shirodkar's procedure: submucosal band applied at the level of the internal cervical os
Third Trimester Bleeding
- Placenta Previa:
- Occurs when placenta implants near or over the cervical os rather than in the uterine fundus
- Causes bleeding
- Premature Separation of the Placenta (Abruptio Placenta):
- Causes bleeding
- Postprocedure Care:
- Maintain the patient on bed rest as ordered
- Assess for evidence of uterine contractions and rupture of membranes
- Monitor vital signs, especially temperature
- Assess for signs and symptoms of infection
Preterm Labor
- Contraction characteristics:
- More frequent than every 10 minutes
- Last 30 seconds or longer
- Persistent (4 every 20 minutes)
- Causes:
- Cervical incompetence
- Preeclampsia/eclampsia
- Maternal injury
- Infection (UTI and chorioamnionitis)
- Multiple births
- Placental disorders
- Assessment:
- Uterine contractions (painful or painless)
- Abdominal cramping
- Low back pain
- Pelvic pressure or heaviness
- Change in the character and amount of usual discharge
- Rupture of amniotic membranes
- Interventions:
- Goal: halt labor
- Focus on stopping the labor: identify and treat infection, restrict activity, and ensure hydration
- Maintain bed rest and a lateral position
- Monitor fetal status
- Administer fluids and medications as prescribed
- Tocolytics (nifedipine, indomethacin, magnesium sulfate, terbutaline sulfate)
- Labor that cannot be halted: membranes ruptured, cervix > 50% effaced, 3-4 cm dilated
- If very immature fetus: CS, NSD
- Caution against analgesic agents, epidural is preferred
Test your knowledge on the causes and assessment of preterm labor, including factors like cervical incompetence, infection, maternal injury, and placental disorders. Learn about the signs and symptoms associated with preterm labor.
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