final- MN- ch 31 and 32

-cerclage is the use of what?

when is it released?

disseminated intravascular coagulation (DIC):
-most often triggered by:
-what 2 other conditions can trigger this?

or consumptive coagulopathy is a pathologic form of clotting that is diffuse and consumers large amounts of clotting factors, causing widespread external bleeding, internal bleeding, or both and clotting

-what occurs in abruption placentae and in retained dead fetus and amniotic fluid embolus syndromes

an overactivation of the clotting cascade and fibrinolytic system, resulting in depletion of platelets and clotting factors

Placenta Previa is when the placenta is implanted where?

-4 types of placenta previa: total, partial, marginal, and low lying

the internal os is entirely covered by the placenta

-4 types of placenta previa: total, partial, marginal, and low lying

implies incomplete coverage of the internal os

-4 types of placenta previa: total, partial, marginal, and low lying

indicates that only an edge of the placenta extends to the margin of the internal os

-4 types of placenta previa: total, partial, marginal, and low lying

when the placenta is implanted in the lower uterine segment but does not reach the os

-a ______previa occurs when unprotected fetal vessels pass across the cervical os in front of the presenting part of the fetus.
- should be suspected when the identification of the presenting part is difficult

vassa previa
-what is at risk for laceration at any time but most frequently during ROM

-appearance of bright red blood at the time of ROM and a sudden change in the fetal heart rate without other known risk factors should indicate a possible

Abruptio Placentae
- -separation occurs in the area of the deciduas basalis when?

-premature separation of the placenta

-detachment of part of all of the placenta from its implantation site

-what is probably the most identified risk factor for abruption

-maternal hypertension is probably the most identified risk factor for abruption, but what is the other risk factor? why?

what is 1 other external cause of placental abruption

-one in which the gestational sac is implanted outside the uterine cavity

-leading pregnancy related cause of first trimester maternal mortality is what?

what is the leading cause of infertility

-there is increased difficulty conceiving after an ectopic pregnancy

true or false

-of the woman with pregestational diabetes, the majority (65%) have type 1 or type 2)

Type 1 or Type 2 diabetes

includes those that are primarily caused by pancreatic islet beta cell destruction and that are prone to ketoacidosis.

Type 1 or Type 2 diabetes

usually have an absolute insulin deficiency

Type 1 or Type 2 diabetes

-thought to be caused by an autoimmune process

Type 1 or Type 2 diabetes

the most prevalent form of the disease and includes individuals who have insulin resistance and
usually relative (rather than absolute) insulin deficiency.

Type 1 or Type 2 diabetes

causes are unknown and goes undiagnosed for years because hyperglycemia develops gradually and
not severe enough to recognize the signs of polyuria, polydipsia, and Polyphagia.

Type 1 or Type 2 diabetes

-many people who develop this kind of diabetes are obese or have an increased amount of body fat
around the abdominal area

Type 1 or Type 2 diabetes


-other risk factors for this are aging, sedentary lifestyle, hypertension, prior gestational diabetes.

Type 1 or Type 2 diabetes


-often has a strong genetic predisposition

is the label sometimes given to type 1 or 2 diabetes that existed before pregnancy

any degree of glucose intolerance with the onset or first recognition
occurring during pregnancy

the definition is appropriate whether or not insulin is used for treatment or the diabetes persists after
pregnancy

-woman experiencing gestational diabetes should be reclassified when?

-during normal pregnancy, glucose is the primary fuel used by the fetus and is transported across the placenta through the process of carrier-mediated facilitated diffusion.
-this means that the glucose levels in the fetus are directly proportional to maternal levels.

true or false

insulin or glucose
-which one crosses the placenta?

around the ___ week of gestation, the fetus begins to secrete its own insulin at levels adequate to us the glucose obtained from the mother.

-therefore, as maternal glucose levels rise, fetal glucose levels are (increased or decreased), resulting in (increased or decreased) fetal insulin secretion

during the 1st trimester of pregnancy, the pregnant woman’s metabolic status is significantly influenced by what?

what stimulate beta cells in the pancreas to increase insulin production, which promotes increased use of glucose and decreased blood glucose with fasting levels being reduced.

-as a result of these normal metabolic changes of pregnancy, women with insulin dependent diabetes are prone to hypoglycemia during what semester?

when there is a decreased tolerance of glucose, increase insulin resistance, decreased hepatic glycogen stores, increased hepatic production of glucose. increasing levels of human chorionic somatomammotropin, estrogen, progesterone, prolactin, cortisol, and insulinase increase insulin resistance through their actions as insulin antagonists. insulin resistance is a glucose sparing mechanism that ensures an abundance supply of glucose for the fetus.

maternal insulin requirements may double or quadruple by the end of the pregnancy.

true or false

-at birth, expulsion of the placenta prompts an abrupt decrease in levels of circulating placental hormones, cortisol and insulinase. maternal tissues quickly regain their prepregnancy sensitivity to insulin

-from the nonbreastfeeding mother , the prepregnancy insulin balance usually returns in how many days

-lactation uses maternal glucose so breastfeeding mothers insulin requirements will remain high during lactation.

true or false

Changing insulin needs during pregnancy

-first trimester:

tell me about the insulin need
-why?


what contributes to hypoglycemia?

Changing insulin needs during pregnancy

-second trimester: insulin needs

Changing insulin needs during pregnancy

-3rd trimester: insulin needs may double or quadruple by usually level off after 36 wks of gestation

true or false

Changing insulin needs during pregnancy

-day of birth: maternal insulin requirements (increase or decrease) drastically to approach prepregnancy levels

-breastfeeding mother maintains (lower or higher) insulin requirements than those of prepregnancy, insulin needs of nonbreastfeeding mother return to prepregnancy levels in 7-10 days

-weaning of breastfeeding infant causes mother’s insulin needs to return to prepregnancy levels

true or false

-poor glycemic control around the time of conception and in the early weeks of pregnancy is associated with

-poor glycemic control later in pregnancy, increases the rate of

-hydramnios (polyhydramnios)- amniotic fluid in excess of 2000 ml is associated with: (3)

-infections are more common and more serious in diabetic pregnant women (vaginal infections and UTIs)

true or false

-disorders of what alter the body’s normal resistance to infection

-ketoacidosis (accumulation of ketones in the blood resulting from hyperglycemia and leading to metabolic acidosis) occur most often when?

-when the maternal metabolism is stressed by illness or infection, the woman is at increased risk for what

the use of what to treat preterm labor may contribute to hyperglycemia and DKA and DKA may also occur as a result of the woman’s failure to take insulin appropriately

-what may occur with blood glucose levels barely exceeding 200 mg/dl, compared to 300-350 mg/dl in the nonpregnant state

-in response to stress factors such as infection or illness, what occurs as a result of increased hepatic glucose production and decrease peripheral glucose use

ketoacidosis occurring at any time during pregnancy can lead to intrauterine fetal death. it is also a cause of

-early in pregnancy, when hepatic production of glucose is diminished and peripheral use of glucose is enhanced, hypoglycemia occurs frequently, often during sleep.

-what is typically observed in pregnancies after 36 weeks of gestation in women with vascular disease or poor glycemic control

-the most important cause of perinatal loss in pregestational diabetic pregnancy is

Diabetes
-anomalies commonly seen in infants primarily affect what 3 systems?

how does macrosomnia result

-macrosomnia is a wt greater than ___grams

-macrosomic infant is at risk for

-infants of mothers with diabetes are also at increased risk for

-hyperglycemia and hyperinsulinemia may be instrumental in delaying _________maturation of the fetus

-for infants born to diabetic women, the transition to extrauterine life is often associated with ________abnormalities

within 30-60 minutes after birth, neonatal hypoglycemia often occurs. why?

types of miscarriage (threatened, inevitable, incomplete, complete, missed)

spotting
mild cramping
cervix is closed
managed with bed rest

types of miscarriage (threatened, inevitable, incomplete, complete, missed)

moderate bleeding
mild to severe contractions
no passage of tissue
cervix dilates

types of miscarriage (threatened, inevitable, incomplete, complete, missed)

often accompanied by ROM and dilation

types of miscarriage (threatened, inevitable, incomplete, complete, missed)

managed with bed rest if no pain, fever, or bleeding.
-if there is pain, ROM, bleeding or fever is present, termination of the pregnancy

types of miscarriage (threatened, inevitable, incomplete, complete, missed)

heavy profuse bleeding
severe cramping
passage of the tissue
dilation

types of miscarriage (threatened, inevitable, incomplete, complete, missed)

fetus delivers, but the placenta doesn't

types of miscarriage (threatened, inevitable, incomplete, complete, missed)

risk for heavy bleeding

types of miscarriage (threatened, inevitable, incomplete, complete, missed)

everything has come out

types of miscarriage (threatened, inevitable, incomplete, complete, missed)

slight bleeding
mild cramps
passage of tissue
no dilation

types of miscarriage (threatened, inevitable, incomplete, complete, missed)

no intervention if contractions are adquate to prevent hemorrhage

types of miscarriage (threatened, inevitable, incomplete, complete, missed)

no bleeding
no cramps
no passage
no dilation

types of miscarriage (threatened, inevitable, incomplete, complete, missed)


fetus died but products of conception stay in her for several weeks (risk for DIC)

types of miscarriage (threatened, inevitable, incomplete, complete, missed)

passage of tissue occurs in which two

types of miscarriage (threatened, inevitable, incomplete, complete, missed)

cervical dilation occurs in which two?

ectopic pregnancy
-clinical manifestations (2)

ectopic pregnancy
-methotrexate is givien, why?

types of previas
-previas are usually painless

true or false

types of previas
-this woman will not dilate because of bleeding (hemorrhage) so she should NOT have a vaginal birth

types of previas
when you see "previa" think what

types of previas
-often types this placenta moves away

abruption vs previa

pain and bleeding

abruption vs previa


painless and bleeding

disseminated intravascular coagulation (DIC)

-worried about people who have what diseases

disseminated intravascular coagulation (DIC)

-people are given what