Which of the following signs will require a mother to seek immediate medical attention

Summary

• Obstetric emergencies are health problems that are life-threatening for pregnant women and their babies.
• An obstetric emergency may arise at any time during pregnancy, labour and birth.
• Hospital care is needed for all obstetric emergencies, as the woman may need specialist care and an extended hospital stay. This may be because of the risk of a premature birth, the loss of a baby or increased risk to the woman’s health. 
• If you think you or your unborn baby are at risk, call your doctor, midwife or hospital, or call 000 for an ambulance.

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1.A client makes a routine visit to the prenatal clinic. Although she’s 14 weeks pregnant, the size of her uterus approximates that in an 18- to 20-week pregnancy. Dr. Diaz diagnoses gestational trophoblastic disease and orders ultrasonography. The nurse expects ultrasonography to reveal:

1. an empty gestational sac.
2. grapelike clusters.
3. a severely malformed fetus.
4. an extrauterine pregnancy.

2.Of the following terms, which is used to refer to a type of gestational trophoblastic neoplasm?

1. Hydatidiform mole
2. Dermoid cyst
3. Doderlein’s bacilli
4. Bartholin’s cyst

3. Which of the following signs will require a mother to seek immediate medical attention?

1. When the first fetal movement is felt
2. No fetal movement is felt on the 6th month
3. Mild uterine contraction
4. Slight dyspnea on the last month of gestation

4. Which of the following signs and symptoms will most likely make the nurse suspect that the patient is having hydatidiform mole?

1. Slight bleeding
2. Passage of clear vesicular mass per vagina
3. Absence of fetal heart beat
4. Enlargement of the uterus

5. Upon assessment the nurse found the following: fundus at 2 fingerbreadths above the umbilicus, last menstrual period (LMP) 5 months ago, fetal heart beat (FHB) not appreciated. Which of the following is the most possible diagnosis of this condition?

1. Hydatidiform mole
2. Missed abortion
3. Pelvic inflammatory disease
4. Ectopic pregnancy

6. Which of the following symptoms occurs with a hydatidiform mole?

1. Heavy, bright red bleeding every 21 days
2. Fetal cardiac motion after 6 weeks gestation
3. Benign tumors found in the smooth muscle of the uterus
4. “Snowstorm” pattern on ultrasound with no fetus or gestational sac

7. Molar pregnancies may be complete, partial, invasive, or malignant.

1. True
2. False

8. Risk factor of trophoblastic disease:

1. over 40
2. low economic status
3. previous molar pregnancy
4. women living in far eastern countries
5. diets deficient in protein and folic acid
6. 30 or younger

9. Check all that apply to the treatment of molar pregnancies:

1. frequent follow ups
2. evacuation of molar pregnancy
3. radiation
4. possible chemotherapy
5. serial hCG levels

10.Check all that cause a “complete” molar pregnancy:

1. placenta grows and produces hCG
2. some fetal components
3. sperm fertilizes empty egg
4. two sperm fertilize one egg
5. no fetus is formed

Answer and Rationale

1. B. grapelike clusters. In a client with gestational trophoblastic disease, an ultrasound performed after the 3rd month shows grapelike clusters of transparent vesicles rather than a fetus. The vesicles contain a clear fluid and may involve all or part of the decidual lining of the uterus. Usually no embryo (and therefore no fetus) is present because it has been absorbed. Because there is no fetus, there can be no extrauterine pregnancy. An extrauterine pregnancy is seen with an ectopic pregnancy.
2. A. Hydatidiform mole
   • A: Hydatidiform mole occurs in 1 in 1000 pregnancies.
   • B: A dermoid cyst is an ovarian tumor of undefined origin that consists of undifferentiated embryonal cells.
   • C: Doderlein’s bacilli is one component of normal vaginal flora.
   • D. Bartholin’s cyst is a cyst in a paired vestibular gland in the vulva.
3. B. No fetal movement is felt on the 6th month. Fetal movement is usually felt by the mother during 4.5 – 5 months. If the pregnancy is already in its 6th month and no fetal movement is felt, the pregnancy is not normal either the fetus is already dead intra-uterine or it is an H-mole.
4. B. Passage of clear vesicular mass per vagina. Hydatidiform mole (H-mole) is characterized by the degeneration of the chorionic villi wherein the villi becomes vesicle-like. These vesicle-like substances when expelled per vagina and is a definite sign that the woman has H-mole.
5. A. Hydatidiform mole. Hydatidiform mole begins as a pregnancy but early in the development of the embryo degeneration occurs. The proliferation of the vesicle-like substances is rapid causing the uterus to enlarge bigger than the expected size based on ages of gestation (AOG). In the situation given, the pregnancy is only 5 months but the size of the uterus is already above the umbilicus which is compatible with 7 months AOG. Also, no fetal heart beat is appreciated because the pregnancy degenerated thus there is no appreciable fetal heart beat.
6. D. “Snowstorm” pattern on ultrasound with no fetus or gestational sac. The chorionic villi of a molar pregnancy resemble a snowstorm pattern on ultrasound. Bleeding with a hydatidiform mole is often dark brown and may occur erratically for weeks or months.
7. A. True
8. A, B, C, D, E.
9. A,B,D,E
10. A,C,E