Term
| Suggestive signs of pregnancy |
|
Definition
amenorrhea
breast tenderness/enlargement
fatigue
syncope/vertigo
urinary frequency
nausea (6-8 wks)
|
|
|
Term
| presumptive signs of pregnancy |
|
Definition
palpable fetal movements
uterine enlargement
softening of uterus
cervical vascular changes |
|
|
Term
Softening of isthmus = ??? sign
softening of anterior wall of uterus = ??? sign
blue discoloration of cervix = ??? sign
softening of cervix = ??? sign |
|
Definition
Isthmus = hegar's
anterior wall = ladin's
blue cervix = Chadwick's
cervix softening = Goodell's |
|
|
Term
Dodge take home message:
If you think a woman might be pregnant and it's important to know, order what test?
If it is CRUCIAL to know if a woman is pregnant, order what test?
ex of this situation? |
|
Definition
important: serum or urine qualitative pregnancy test
crucial: serum quantitiative HCG
ex: accutane
|
|
|
Term
| other tests to diagnose pregnancy (other than HCG) |
|
Definition
xrays: fetal bones show up at about 14 weeks gestation
US: vaginal probe 1st trimester, abdominal >12 weeks
|
|
|
Term
at what gestational age can you detect:
gestational sac
2mm embryo
cardiac activity
movement |
|
Definition
gestational sac: shows up at 5-5.5 weeks (3 weeks after conception)
2mm embryo - at 5.5-6 weeks
cardiac activity: 5.5-6 weeks
movement: 7.5-8.5 weeks |
|
|
Term
| Gold Standard for diagnosing pregnancy |
|
Definition
Quantitative (NOT qualitative) HCG test
Absolute: if >5mIU/ml
possible if >2mIU/ml
Typical post-fertilization 14 days: >30mIU/ml |
|
|
Term
1. dyspareunia
2. episiotomy |
|
Definition
dyspareunia - pain during sexual intercourse
most common cause: vulvodynia
episiotomy: surgical incision of the vulva to prevent laceration at the time of delivery or to facilitate vaginal surgery |
|
|
Term
What dz?
Cause: uncertain. not an STD but associated with sexual activity
Sx: Thin, white, milky discharge and characteristic "fishy smell"
dx?
complications?
tx? |
|
Definition
bacterial vaginosis (gardnerella vaginalis)
dx: look for clue cells on saline wet mount slide. sniff test
complications: increased risk of premature labor, increased risk of PID if exposed to chlamydia, increased risk of post-GYN surgery infection
tx: oral or topical metronidazole, topical clindamycin |
|
|
Term
| epithelial cells will punctated inclusions, making a speckled pattern |
|
Definition
|
|
Term
| first 28 days of life is considered the ___ period |
|
Definition
|
|
Term
1. cystocele
2. nullipara
3. macrosomia - definition, cause, complications
4. primigravida |
|
Definition
cystocele: herniation of urinary bladder into vagina
nullipara: never had a child
macrosomia: large fetal size (>10 lbs). most commonly seen in moms with type II or gestational diabetes. baby at risk for metabolic problems after birth as well as birth trauma
primigravida: woman who's pregnant for the first timek |
|
|
Term
| term, preterm, and postterm |
|
Definition
term: 37-42 weeks
preterm: <37 - greater risk for death, resp problems, sequela
Post term: >42 |
|
|
Term
post-partum time frame: delivery - 6 weeks
uterus regresses to 20 weeks size on postpartum day ___
rapid cardiovascular and metabolic changes: such as? |
|
Definition
puerperium
20 weeks size by day 1
weight loss: 4 kg over 6 weeks
blood loss: 500-1,000 ml. normalized after 3 weeks
rapid fall in insulin resistance
coagulation: rapid fall in fibrinogen and platelets
lipid chemistry; normal <1week |
|
|
Term
| 3 measures of how "ready" a woman is to deliver |
|
Definition
dilation
- 1 finger = 1-2 cm dilated
- 2 fingers = 2-3 cm dilated
effacement
- usually an inch thick
- needs to be paper thin
station - how far down the birth canal is the head?
- 0 = at ischial spine
- -1,2,3 = above the ischial spine
- +1,2,3 = below ischial spine
|
|
|
Term
average length of human pregnancy:
___ days after conception (fertilization)
___ dayas after 1st day of last menstrual period
"due date" = ____ = 40 weeks |
|
Definition
266
280
estimated date of delivery (EDD) |
|
|
Term
trimesters:
1st: ___ - ___
2nd: ___ - ___
3rd: ___ - ___ |
|
Definition
1st: conception to 14 weeks
2nd: 15-27 weeks
3rd: 28-40 weeks |
|
|
Term
| a baby is considered a "fetus" at ___ weeks becuase all organ systems have been started |
|
Definition
|
|
Term
| Nagele's rule of dating the EDD |
|
Definition
LMP + 7 days - 3 mos
LMP of July 1 = EDD of april 8 |
|
|
Term
what is quickening?
when would it first be noticed? |
|
Definition
first fetal movement
nulliparus: 18-22 weeks
multiparas: 14-18 weeks |
|
|
Term
when does a baby first start to move?
when can fetal heart beat first be heard?
when does cardiac activity begin? |
|
Definition
movement: 7-8 weeks
HB: 10 weeks via doppler, 16-20 weeks via fetoscope
cardiac: 5 weeks |
|
|
Term
Uterine growth marks:
___: size of your fist
___: palpable at or slightly above pubic symphisis
___: palpable at umbilicus
___: palpable at xiphoid |
|
Definition
non-pregnant
12 weeks
20 weeks
36 weeks
in general, height in cm = weeks gestation |
|
|
Term
Pregnancy terms:
___: 37-42 weeks
___: >42 weeks
___: 28-36 weeks
___: 22-27 weeks
___: <22 weeks
___: loss before 20 weeks or <500 g |
|
Definition
term
post term
premature
immature
non-viable
abortion |
|
|
Term
| ____: trophoblastic proliferation with no embryo |
|
Definition
| gestational trophoblastic disaese |
|
|
Term
___: intrauterine fetal death before or during labor
___: death in the first 28 days of life
___: # of stillbirths and neonatal losses per 1,000 births. Rational goal <10/1,000
___: pregnant woman who dies during pregnancy or within 6 weeks of delivery/termination. rational goal 11-12/100,000 |
|
Definition
stillbirth
neonatal death
perinatal death (mortality) rate
maternal mortality |
|
|
Term
| direct v. indirect maternal mortality |
|
Definition
direct: specifically related to pregnancy (bleeding, infection)
indirect: somewhat related to pregnancy (pregnant woman who gets swine flu is more likely to die than general public) |
|
|
Term
___: # of pregnancies
___: # of births
4 digit parity system: what does each # stand for? |
|
Definition
gravity
parity
1st digit: # of full term pregnancies
2nd digit: number of preterm deliveries
3rd digit: # of pregnancies that ended before 20 weeks
4th digit: # of kids currently alive |
|
|
Term
G3P1101
G4P0030
G1P1002
G1P1000 |
|
Definition
G3P1101: 3 pregnancies, pregnant now, one full term, 1 pre-term, 1 baby at home
G4P0030: 4 pregnancies, pregnant now, 3 early pregnancies ended
G1P1002: 1 pregnancy, 1 full term birth, 2 kids at home = twins
G1P1000: 1 pregnancy, 1 full term birth, 0 kids at home |
|
|
Term
| Normal fetal heart rate compared to maternal HR |
|
Definition
fetal: 120-160 bpm
maternal: <100 bpm |
|
|
Term
| How often should mom come in for prenatal visits? |
|
Definition
2nd trimester: every 4 weeks
third trimester: every 2 weeks
36 weeks and beyond: every week |
|
|
Term
DDX for fluid loss through vagina late in pregnancy
how do you decide which it is? |
|
Definition
amniotic fluid (rupture of membrane)
urine
blood
determine which it is via STERILE speculum exam
determined by pH via nitrazine strip:
acidic (yellow): <7 = probably urine
basic (blue) + ferning: >7 = probably amniotic fluid = "nitrazine positive"
red = blood |
|
|
Term
1. rupture of membanes before labor
2. rupture of membranes before 37 weeks
3. rupture of membranes latent phase > 24 hours (?)
risk factors of these? |
|
Definition
1. premature rupture of membranes (PROM)
2. preterm rupture of membranes
3. prolonged rupture of membranes
risk: similar to preterm labor |
|
|
Term
| ___ is THE single most importnat cause of neonatal death, perinatal death, and neonatal morbidity |
|
Definition
|
|
Term
risk factors for ____:
prior preterm labor
multiple gestation
african americans
low SES |
|
Definition
|
|
Term
___
used 1027- 1968 to treat or prevent miscarriage, lbw, poor ob outcome
shown by 1952 not to be helpful
show by 1968 to cause increased risk of vaginal cancer for female fetus, miscarriages, ectopic pregnancy for female fetus, premature labor, infertility due to "T-shaped" uterus |
|
Definition
| DES - diethylstilbesterol |
|
|
Term
| what dose fetal fibronectin in the maternal serum indicate? |
|
Definition
preterm labor
cervical legth is only other thing that is useful in predicting preterm labor. >25 mm = very low risk |
|
|
Term
___: regular contractions that cause a change in the cervix (effacement + dilation)
___: warm up contractions |
|
Definition
labor
braxton-hicks contractions |
|
|
Term
|
Definition
| tocolysis usually via magnesium sulfate |
|
|
Term
|
Definition
tocolysis to delay delivery a day or two
transport to appropriate premie center
glucocorticoids (betamethasone or dexamethasone) when <34 weeks to help mature surfactant in fetus |
|
|
Term
neonatal survival estimates:
<22 weeks
22-24 weeks
26-28 weeks
28-34 weeks
>34 weeks |
|
Definition
<22 = <1%
22-24 = 5-10%
26-28 = 50-90%
28-34 = 90-99%
>34 = 99% |
|
|
Term
|
Definition
risks: infection (chorioamnionitis) - risk to baby and mom
tx: NO vaginal exams to limit bacteria, abx |
|
|
Term
| diabetic obstetrical issues |
|
Definition
birth defecs - related to glucose control at conception and early pregnancy
late pregnancy intrauterine fetal death (stillbirth)
large fetal size (macrosomia) >10lbs - risk of birth trauma |
|
|
Term
| tx of diabetes in pregnancy |
|
Definition
TIGHT glucose control
early delivery: 37-38 weeks |
|
|
Term
| Changes in insulin/glucose in pregnancy |
|
Definition
first trimester: insulin secretion & sensitivity rise, fasting glucose falls
2nd & 3rd trimester: insulin sensitivity falls, fasting glucose rises, due to HPL
--> ULTIMATELY 2-3x as much insulin may be needed during 3rd trimester than before pregnancy |
|
|
Term
| ddx for first trimester bleeding |
|
Definition
1. benign bleeding of early pregnancy - dx of exclusion
- due to luteal-placental shift or cervix
2. threatened spontaneous abortion
3. ectopic pregnancy
4. gestational trophoblastic dz |
|
|
Term
| High HCG + no gestational sac in uterus = ? |
|
Definition
|
|
Term
1. ___: bleeding during any pregnancy <14 weeks
2. ___: some plaenta remains in uterus after abortion. all products of conception (POC) are not expelled.
3. ___: luteum dries but embryo doesn't get the message
4. ___: infection during miscarriage. common during elective abortions
5. ___: consistent miscarriages |
|
Definition
threatened abortion
incomplete abortion
missed abortion
septic abortion
recurrent abortion |
|
|
Term
| most notable risk factor for spontaneous abortion (miscarriage) |
|
Definition
| intrinsic embryo health (unhealthy egg/sperm, egg that's too old) |
|
|
Term
| ___ - a gestational sac with no embryo - represents VERY early abortion |
|
Definition
|
|
Term
| spontaneous abortion: embryo death precedes uterine evacuation by __-__ weeks |
|
Definition
|
|
Term
abortion usually >10 weeks where products of conception are not completely expelled. mom can bleed to death. has heavy cramping "like Labor"
tx? |
|
Definition
incomplete spontaneous abortion
requires uterine currettage |
|
|
Term
fever, discharge, pelvic pain
leukocytosis, elevated sed rate
after elective abortion/uterine instrumentation
requires hospitalization, IV abx, and curettage to evacuate uterus
can occasionally occur with incomplete abortion |
|
Definition
|
|
Term
|
Definition
chromosomal analysis
thyroid screen
evaluate uterus |
|
|
Term
Typical time course of morning sickness
beings __-__ weeks of gestation
Peaks at __-__ weeks
Abates (usually) after about ___ weeks
in rare cases, can persist into the 3rd trimester |
|
Definition
5-7
8-10
12
women who make it 8-9 weeks w/o n/v probably won't have any |
|
|
Term
| cause of n/v in pregnancy |
|
Definition
| probably related to HCG levels |
|
|
Term
| tx for n/v during pregnancy |
|
Definition
anti-emetics
B6 and doxylmaine (unisom) are first line |
|
|
Term
severe form of n/v during pregnancy
can be life threatening due to severe dehydration
consider multiple pregnancy or gestastional trophoblastic disease as a cuase
usually requires hospitalization: IV hydration + anti-emetics
hyperalimentation
pregnancy termination necessary in rare cases
corticosteroids may help prevent |
|
Definition
|
|
Term
| CV changes during pregnancy |
|
Definition
increase in blood volume by 8 weeks, +45% by 34 weeks
CO: +30-50% during pregnancy, +30% uring labor, +45% during pushing
Vascular resistance: falls during 1st and 2nd trimester.
BP: falls due to increased CO and decreased PVR |
|
|
Term
| Normal physiologic CV changes during pregnancy (other than blood volume, TPR, and CO) |
|
Definition
systolic flow murmur (grade 1 & 2)
Split in S1
Distended neck veins (in late pregnancy)
dyspnea
tachypnea
shift in PMI due to uterus size
Normal pregnancy does NOT cuase:
diastolic murmurs
grade 3-4 systolic murmurs
pleural edema |
|
|
Term
| supine hypotension syndrome |
|
Definition
after about 20 weeks:
woman's uterus compresses her vena cava when she lies flat on her back which can result in syncope
thus, a woman past 20 weeks should lay on her side or at 30 deg head |
|
|
Term
|
Definition
growth measurements
biochemical markers - is placenta producing the right hormones?
biophysical assessments - US assessment of fetal activity
placental assessment: placental aging (tends to be exaggerated in diabetics) |
|
|
Term
| methods of measuring biophysical assessment in fetus |
|
Definition
fetal movement - daily kick count
non-stress test
vibroacoustic timulation "Wake up" tests
contraction stress test (CST or Stress test) to measure blood flow through uterine artery
US assessment of amniotic fluid volume and respiratory movement |
|
|
Term
| Normal v. abnormal fetal heart beat as recorded by a non-stress test |
|
Definition
FHR is fluctuant. HR increases when baby kicks
abnormal: no variation of HR |
|
|
Term
| how are contractions induced for a contraction stimulation test |
|
Definition
| IV oxytocin or breast nipple stimulation |
|
|
Term
| What would a positive (worrisome) CST show? |
|
Definition
| no variability in FHR with contractions or decreased FHR after contractions. indicates fetal hypoxia. |
|
|
Term
| causes of htn during pregnancy |
|
Definition
chronic htn
pregnancy-induced:
- gestiational htn
-preeclampsia-eclampsia
- superimposed preeclampsia (preeclampsia in a pt who already has htn) |
|
|
Term
| risks associated with chronic htn during pregnancy |
|
Definition
preeclampsia
palcenta abruption
preterm labor
intrauterine growth retardation
discontinue ACE and ARBs because they are associated wtih fetal abnormalities |
|
|
Term
pregnant pt wtih bp >140/90 wiht NO proteinuria
dx?
tx? |
|
Definition
gestational htn
no tx unless bp > 160/110 |
|
|
Term
pregnant >140/90 + proteinuria (300-2,000 mg/24 hours or 1+/2+
edema common but not required for dx |
|
Definition
|
|
Term
BP >160/110 OR
proteinuria >2g/24 hours OR
oliguria (<500 ml/24 hours) OR
liver abnormalities/RUQ pain OR
pulmonary edema OR
thrombocytopenia (<100,000/mm3) |
|
Definition
|
|
Term
preeclampsia wtih grand mal seizures
fetal mortality: 13-30%
Maternal mortality: 4-5% |
|
Definition
eclampsia
can occur before, during, or after labor |
|
|
Term
|
Definition
mild: deliver if >37 weeks, hospitalize if <37 weeks
severe: deliver regardless of gestational age, delay 24-48 hours with steroids if <34 weeks
for both, main goal is preventing eclampsia with:
IV magnesium sulfate |
|
|
Term
|
Definition
H: hemolysis
EL: elevated liver enzymes
LP: low platelet counts
10% incidence in severe preeclampsia |
|
|
Term
lactation:
estrogen, progesterone, placental lactogen suppresses lactation during pregnancy
initial lactation secretion is ___: low on fat and CHO and high in vitamines and Igs
___ is essential for ongoing lactation
Milk "let down" reflex loop is critical - involves ___ |
|
Definition
colostrum
prolactin
oxytocin |
|
|
Term
| how do you suppress lactation in a new mother? |
|
Definition
mainly: avoid nipple stimulation
Drugs (estrogen and bromocriptine) used to be used but aren't anymore because of increased risk for stroke |
|
|
Term
| types of gestational trophoblastic disease (GTD) |
|
Definition
hydatidiform mole ("molar pregnancy") - most common
choriocarcinoma: life threatening but treatable
intermediate forms: chorioadenoma destruans, placental site-trophoblastic tumor (PSTT) |
|
|
Term
trophoblastic neoplasia that is common in mexicans and asians
associatd wtih dispermic fertilization, maternal pronucleus inactivation
non-viable pregnancy
produces lots of HCG
Pt presents with high HCG, hyperemesis gravidarum, preeclampsia, ovarian cysts, large uterus, uterine bleeding
US shows absent embryo and distinctive pattern of small lucent areas in a large uterus
tx? |
|
Definition
molar pregnancy
tx: suction curettage
monitor HCG levels for one year - put pt on contraception for a year
if HCG continues to rise, will cause invasive disease and increased risk for choriocarcinoma |
|
|
Term
24 y/o woman presents with pos home pregnancy test
Knife-like LLQ pain for 12 hours
LMP 9 weeks ago
first trimester bleeding
Serum HCG is normal or low
hx of right tubal pregnancy 3 years ago
dx? made via?
tx?
complications? |
|
Definition
ectopic pregnancy dx made via US - will show empty uterus and bulge in one fallopian tube
tx: chemo (methotrexate) + extensive follow up to make sure serum HCG returns to normal
or surgery (laparoscopy/laparotomy)
complications - rupture:
- life-threatening event with massive blood loss, severe pain or syncope. requires laparotomy |
|
|
Term
pregnancy with two gestations: one IUP and the other ectopic
vary rare except after IVF |
|
Definition
|
|
Term
rare pregnancy with high fetal and maternal mortality rates
requires surgery |
|
Definition
|
|
Term
| signs that labor is imminent |
|
Definition
"dropping" of fetus - can be up to 4 weeks before delivery
Braxton Hicks contractions/false labor
"Show" - mucusy/bloody plug comes out + rupture of membranes
true contractions 2-2.5 min apart = ready to deliver |
|
|
Term
|
Definition
1. begins when contractions begin to achieve dilation and effacement and ends with complete dilation (10 cm)
2. latent phase: irregular to regular contractions wiht little or no progress
3. active phase: regular progress expected, failure to progress a potential problem
4. Second stage: full dilation to delivery of baby
5. third stage - delivery of placenta |
|
|
Term
| average length of labor for nullip and multip pts |
|
Definition
nullip: 10.1 hour mean
multip: 8.2 hour mean |
|
|
Term
Y-shaped indentation felt when examining station on a normal vertex delivery is the ____
4 pronged indentation felt when examining station is the ____ and means the baby's head is not flexed down yet. |
|
Definition
posteiror fontanelle
anterior fontanelle |
|
|
Term
| when can an epidural be given? |
|
Definition
|
|
Term
___ - when uterus doesn't contract like it should post-labor and there is excessive bleeding when the placenta is delivered.
how can this be prevented? |
|
Definition
uterine atony
give mom oxytocin to help uterine contractions |
|
|
Term
| Any time you want to make contractions stronger, eating during birth or during delivery of placenta, give mom ___ |
|
Definition
|
|
Term
| cephalopelvic disproportion |
|
Definition
when baby's head is too big for a woman's pelvis
needs C-section
often seen in babies >10 lbs |
|
|
Term
| FHR reaction to contractions |
|
Definition
normal: HR slows before contraction and speeds up after, probably due to pressure on baby's head
late deceleration: deceleration of baby's hr begins after the peak of contraction. indicates hypoxia. needs stat c-section
variable deceleration: FHR varies dramatically with contractions. common. usually indicates cord compression. OK as long as it's not too deep |
|
|
Term
methods of extracting a baby without doing c section. this is done when:
head is engaged
position of head is known
position must be a deliverable one
cervix completly dilated
membranes rupturd
no cephalopelvic disproportion (CPD) |
|
Definition
outlet, low, mid forceps
vacuum extractor |
|
|
Term
| Preparation for forceps delivery |
|
Definition
adequate anesthesia (numb pudendal nerve at ischial spine)
cath in and out for mid forceps
episiotomy |
|
|
Term
Malpresentation of baby during labor:
OT
OP
Face, Brow
Breech: frank, complete, incomplete (footling)
transverse lie |
|
Definition
OT: occiput transverse. probably need to rotate baby with forceps
OP: occiput posterior. probably need assisted delivery
Frank breech: legs extended and feet are by baby's head. butt is presenting part. can cause compresion of umbilical cord and cause hypoxia or trapping of head
complete breech: butt is presenting part and baby is sitting indian style
incomplete/footling breech: anything that's not frank or complete. may just be one foot that is presenting part
transverse lie: must be delivered via c-section |
|
|
Term
2 incisions during c section
skin - can be midline vertical or pfannensteil transverse
uterine incision - low transverse, low vertical, classical, t-shaped
which uterine incision is preferred? |
|
Definition
| low transverse - due to much lower rupture rate in future pregnancies |
|
|
Term
| What is the major organ you need to get out of the way during a c section? |
|
Definition
|
|
Term
| 3 P's of progression of baby during delivery |
|
Definition
Passenger: baby. how big the baby is or the baby's head
Passage: birth canal
Powers: force of contraction |
|
|
Term
large baby + obese mom --> baby's brachial plexus is injured during delivery
result? |
|
Definition
|
|
Term
|
Definition
| abnormal or difficult childbirth |
|
|
Term
| when placenta gets stuck in uterus after birth |
|
Definition
|
|
Term
|
Definition
premature separation of placenta
high parity
htn
hx of previous abrutpion |
|
|
Term
| post-partum complications |
|
Definition
postpartum endometritis - esp with long labor and lots of vaginal exams. increased cramping, discomfort, fever
DVT |
|
|
Term
| 28 y/o, 10 weeks pregnant, with hx of several first trimester spontaneous abortions. what should we be concerned about? |
|
Definition
cervical incompetence - painless, gradual dilation of cervix between 14-27 weeks.
complications: SROM, expulsion, feeling vaginal pressure due to bulging of amniotic fluid
risk factos: D&C, conization, LEEP (surgical procedures to cervix), congenital
tx: Cerclage - putting stitch around cervix |
|
|
Term
causes of third trimester bleeding:
cervical sources: cervical plug/"bloody show", postcoital, placental pathology (polyp, tumor)
placenta previa or abruptio
iatrogenic |
|
Definition
cervical causes tend to be benign and don't produce much blood
placental causes can produce a lot of blood - a cup or more |
|
|
Term
placenta within zone of cervical effacement and dilation.
classical presentation: painless third trimester bleeding due to effacement and dilation
what are some risk factors for this?
3 types?
complications? |
|
Definition
placenta previa
risk factors: uterine scarring (previous c section), hypoperfused endometrium (age, multiparity), enlarged placenta (multiple pregnancy)
complications: torrential bleeding - pt can bleed out in 5 min
3 types:marginal (partial), complete, low-lying |
|
|
Term
| pt with placenta previa at 20 weeks.. should we be concerned? |
|
Definition
| yes, need to watch it, but good chance that it will be normal by delivery date |
|
|
Term
| never ever ever ever do ____ when there is vaginal bleeding until you know for sure that there is not a placenta previa |
|
Definition
|
|
Term
management of placenta previa:
total
partial
low lying |
|
Definition
total: c-section
partial: vaginal delivery may be possible
low-lying: vaginal delivery may be possible |
|
|
Term
|
Definition
when the fetus is the source of the bleeding during a placenta previa (not usually the case).
amniotomy is the only issue with this. happens when umbilical artery/vein is not protected like normal by umbilical cord (velamentous cord) and vessels are crossing the internal os
risk of fetal death is very high
|
|
|
Term
| amniotomy is followed by fetal tachycardia and bleeding. what happened? |
|
Definition
|
|
Term
|
Definition
|
|
Term
complication of 0.5-1% of pregnancies
main sx: bleeding and pain at placental separation site + labor contractions during third trimester
PAINFUL third trimester bleeding
can be due to trauma or ischemia/necrosis due to HTN
tx? |
|
Definition
placental abruption
tx: emergency delivery (either c-section or vaginal), tocolysis for fetal distress, volume replacement (blood transufision), watch for DIC (falling platelet count, elevated fibrin split products) |
|
|
Term
pt with painless, extensive third trimester bleeding. US shows placenta low on posterior wall
dx?
tx? |
|
Definition
placenta previa (marginal, possibly partial)
tx: delivery, expectant management if bleeding stops, double setup vaginal exam |
|
|
Term
|
Definition
| pt taken to operating room for very careful vaginal exam (usually following extensive bleeding) with room set up for emergency C-section if need be |
|
|
