Newer Tx methotrexate inhibits folic acid to stop growth of baby and prevents

Newer tx methotrexate inhibits folic acid to stop

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-Newer Tx: methotrexate-inhibits folic acid to stop growth of baby and prevents cell duplication, give RhoGam for negative mom -Nursing care: fluids, vitals, assess emotional status/coping abilities, assess her for bleeding4. Gestational Trophoblastic Disease/Hydatiform Mole/Molar Pregnancy (most of the time called a molar pregnancy)-abnormal placenta development; sacs in placenta fill with fluid, not blood-leads to loss of pregnancy, possible risk of death. -associated with age >35, increased stress levels, carotene deficiencyTypes:a. Complete Mole- an egg with no genetic material from an egg that develoeds from an egg with genetic material in egg-bleeding like “prune juice discharge” as old blood and plasma released-increased risk of cancer (proliferation of trophoblastic tissue) b. Parital Mole- egg fertilized by 2 sperm (one egg has 23 chromosomes and another egg has 46 chromosomes) -leads to malformation of baby… egg or sperm didn’t go under meiotic division.-total:69 chromosomes (TOO MANY!!) -survives longer (up to 10 wks)-enlargement of mom’s stomach (more than it should) -increased HcG levels (hyperemesis gravidarum)c. Also invasive mole (complete mole in which trophoblastic tissue invades myometrium of uterus)-Occurs in 1 out of 1500 in US; 1 out of 120 in Asia-More often in extremes of age, family history.-S&S: “prune juice”directly associated with trophoblastic disease (1/1500pregnancies) bleeding, anemia, enlarged uterus, no FHR, increased HcG, hyperemesis gravidarum, PIH usually does not show up until the second trimester of pregnancy (if before, bad!)-Diagnosis: U/S-Tx: D&C, 20% of women with molar pregnancy will develop cancer (esp. uterine CA). Nursing care: support!!!5. Placenta Previa-painless bright red vaginal bleeding, comes out before the baby, usually after 20 wks gestation-placenta comes before baby (low-lying placenta)6. Abruptio Placenta-painfulbleedingcan happen at any point in pregnancy -placenta pulls away from uterine lining before birthC. Incompetent CervixPremature dilation of cervix OB Notes39
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0.5-1% of all pregnanciesResponsible for up to 15-20% of fetal loss/spontaneous abortions in second trimester.oMiscarriages often occur more in the first trimesterCause: congenital/structural defect, trauma to cervixCervix dilates and effaces without uterine contractions around 14-16 wksoWoman may not know that it is happeningoCervix thins out (effacement) oDilated 4-5 cmoBleeding and spottingoWoman may lose 2-3 babies before problem is figured out Tx: Shirodkar-Barter Procedure or Cerclageometal band around internal os; cerclage on the neck of the cervixleft in place with C-section (more invasive)Vaginal—taken out “McDonald’s procedure” purse-string suture pull Either can be due to personal preference, person’s anatomy Remove band or suture at 37 weeks b/c she is far enough into her term D. PROM- Premature Rupture of Membranes (Water breaks before labor)Spontaneous rupture of membranes before onset of laborPreterm PROM- water breaksbefore36 wks
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  • progesterone, A., Late pregnancy, OB Notes

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