What is placenta abruptiowhen the placenta detachs before the birth pf the baby
what is the role of the placenta- maintains pregnancy<div>- delivers oxygen and nutrients</div><div>- removes waste</div>
when should the placenta detachafter the birth of the baby
what are the causes of abruptia placenta- chronic hpt<div>- preclampsia</div><div>- trauma to the abdomen</div><div>- history of many pregnancies</div><div>- cocaine or smoking</div><div>- multiple babies</div><div>- history of previous abruptia placenta</div>
what are the signs and symptoms of abruptia placenta- dark red bleeding<div>- extended fundal height</div><div>- tender uterus</div><div>- abdominal pain/contraction</div><div>- concealed bleeding</div><div>- hard abdomen&nbsp;</div><div>- experience of disceminated intervascular coagulation</div><div>- distressed baby&nbsp;</div>
when a patient has abruptia placenta what do you have to monitor for- monitor for DIC (disceminated intervascular coagulation)<div>- monitor for bleeding&nbsp;</div>
what do you have to check and monitor if a patient is going into DIC- low platelet, fibronogen and prothombin levels<div>- bleeding gums</div><div>- oozing from iv sites</div><div>- petecnia or echymosis</div><div>- micro emboli</div><div><br></div>
a patient who is 33 weeks pregnant comes in complaining of dark red bleeding, tender uterus and abdominal pain. the patients bp is 180/120 p= 120 bpm. The day before the bleeding started the patient had fallen and injured herself. What is your nursing diagnosis for the patient and what is your nursing interventions.<div><br></div>nursing diagnosis - patient is experiencing abruptia placenta<div>nursing interventions -&nbsp;</div><div>- monitor patient for DIC and concealed bleeding</div><div>- pad checks&nbsp;</div><div>- check vital signs every 15mins</div><div>- check patients platelet count and clotting factors</div><div>- check for cleeding gums</div><div>- check for oozing from the iv site</div><div>- observe any bruising ( echymosis)&nbsp;</div><div>- observe if patient has shortness of breath, chest pain, mental status changes, urine output decreases - this could indicate a clot in any of these major organs&nbsp;</div><div>- check fundel height</div><div>- NO pv or abdominal exams&nbsp;</div><div>- patient should lay on their left side and not in a supine position in order to prevent supine hypertension (lying on the left side helps increase perfusion to the uterus)</div><div>- monitor babys hr&nbsp;</div><div>- prep patient for delivery. if they are stable they ma be able to deliver vaginally but if the patient is unstable they shoudl deliver via c section.</div>
what is placenta previaabdominal attachment of rhe placenta in the uterus near or over the cervical opening&nbsp;
where should the placenta attachat the top or the side of the uterus
&nbsp;how do you manage a patient with hypertension at an MOU&nbsp;- If patients BP is stable discuss patient with doctor and change meds to alpha methyldopa 500mg 8hourly via oral<div>- patient should then be transferred to high risk facility at 24 weeks in order to go for blood tests for early detection of pre eclampsia and placental functions</div><div>- if patients BP remains stable they are an intermediate risk and all the tests performed at a high risk facility remains normal</div><div>- patient should attend HR clinic at MOU until 36 weeks if BP remians stable</div>
how do you manage hypertension at a district hospital- do ultrasound in order to determine the relation between GA and fetus weight - if no dating u/s available<div>- use the umbilical artery doppler test in order to test for fetal well-being</div><div>- for viable baby a CTG should be coordinated and a fetus kickchart started</div><div>- test for proteinuria</div><div>- in order to exclude pre clampsia with unsure dip stick protenuria the first time, do another one 24hrs later</div><div>- control BP: anti HPT methyldopa 1g orally if BP is raised, after that 500mg 8 hourly via oral (if patient is on hpt meds then proceed with that)</div><div>- delivery should commence at 37 weeks of gestation&nbsp;&nbsp;</div>
when does gestational hypertension occurafter 20 weeks GA&nbsp;
what do you check for in a women diagnosed with gestational hypertension at a clinicproteinuria<div>oedema</div><div>increased weight gain<br><br></div>
what should you ask a patient about when they have been diagnosed with gestational hypertension at a clinic- family history of hypertension<div>- history of gestational hypertension</div><div>- previous stillbirths</div><div>- neonatal deaths</div><div>- bleeding in previous or index pregnancy</div><div>- any symptoms of persistent headaches</div>
who is at risk for pre clampsia&nbsp;- primigravs<div>- multigravs with new partners</div><div>- wmen aged 35 and above</div><div>- chronic hpt, previous pre clampsia</div><div>- multiple pregnancies</div><div>- diabetics</div><div>- previous abruptio placentae</div><div>- obesity</div>
why should you not use diuretics in pre clampsiapatient is already hypovoleamic&nbsp;
what may help a women reduce her chance of getting pre eclampsia- calcium supplementation: 1g elemental calcium daily ( 2 tab orally x 3 times a day)&nbsp;<div>- low dose aspirin: 75mp daily from the 12 weeks ga to 34 weeks ga&nbsp;</div>
what effect does pre eclampsia have on utero-placental circulationIUGR<div>Fetal distress</div><div>abruptio placenta&nbsp;</div><div><br></div><div>these could cause&nbsp;</div><div>- fetal death&nbsp;</div><div>- pre term birth</div>
what is antepartum bleedingbleeding from the genital tract from 20 weeks of pregnancy up to delivery of the baby&nbsp;
what is the 3rd most important cause of maternal death in south africaantepartum bleeding<br><br>
what is the time frame for a highest risk of death for antepartum bleeding24 hours
what are the types of antepartum bleeding- spotting bleeding<div>- minor haemorrhage</div><div>- major haemorrhage</div><div>- massive haemorrhage</div>
how much blood would a women have to lose for the antepartum bleeding to be considered a minor haemorrhage&nbsp;50ml or less
how much blood would a women have to lose in order for the antepartum bleeding to be considered major haemorrhage50-1000ml minus the shock
how much blood would a women have to lose in order for her antepartum bleeding to be conidered a massive haemorragemore than a 1000ml including shock&nbsp;
what are the causes of APH&gt; placental - abruptio placentae, placenta praevia, vasa praevia<div>&gt; non-placental - vaginal and cervical lesions including cancer, cervical infections, trauma and decidual bleeding</div><div>&gt; unknown - cause of APH unknown origin</div>
what cayses bleeding in the first trimester of pregnancy&nbsp;- abortion/miscarriage<div>- ectopic pregnancy</div><div>- implantation of the placenta in the uterus</div><div>- infection</div><div>- trauma</div>
what are causes of bleeding in late pregnancy (after 20 weeks)- vasa previa<div>- show</div><div><br></div><div>major</div><div>- placental previa</div><div>- placental abruption</div>
what are some complications of antepartum haemorrhage- hypovalaemic shock&nbsp;<div>- couvelaire uterus</div><div>- disseminated intravascular coagulation</div><div>- high rist of premature delivery</div><div>- fetal hypoxia</div><div>- maternal death</div><div>- perinatal mortality</div><div>- pph</div>
can occur as a complication of placenta previa&nbsp;vasa previa
if a patients membranes ruptures and clear blood is visible what could be the diagnosisvasa previa
vasa previathe presentation of the umbilical or fetal blood vessels that run in the membranes and lie in front of the cervical os
placenta praeviathe implantation of the placenta in the lower segment of the uterus
placenta abruptionthe accidental haemorrhage where the placenta has separated partially or completely from the uterine wall<div><br></div><div>the placenta is usally implanted in the upper segment of the fundus</div>
when is the peak time for a miscarriagefrom week 6 - 10 of pregnancy
interuption of pregnancy before the doetus becomes viable at 26 weeks of gestationmiscarriage
abortionthe termination of a pregnnacy before the fetus is viable&nbsp;
what are causes of miscarriage- abnormal zygote development&nbsp;<div>- foetal death&nbsp;</div><div>- advanced maternal age</div><div>- chronic disease</div><div>- decreased progesterone&nbsp;</div><div>- malnutriion</div><div>- recreational drugs</div><div>- abnormalities of the reproductive tract</div><div>- specific infections such as syphilis, rubella ad toxoplasmosis</div>
what are two types of threatening miscarriagesretained and term pregnancy<br><br>
threatening miscarriageindicated by mild bleeding in early pregnancy without cervical dilation
blood tests measures what hormones in a womens body if abnormal hormones is the cause of a threatening miscarriage- HCG&nbsp;<div>- progesterone</div>
what are the symptoms for a threatening miscarriage- pregnant women has slight bleeding or spotting through an undilated cervix and no abdominal pain<div>- they may also pass tissue with clot like material from the vagina</div>
what are threatening miscarriages most likely due to&nbsp;chromosomal abnormalities in the embryo
what are less common factors of a threatening miscarriage in pregnancies- an incompetent cervix<div>- uterine fibroids</div><div>- intra uterine inflammation, viral infection</div><div>- multiparity</div><div>- obesity</div><div>- uncontrolled diabetes</div>
inevitable miscarriagewhen a threatening miscarriage progresses, the volume of vaginal bleeding increases and the cervix dilates
if a women who has vaginal bleeding increases, her cervix dilates and has an increase of cramping and lower abdominal pain, what is she experiencinginevitable miscarriage
if a women is experiencing an inevitable miscarriage at 18 weeks how will she be treatedshe will have an evacuation of uterine contents
if a women is 14 weeks pregnant and experiences an ineveitable miscarriage, what will be the plan t treat herwe will wait for a spontaneous expulsion of the products of conception
complete miscarriagewhen all products of conception includes the embryo and placenta with intact membranes from the uterus are expelled from the uterus<div>bleeding is usually mild and os is closed</div>
incomplete miscarriagecervix will remain open. the products of coneption may be visible or felt, usually the fetus is passed while the placenta and membranes are retained.&nbsp;<div>there may be profuse/light bleeding as the uterus cannot contract and retract effectively due to the products of conception being retained in utero</div>
habitual or recurrent miscarriagethree or more consecutive spontaneous miscarriages after 14 weeks&nbsp;
what are the causes of habitual miscarriage- uterine abnormality<div>- cervicaal incompetence</div>
hydatidiform molethe abnormal development of the primitive chorion, where hydropic or cystic degeneration of the centre of the villi occurs
products of conception resemble a large bunch of grapeshydatidiform mole
what are the signs and symptoms of hydatidiform mole- vaginal bleeding&nbsp;<div>- excessive nausea and vomiting</div><div>- hypertension may develop before 20 weeks of pregnancy&nbsp;</div><div>- uterus large for the period of gestation, soft and bulky</div>
embryo is absorbed and no fetus or placenta can be identified&nbsp;hydatidiform mole
not all products of conception are expelledincomplete miscarriage
all products of conception are expelledcomplete miscarriage
vaginal bleeding with closed cervix and no painthreatening miscarriage
vaginal bleeding and pain with cervical dilationinevitable miscarriage
three or more consecutive miscarriages after 14 weekshabitual miscarriages&nbsp;<br><br>
a patient who comes in complaining of LAP. she is 17 weeks GA. She has ROM and on speculum insertion she is internal os open. what would her diagnosis be and what is the management for her.she is having an inevitable miscarriage.&nbsp;<div>Her management would be to perform an MVA&nbsp;</div>
induced abortionwhen a procedure is done or medication is taken to end a pregnancy or the intentional termination of a pregnancy before the fetus can live independently viable&nbsp;<div>interruption of pregnancy on demand</div><div><br></div>
elective abortiona women chooses to end her pregnancy and it is not for maternal or fetal health reasons
therapeutic abortionperformed in order to preserve the ehalth or save the life of a pregnant women&nbsp;
septic abortioninfection of th uterus following a miscarriage
placental abruptionis the premature seperation of a placenta from its implantation in the uterus
what are the two forms of placenta abruption- concealed (20%)&nbsp;<div>- revealed (80%)</div>
what is a concealed placenta abruptionwhere the bleeding is confined within the uterine cavity. it is also more severe form because the amount of blood loss is easily underestimated
what is a revealed placental abruptionthis is where the blood drains through the cervix usually with incomplete or detachment
risk factors of placental abruption- uterine abnormalities<div>- hypertension / pre-eclampsia</div><div>- cigarette smoking</div><div>- multiple pregnancies</div><div>- short umbilical cord</div><div>- decompression of uterus (polyhydramnios)</div><div>- folic acid deficiency - anemia&nbsp;</div><div>- poor nutrition and social conditions</div>
what is the cause of placental abruption- the maternal vessels tearing away rom the decidua basalis. Seeperatoin results in bleeding into the decidua basalis h=behind the placenta causing a retroplacental clot<div>- direct trauma to the uterus</div>
what are the degrees of abruptio placenta- asymptomatic<div>- grade 1&nbsp;</div><div>- grade 2</div><div>- graade 3</div>
what degree of abruption placenta is mary having. She has a small amount of vaginal bleeding nd uterine contractions. There is ni sign of fetal distress or low blood pressuregrade 1&nbsp;
explain what would occur if a women is experiencing a grade 2 placental abruptionshe would have mild to moderate bleeding, uterine contractions and there will be some sign of fetal distress
describe grade 3 placental abruption&nbsp;there will be moderate to severe bleeding which could be concealed. there would be uterine ontractions that does not relax, abdominal pain, low blood pressure and fetal death
what are the onset and symptoms for abruption placenta- more common after 28 weeks<div>- retroplacental clot may begin to develop overtime</div><div>- pain with or without external and concealed vaginal bleeding&nbsp;</div><div>- uterus is hard (woody) and tender</div><div>- dark clots of blood (may be concealed but if not then clots)</div><div>- large SFH for expected dates</div><div>- difficult to feel baby or hear fetal heart</div><div>- FM may be absent or reduced</div>
what would you do for a patient if she shows signs of abruption placenta at an MOU- admit her to labour ward<div>- start an iv of ringers lactate</div><div>- if mother is in shock then resuscitate with 1-2L of ringers lactate</div><div>- no vaginal exams should be done</div><div>- monitor vital signs every 15min</div><div>- give oxygen with a face mask at 60% 6-8L in order to help improve tissue perfusion</div><div>- insert a catheter</div><div>- monitor her blood loss</div><div>- contact referral hospital</div><div>- monitor fetal heart rate&nbsp;</div><div><br></div>
what would you do for a patient who presents with placental abruption with mild bleeding at a hospital setting.- continue obs in order to detect hypovolaemic shock<div>- take blood for FBC and cross match</div><div>- do an ultrasound scan in order to help with the diagnosis</div><div>- mmonitor uterine contractions (if she is having frequent uterine contractions &gt;5/10 minutes) this could suggest abruptio placenta</div><div>- if baby is in fetal distress and fetus is viable then deliver the women by an emergency c sections</div><div>- insert a speculum in order to exclude a local cause</div><div>- further management depends on cause</div>
what other maternal illness is in collaboration with abruptio placenta&nbsp;pre-eclampsia
if a patient is experiencing abruptio placenta and the fetus is not viable, how would you manage her- rupture membranes&nbsp;<div>- augment labour with oxytocic</div><div>- monitor blood loss carefully</div>
how would you manage a patient who has placenta abruptio and the fetus is dead&nbsp;- deliver urgently&nbsp;<div>- take bloods for a cross match, FBC, INR, PTT (partial thromboplastin test) and serum urea and creatine&nbsp;</div><div>- blood tranfusion (2-4 units) is usually necessary</div><div>- insert CVP line</div><div>- insert catheter and&nbsp; monitor hourly urine outout</div><div>- give fluids in order to maintain a systolic bp of 100mmhg or more</div><div>- if there is no progress of labour with in 1-2 hours after AROM then augment</div><div>- give analgesia - morphine 5mg IM 4 hourly</div>
diagnose the patient<div><br></div><div>Mrs September who is 37 weeks pregnant. she has gestational hypertension for which she takes alpha methyldopa in order to help her BP. She comes into the clinic and her vitals are BP=150/90 P=111 T=37C FM= vary faint . she is experiencing pain which is always present. On in examination her abdomen is hard and tender and her SFH is large for her GA. she is also&nbsp; complaining of bleeding which is dark red and has blots</div>the patient is experience abruption placenta and should be transferred to a tertiary instution.&nbsp;
placenta previaa condition in which the placenta is implanted in the lower segmant of the uterus and is too close to covering the cervix
what is the statistics for plcenta previa1 in every 200 births
what are the four types of placenta previa- total placenta previa<div>- partial placenta previa</div><div>- marginal placenta previa</div><div>- low lying placenta</div>
explain total placenta previathis would be classified as a grade 4&nbsp;<div>completely ocvers the internal os&nbsp;</div>
explain partial placenta pleviaclassified as a grade 3<div>when the edge of the placenta is partially over the nternal os when undilated and up to 4cm when dilated&nbsp;<div><br></div></div>
explain a marginal placenta previaclassified as a grade 2&nbsp;<div>when the placenta reaches the edge of the internal os</div>
explain a low lying placentaclassified as a grade 1&nbsp;<div>placenta is implanted in the lower segment</div>
what is th emanagement of placenta previa dependent ongestation of the pregnancy
how should the women be managed if placenta previa is diagnosed in the 2nd trimesterfollow up and recheck the location in the 3rd trimester
how can placenta previa be monitored during the 2nd and 3rd trimester- transvaginal ultrasound<div>- trans abdominal ultrasound&nbsp;</div><div>- mri scan</div>
what are risk factors for placenta previa- advanced maternal age<div>- multiple pregnancy&nbsp;</div><div>- grand multipara</div><div>- damage of the endometrium in the upper segment due to previous dilation and curettage to remove any tissue from the uterus</div><div>- previous c section</div><div>- previous placenta previa</div>
what are the symptoms of placenta previa- sudden and painless vaginal bleeding&nbsp;<div>- bright red blood with no clots</div><div>- no abdominal pain or tenderness</div><div>- baby in breach or transverse positiion&nbsp;</div>
if a patient is 34 weeks and she is bleeding due to placenta previa with and bleeding, how will you manage heradmit to hopsital&nbsp;<div>bed rest till bleeding stops</div><div>give corticosteriods</div>
what effect does placenta previa have on the mother- preterm labour<div>- c section</div><div>- placenta accreta</div><div>- shock and death</div>
what is the effect of placenta previa on the baby- preterm birth, foetal distress, high risk - perinatal death<div>- IUGR</div>
why is the mother given pitocin after a c sectionsin order to cause the uterus to contract which can help stop bleeding&nbsp;<div><br></div>
placenta accretadeeply implanted placenta and doesnt seperate easily at delivery
how would you deliver a grade 2 Placenta previavaginallly is vertex and presenting part is engagde
how would you deliver a grade 4 placenta previac section because of risk of heavy bleeding in labour as cervix dilates
how would manage a patient at the MOU if they have placenta previa- admit to labour wards<div>- start an iv with ringers lactate</div><div>- if mother is in shock resuscitate with 1-2 L of ringers lactarw</div><div>- monitor vital signs every 15 minutes</div><div>- give oxygen via face mask @60% (6-8L) in order to improve tissue perfusion</div><div>- insert a catheter</div><div>- Do not do a digital vagnial exam</div><div>- monitor FHR</div><div>- contact refferal hospital</div><div>- transfer patient to tertiary instiude urgently.&nbsp;</div>
how would you monitor a patient with placenta previa at a hospitalthis is if bleeding is milk&nbsp;<div>- continue obs in order to detect hypovolaemic shock</div><div>- take blood for FBC and cross match</div><div>- do an ultrasound scan to help with the diagnosis</div><div>- if placenta previa is found manage accordingly</div><div>- if no placenta previa exclude minor abruption by doing a full clinical examination and CTg</div><div>- monitor uterine contractions&nbsp;</div><div>- monitor FHR for fetal distress: if fetus is viable then deliver the women by an emergency c section&nbsp;</div><div>- dp a speculum exam in order to exclude a local cause</div><div>- further management depends on cause</div><div>- measure blood loss</div><div>- take bloods for cross matching and FBC&nbsp;</div><div>- do a blood transfusion is HB is less than 10g/dl</div><div>- if patient is less than 36 weeks and bleeding subsides then manage and allow fetus to grow&nbsp;</div><div>- adminster corticosteriods</div><div><br></div>
definition of hyoertensiona dystolic blood pressure of more than 90mmHg but less than 110mmHg taken two houra apart and a systolic blood pressure of more than 140mmHg but less than 160mmHg&nbsp;
chronic hypertensionhypertension that is present before 20weeks of gestation or is the women was already taking antihypertensive medication before pregnancy
gestational hypertensionnew onset hypertensions that presents only after 20 weeks of gestation without a significant sign of proteinura
pre eclampsiahypertension with significant proteinuria developing for the first time after 20 weeks of gestation.&nbsp;<div>pre eclampsia can also be superimposed on chronic hypertension and present with significant proteinuria</div>
what is imminent eclampsiasymptoms and signs that characterises severe pre eclamptic women
what are signs and symtpoms of severe pre eclampsia- severe persistent headache<div>- visual disturbances&nbsp;</div><div>- epigastric pain</div><div>- hyper-reflexia</div><div>- clonus</div><div>- dizzyness and fainting</div><div>- vomiting</div>
eclampsiageneralised tonic-clonic seizures after 20 weeks of pregnancy and within 7 days after delivery - its associated with hypertension and proteinuria
how would you manage a patient with chronic hypertension at an mou- if patients blood pressure is within normal range and patient is compliant, then discuss patient and change oral medication to alpha methyldopa 500mg 8 hourly via oral<div>- ensure patient is seen at 24 weeks at a high risk facility for blood tests related to the early detection of pre eclampsia and placental function</div><div>- patient should then attend the high risk clinic at the MOU until 36 weeks if BP is still stable at each visit</div>
how do you manage a patient with gestational hypertension at an MOU&nbsp;- check for proteinuria, oedema and increased weight gain<div>- ask about family hx of hypertension, hx of hypertension in previous pregnancies. basicalluy obstetric history</div><div>- ask about bleeding during the pregnancy so far and if patient has any symptoms of persistent headache&nbsp;</div>
what systems does pre eclampsia affect- circulatory system<div>- central&nbsp; nervous system</div><div>- coagulation</div><div>- liver</div>
who is at risk for pre eclampsia- primigravida<div>- multi gravida with new partners</div><div>- women of advanced maternal age&nbsp;</div><div>- chronic hypertension</div><div>- multiple pregnancies</div><div>- diabetics&nbsp;</div><div>- previous abruptio placentae</div><div>- obesity</div>
what type of drugs should not be used in pre eclampsia and why should not be useddiuretics<div>the woen is already hypovoleamic and these drugs may be dangerous<br><br></div>
what tablets may help reduce the chance of women getting pre eclampsia- calcium supplementation<div>- low dose aspirin</div>
how will calcium supplementation be adminstered to pregnant women1g elemental calcium given in divided doses daily<div>calcium carbonate 168mg - 2 tablets orally 3 times daily with food. It is best taken before or after iron supplements</div><div><br><br></div>
how will low dose aspirin be administered to pregnant women&nbsp;75mg or quarter of a standard tablet to be taken daily from the 12th week of pregnancy until 34 weeks gestational age.<div>it is usually prescribed to patients whoe have had previous pregnancy loss due to severe pre-eclampsia or abruptio placenta</div>
imminent eclampsia&nbsp;symptoms and signs in imminent eclamptic women - presents with severe headaches, visual disturbances, epigastric pain, hyperflexia, dizziness and vomiting
HELLP Syndromethe presence of haemolysis, elevated liver enzymes and low platelets
what is capillary permeability affected byhypertensions and changes in endothelial cells
when placenta protein leakes from the damaged blood vessels what occursa decrease in plasma colloid pressure and an increase in oedema within the intracellular space
what does the decrease in intravascular plasma volume causehypocolaaemia and heamoconceptration shown in elevated hematocrit<div><br></div>
what causes a severe case of vasospasm which causes impaired oxygenation and cyanosislungs becoming congested with fluid and pulmonary oedema occurs
when is coagulation cascade activatedwhen vasoconstriction causes a distruption of the vascular endotheliem&nbsp;
what happens to the coagulation system during pre eclampsiathere is an increased platelet usage which produces thrombocytopeania and may be responsible for the development of disseminated intravascular coagulation
hypertension leads to vasospasm if the ______ ___________afferent arterioles
in the renal systern, vasospasm of the afferent arterioles results in ...a decreased renal blood flow, which in turn produces hypoxia an oedema of the endothelial cells of the gloerular capillaries
how is renal damage presented- reduced creatinine clearance<div>- increased serum creatinine and uric acid levels&nbsp;</div><div><br></div>
oliguriadevelops as the renal system condition becomes worse. this signifies the severity of the condition and kidney damage