OB Final Exam Review PDF

Complications of Pregnancy Adolescent Pregnancy: - Erikson→ identity vs. role confusion, identify with their peers - Piaget→ says they are ‘present oriented’ and not thinking about the future/consequences - Consequences: less likely to complete high school, dependence on welfare, sing...

Complications of Pregnancy Adolescent Pregnancy: - Erikson→ identity vs. role confusion, identify with their peers - Piaget→ says they are ‘present oriented’ and not thinking about the future/consequences - Consequences: less likely to complete high school, dependence on welfare, single parenthood, more likely to abuse or neglect child (lost their own childhood and take out on kid) - Physical consequences: poor nutritional intake (both baby and mom still growing), preeclampsia, CPD (baby’s head too big for mom’s immature pelvis, #1 reason for C/s), anemia (makes infection worse), drugs, STIs (high risk activities/unprotected sex), fetal death, LBW - Brain finishes developing at 25, so not full judgment until then - Nursing objectives: first question you ask teenager is how they are feeling about this, deal with feelings first or else education will not work if they are in denial - Provide support system, nursing staff is there for her, may be afraid to tell parents - Education - Assessment of complications - Provide options for consideration (abortion, adoption, keeping kid) Abortion: any interruption of pregnancy before viability, includes natural (4 types) and induced - Early→ 1st trimester - Late→ usually 2nd trimester, but can be later - Causes: natural→ infections, too low progesterone, bad implantation, chromosomal abnormalities that are incompatible with life - Heavy period may not realize is miscarriage - Woman usually blames herself, first thing we want to get rid of is the fault 1. Threatened Abortion: bright red vaginal bleeding, no cramping, no dilation - Just spotting with no pain, puts pad on and sees blood - Interventions: HCG and progesterone levels, limit activity, pelvic rest - Modified bed rest, no sex, no douching, no tampons, nothing inside vagina - Bleeding so if Rh negative, give Rhogam - Can resolve, called ‘threatened abortion’ because does not mean it will actually happen 2. Imminent (Inevitable) Abortion: moderate bright red vaginal bleeding, contractions (pain), dilation, possible passage of tissue fragments (can be placental, fetal, embryonic) - Inevitable, meaning pregnancy is over - Interventions: save fragments and send to patho lab - D&C scrapes uterus lining, take out conception contents, prepare it for next pregnancy - Run hormone levels, give Rhogam if Rh negative 3. Incomplete Abortion: moderate bright red vaginal bleeding, contractions, dilation, spontaneous expulsion of partial contents of conception (usually fetus only→ placenta left inside, fetus comes out) - Interventions: save fragments, D&C - Look for signs of infection and shock during any type of abortion - A lot of women will be put on iron 4. Complete Abortion: moderate bright red vaginal bleeding, contractions, dilation, spontaneous expulsion of entire contents of conception - Everything came out so no procedures needed, just monitor Clinical Interruption of Pregnancy: induced abortion - Elective procedure → NY state can have abortion up to 39 weeks - Therapeutic→ usually performed out of medical necessity, done on purpose - Since legal in NY, must push own feelings aside to work with pt if she chooses to have abortion - Procedures:  - Mifepristone (RU-486)/Misoprostol: abortion pill used to end almost all early pregnancies (1st trimester), offered within first 8 weeks of pregnancy with 2 pills - 1st pill Mifepristone (setup) taken in doctor’s office blocks progesterone so that it can no longer stop estrogen from contracting the uterus - Woman then has 2-3 days to take the 2nd pill (closer) known as Misoprostol, a prostaglandin that ends the pregnancy - She will get cramping and bleeding after the 2nd pill - Some states put timeline on when can be taken, most are at 6-8 weeks - If she goes home and gets a period, a lot of times will get Rhogam to prevent any mixing before the pregnancy ends - Be on the lookout for bleeding, pain, infection - Vacuum aspiration: further along can use vacuum to aspirate contents of conception - Dilation and evacuation: use an extraction tube to evacuate the embryonic tissue - Usually done in 2nd trimester and uses surgical instruments to extract uterus, watch for infection - Nursing implications for induced abortions: watch for potential complications - Follow-up 2 weeks later to ensure pregnancy has ended - Rhogam - Psychosocial support, not an easy decision - Education for home of what is an appropriate amount of bleeding vs. hemorrhage, signs of shock, infection, fever, SOB, clots Ectopic Pregnancy: fertilized ovum is implanted in any tissue other than uterine wall, in wrong place - 98% stuck in fallopian tubes due to cilial damage or inflammation in tubes, 2% outside tubes - 1% occurrence overall - Causes: cilia damage and tube occlusion, history of PID, tubal surgery (manipulation of tubes), excessive estrogen and progesterone, advancing age (over 35 body slows down), smoking, vaginal douching (reverses flow and send things back up), endometriosis, scar tissue - Sitting and growing in the tube will lead to rupture, causing internal bleeding/hemorrhage, shock, and death = emergency! - Symptoms: pain (R or L side of lower abd depending on which tube, pain referred to shoulder) - Vaginal bleeding - Low serum Hematocrit (hemorrhaging) - Elevated HCG because still pregnant - Diagnosis: ultrasound and laparoscopy - For women with lower abdominal pain, always do US to see what’s going on - Treatment: if catch very early, surgery is not needed - Nonsurgical→ Methotrexate (antineoplastic/chemo med usually used to stop rapidly dividing cancer cells, embryo is also rapidly dividing) - Surgical→ laparoscopy or laparotomy - Salpingectomy (take out part or whole tube, pregnancy is over), leave ovary unless pregnancy is on it - Future pregnancies: 30% difficulty conceiving again - If tube spared, 60% future success - Repeat tubal pregnancy = 15% - Can get pregnant with one tube, but chance of it happening again in other tube Gestational Trophoblastic Disease: aka hydatidiform mole, placenta starts to develop and trophoblast takes over, uterus eliminates the embryo so no fetus developing - Abnormal placenta and abnormal trophoblast proliferation  - Snowstorm pattern on ultrasound - Symptoms: - Bleeding: when a mole that was evacuated comes out, start to see dark areas of bleeding during break down/deterioration, vesicles look like grape-like clusters and exhibit clear fluid after the dark bleeding - Enlarged uterus: when doing fundal height, there will be large uterus with no FHR - Hyperemesis: nausea makes woman think she has healthy pregnancy, she does not - PIH symptoms/preeclampsia association: usually earlier than 20 weeks will see high BP and proteinuria - Treatment: ultrasound, evacuation, check HCG x 1 year - Evacuate the mole to get the body ready for another pregnancy - However, hydatidiform moles are very closely associated with the development of choriocarcinoma → very rapidly metastasizing malignancy - Some physicians will put them on Glucophorin prophylactically to prevent this - Need to check HCG levels regularly for first year because if elevated, it indicates that it has seroconverted to choriocarcinoma, assure her that you are watching over her to make sure that this does not happen - Do not want this woman to get pregnant for at least a year following the evacuation - Can happen again, seems more prevalent in Asian population Premature Labor: occurs before 37 weeks (between 20 and 37 weeks) - Considered premature labor if uterine contractions that cause cervical dilation & effacement - Associated with dehydration, UTI, chorioamnionitis - Dehydration stimulates ADH from posterior pituitary, Oxytocin also sits in posterior pituitary and stimulates contractions - Infections alter and irritate lining of uterus and amniotic sac, causing premature labor - Can stop premature labor if no ROM, FHR ok, no bleeding, dilation