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84 Cards in this Set
- Front
- Back
What is the ectoderm & what does it give rise to?
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upper layer of the embryonic disk
gives rise to: - CNS - glands - epidermis - skin - nails - hair - lens of eye - tooth enamel - floor of amniotic cavity |
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What is the mesoderm & what does it give rise to?
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middle layer of embryonic disk
gives rise to: - muscles - CV system - dermis - connective tissue -spleen - urogenital system |
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What is the endoderm & what does it give rise to?
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lower layer of embryonic disk
gives rise to: - epithelial lining of respiratory tract - GI tract - oropharynx - liver - pancreas - urethra - vagina - bladder |
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preembryonic phase
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conception - 14 days
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embryonic phase
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3 weeks - 8 weeks
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fetal phase
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9 weeks - birth
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what does CRL stand for
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crown rump length:
- measuring from head to butt - gets bigger as fetus develops |
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function of hCG
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- preserves function of corpus luteum
- ensures continued supply of estrogen & progesterone is present in order to maintain pregnancy |
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function of HPL
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- stimulates maternal metabolism
- increases maternal resistance to insulin (allows higher BG level) - facilitates glucose transport across the placental membrane - stimulates breast development to prepare for lactation |
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function of progesterone during pregnancy
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- stimulates maternal metabolism
- stimulates development of breast alveoli |
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function of estrogen during pregnancy
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- stimulates uterine growth
- stimulates uteroplacental blood flow - causes proliferation of glandular breast tissue |
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which 2 pregnancy hormones have very similar functions
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HPL & progesterone
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chorion vs amnion
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chorion = outer membrane
amnion = inner membrane |
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how much does the basal metabolic rate increase during pregnancy?
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15 - 20%
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how much does blood volume increase during pregnancy?
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50%
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normal increase in HR during pregnancy
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10 bpm
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normal CO increase during pregnancy?
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30 - 50%
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normal change in BP during pregnancy?
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lowers by 10 - 15 mmHg (ONLY during 2nd trimester)
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increase in GFR during pregnancy?
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50% (same as increase in blood volume)
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increase in kcal needed
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increase of 300 kcal/day
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increase in protein needed
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need to be up to 60 g/day
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increase in iron
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need to be up to 30 mg/day
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increase in calcium
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need to be up to 1200 mg/day
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recommended weight gain for women w/ low BMI
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25 - 40 lbs
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recommended weight gain for women w/ normal BMI
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25 - 35 lbs
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recommended weight gain for women w/ high BMI
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15 - 20 lbs
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recommended weight gain for women w/ BMI above 29 (obese)
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15 lbs
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pattern of weight gain during pregnancy
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1st trimester --> 3-4 lb increase
by 20 weeks --> should be around 10 lbs weight gain 2nd & 3rd trimester --> 1 lb increase/week |
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how is PIH diagnosed
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beyond 20 weeks, 2 measurements at least 6 hours apart:
> 140/90 (don't need both values to be above) OR an increase in the baseline by: >30 mmHg systolic >15 mmHg diastolic |
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how is pre-eclampsia diagnosed
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PIH w/ proteinuria after 20 weeks
also edema that's not just dependent (so especially in the hands & face) |
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sxs of pre-eclampsia
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- headaches
- visual changes - epigastric pain - elevated BP - sudden excessive weight gain (4.4 lb/week) - hand & face edema - proteinuria |
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mild vs severe pre-eclampsia
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MILD:
- BP 140/90 - 2+ to 3+ proteinuria - moderate puffiness - DTRs WNL SEVERE: - BP 160/110 - 3+ to 4+ proteinuria* - generalized edema & noticeable puffiness (anasarca) - hyperreflexive (3+ to 4+ DTRs) - symptomatic - oliguria |
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drug given to prevent seizures (and its antidote) & in which cases of pre-eclampsia would it be given?
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magnesium sulfate (antidote: calcium gluconate)
would be given prophylactically in severe cases of pre-eclampsia to prevent seizures |
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define eclampsia
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pre-eclampsia w/ convulsions
tx: MgSO4 therapy (lessens ctxs & BP) |
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what is the loading dose & the maintenance dose for MgSO4 to treat eclampsia
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loading dose = 4-6 g over 15-30 min
maintenance dose = 2 g/hr |
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define HELLP syndrome
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H - hemolysis
E - elevated L - liver enzymes (AST & ALT) L - low P - platelets (below 100,000) life-threatening variation of pre-eclampsia that happens w/ about 5% of the time tx: c-section & birth |
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define SAB
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spontaneous abortion that happens before 20 weeks
early SAB = before 12 weeks late SAB = 12-20 weeks |
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what are the 6 types of SAB (just list)
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1. complete
2. incomplete 3. threatened 4. inevitable 5. missed 6. recurrent |
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complete SAB
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all of the POCs have been passed and expelled through the uterus
cervix is closed |
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incomplete SAB
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some but not all POCs have been expelled from the uterus
cervix is still opened & could have some POCs in cervix may have bleeding & uterine cramping |
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threatened SAB
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w/o cervical change, the woman has some spotting, bleeding, and cramping
POCs are still in uterus tx: bedrest & no sex for 2 weeks |
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inevitable SAB
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some but not all POCs have been expelled and cervix is opened
SAB will happen/is inevitable |
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missed SAB
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POCs are still inside after fetus has died
cervix is closed though (usually, the uterus has atonied) |
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recurrent SAB
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3 or more serial pregnancies that end in SAB
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risks for SAB
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- endocrine imbalance
- infection - maternal structural problems - immunological factors - systemic disorders - drug use - inadequate nutrition |
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define insufficient cervix & tx
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passive & painless dilation of the cervix within 2nd trimester
tx: - cerclage in 2nd trimester - no sex, no standing for long periods of time - cerclage is often taken out at 37 weeks or during scheduled c-section |
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sxs of ectopic pregnancy
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- abnormally low or slow-rising hCG levels
- adnexal (outside of uterus) tenderness & fullness on exam - referred shoulder pain on same side |
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define GTD
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gestational trophoblastic disease
it's an abnormal growth of trophoblast cells that attach the fertilized ovum to the uterine wall --> the proliferating trophoblasts fill the uterus w/ vesicles that resemble a cluster of grapes not a viable pregnancy |
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define molar pregnancy
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type of GTD in which a slow-growing tumor arises from abnormally growing trophoblast cells
also not a viable pregnancy 2 types: complete & partial |
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complete vs partial molar pregnancy
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complete = contains no genetic material/fetal tissue
- believed to occur when the ovum is fertilized by sperm & then duplicates its own chromosomes while the chromosomes of the ovum are inactivated partial = some fetal tissue/membranes & some chromosomal contribution, but the fetus is NOT VIABLE - cause unknown |
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sxs & tx of molar pregnancy
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sxs:
- vaginal bleeding - severe N/V - uterus is large for gestation dates - no FHR/tones or activity is detected - hCG levels are high & rising rapidly - cramping tx: - immediate vacuum evacuation after diagnosis by ultrasound - identifying tissues to see if there's a malignancy present - monitor hCG levels weekly (should be down completely by week 3) - advise woman not to get pregnant for 1 yr & continued monitoring - grief & bereavement counseling |
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2 causes of late pregnancy bleeding & which of these is painful
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1. placenta previa
--> merely a POSITION, so it's PAINFUL 2. placental abruption --> this is a SEPARATION so it's SUPER PAINFUL |
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define placenta previa
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when the placenta partially or completely covers the internal cervical os
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3 types of placenta previa & which can be delivered vaginally?
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generally, placenta previa can't be delivered vaginally
3 types: 1. complete (covers all of internal os) 2. partial (covers part of internal os) 3. marginal (only covers small part of internal os --> SOMETIMES the placenta will switch positions and move up & can be delivered vaginally) |
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management of placenta previa
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- bed rest
- NPV - evaluation of fetal well-being - NEVER DO VAGINAL EXAMS - c-section |
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sxs of placental abruption
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- board-like abdomen
- localized uterine tenderness - vaginal bleeding may be concealed |
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what must you r/o if a woman comes in with placental abruption?
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domestic violence (a risk factor for placental abruption is physical trauma)
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how is GDM diagnosed
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GDM = gestation diabetes, onset is after 24 weeks
screening = GCT (glucose challenge test) --> 24-28 weeks diagnostic = GTT (glucose tolerance test) --> f/u to elevated GCT to diagnose GDM: - GCT value > 200 OR - 2 abnormal values on GTT (could be fasting, 1 hr, 2 hr, 3 hr) - fasting = >105 [remember! normal values = (65-70) - (100-105)] |
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causes of s<d
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s<d = size is less than dates
causes: - IUGR - SGA - oligohydramnios (low AF) |
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causes of s>d
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- macrosomia
- LGA - multifetal pregnancy - fibroid uterus - polyhydramnios (too much AF) |
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2 types of IUGR
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1. symmetrical = long-term insult (baby is small everywhere, including head)
2. asymmetrical = happens late & is head-sparing |
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normal AFI for term baby
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AFI = amniotic fluid index
normal = 5-20 cm |
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what constitutes oligohydramnios?
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AFI< 5 cm
generally means baby isn't urinating --> could be a/w congenital anomalies, IUGR, PROM, post-maturity, or fetal distress during labor associated w/ increased perinatal mortality rate |
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normal AFV for a term baby
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AFV = amniotic fluid volume
normal = 800-1200 ccs |
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what constitutes polyhydramnios?
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AFI > 20 cm
also a/w: - difficulty auscultating fetal heart tones & palpating fetus - unstable fetal lie (increased risk for cord prolapse) - need to r/o GDM & ABO/RH disease |
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complications of polyhydramnios
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- fetal malpresentation (baby is moving around excessively)
- placental abruption (uterus is heavy b/c of so much fluid) - uterine dysfunction during labor - PPH - cord prolapse - preterm labor |
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requirements for use of forceps or vacuum
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- ROM
- cervix fully dilated - absence of CPD (must r/o) - empty bladder |
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most common type of forceps classification
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low forceps (baby is at 2+ station)
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advantages of vacuum-assisted birth over forceps delivery
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- less maternal discomfort
- less risk of lacerations/perineal & cervical trauma disadvantages: - could have major caput or cephalohematoma |
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indications for a c/s (c-section)
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- maternal or fetal distress
- CPD - malpresentation (breech or transverse) - placental previa or abruption - cord prolapse - failed induction - multi-fetal pregnancies - pre-eclampsia/eclampsia - active herpes infection |
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classical c/s
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- rare today
- vertical incision into upper body of uterus where fundus is (creates major scar tissue) *VBAC is contraindicated |
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lower uterine segment c/s
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2 types:
1. low transverse *VBAC is possible!! 2. low vertical incision *VBAC is contraindicated |
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contraindications for c/s
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- if platelets are <90 [normal is (150-165) - (400-450)] or other coagulation defects
- fetal death (FD) - fetus is not expected to survive |
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complications of a VBAC
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- uterine rupture
- retained placenta - cord prolapse - shoulder dystocia - PPH - PP infection |
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2 types of uterine rupture
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1. incomplete rupture
- pain may not be present - non-reassuring signs (decreased FHR, no accels) - woman may experience N/V, faintness, abdominal tenderness, hypotonic uterine ctxs - lack of progress 2. complete rupture - woman may complain of sudden, sharp, shooting abdominal pain - may state that "something gave way" |
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3 types of adherent placenta
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1. acreta
- slight penetration of myometrium 2. increta - "in deep" - deep penetration of myometrium 3. percreta - "per"/perforation - complete perforation of uterus |
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management of cord prolapse
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- put woman in reverse trendelenberg or knees to chest
- w/ gloves on, put hand inside vagina & push up on baby's head - give O2 & IV fluids - monitor FHR - keep cord wet/perfused w/ gauze if possible - birth by c/s |
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define shoulder dystocia and why would it happen?
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shoulder dystocia = anterior shoulder can't pass under the pubic arch of maternal pelvis (gets stuck)
r/t macrosomia (large baby) and pelvic anomalies turtle sign = think shoulder dystocia!!! |
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management of shoulder dystocia
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- mcrobert's maneuver (pull knees to chest to simulate squatting --> opens pelvic outlet)
- suprapubic pressure to collapse shoulder angle |
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risk factors for PPH
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- most common is uterine atony
- retained placenta fragments - placenta acreta - uterine rupture or inversion from pulling on cord - cervical or vaginal lacerations - hematomas (collections of blood) - infection (endometritis) - coagulopathies |
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management of PPH
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- bimanual compression (massaging on top & from within)
- pharmacological interventions (pitocin) - uterine exploration (via surgery) - surgical interventions (hysterectomy) |
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1st and 2nd line drug therapy for management of PPH
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1st line:
pitocin (10-40 units) 2nd line: methergine (vasoconstrictor) (0.2 mg IM) **containdicated in HTN/PIH --> could cause stroke |
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primary sxs of uterine inversion
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- hemorrhage
- pain - shock (r/t pain OR hemorrhage) |
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define post-partum infection
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any infection that occurs within 28 days after miscarriage, ETOP, and childbirth
fever >100.4 on 2 successive days of the first 10 PP days |