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plus doxylamine is safe effective and should be considered first-lineIV fluidsCorrection of ketosis and vitamin deficiency: ThiamineMedications for refractory cases:Antinausea (Phenergan, Zofran, Reglan) PZRProton Pump Inhibitors. Possible use of steroidsGradual reintroduction of foodIncompetent CervixoPainless dilation of cervix.Her cervix is changing funneling and dilatingWITHOUT her feeling contractions. Has to do with the matrix of the tissue in the lower uterine segment/cervix. If it progresses, it can cause contractions and preterm labor. The use of Ultrasound is not recommended for diagnosingoSigns & Symptoms: Pinkish vaginal discharge, Woman reports increased pelvic pressure. Can progress to PSROM, contractions, labor and birthoTreatmentCerclageoNursing actions, discharge teachingCervical cultures for chlamydia, gonorrhea, and other cervical infectionsREST: Pelvic rest = no sex! Nothing inside the vaginaMonitor for signs of infectionInfectionsoKnow which ones are a problem in pregnancyRisks during pregnancy or deliveryoEffects on motherSexually transmitted infections (STIs)STIs during pregnancy can lead to PTL, PROM, and uterine infection.STIs can cause pelvic inflammatory diseasePelvic inflammatory disease (PID) can lead to oinfertility, ochronic hepatitis, and ocervical and other cancersBacterial VaginosisoOvergrowth of bacteria in vaginal microbiomeoTreatment with metronidazole (Flagyl)Chlamydia/GonorrheaoCan lead to PPROM, preterm laboroInfections in the neonateoTreated with antibiotics- need for partner(s) treatmentTrichomoniasis
oProtozoan ParasiteoCan lead to PPROM, preterm labor, low birth weight, respiratory and genital infection in newbornoTreatment with Metronidazole(cdc states partner does not need to be treated.)SyphilisoScreening Test: RPR & VDRLoCrosses placenta.oCan cause preterm birth, physical deformity, neurological complications, stillbirth and neonatal deathoTreatment with Penicillin G IMoEffects on fetus/newbornSexually transmitted infections (STIs)STIs can pass to the fetus by crossing the placentatransmitted to the baby during deliveryHarmful effects to babies include preterm birth, low birth weight, neonatal sepsis, and neurological damageTORCH infections: Infections acquired in utero can result in intrauterine growth restriction, prematurity, chronic postnatal infection, and even death.Toxoplasmosis, Other (hepatitis B), Rubella,Cytomegalovirus Herpes simplex virus
HIV <2% risk of infection w/antiviral medicationPPROMIUGRHerpes HSV1(mouth) or HSV2(genitals) IgG antibodiesAny lesion or outbreak = must do C-sectiondeliverySyphilisScreening Test: RPR & VDRLCrosses placenta.