Abnormal Vaginal Bleeding/Ectopic Pregnancy/Endometriosis Flashcards
Abnormal Vaginal Bleeding (4 types)
- aka uterine bleeding, common gynecological conern. Types of irregularities
a) oligomenorrhea
b) amenorrhea
c) menorrhagia
d) metrorrhagia
Causes of abnormal vaginal/uterine bleeding
Causes may vary from anovulatory menstrual cycles to more serious causes such as ectopic pregnancy or endometrial cancer
Menorrhagia
- common cause
- excessive bleeding characterized as an increased duration (>7 days), increased amount (>80ml) or both
- the most common cause -> anovulatory uterine bleeding
- For young women with excessive bleeding, clotting disorders must be considered
Metrorrhagia
- possible causes (2)
- Also referred to as spotting, or breakthrough bleeding, is bleeding between menstrual periods
- For women of reproductive age, spontaneous abortion or ectopic pregnancy must be considred
- for women who are postmenopausal, endometrial cancer must be considered whenever spotting is experienced
Amenorrhea
- primary vs secondary?
Aside from pregnancy - the most common cause for missing menses is anovulation
- Primary: failure of menstrual cycles to begin by 16 years (or 14 years with secondary sex characteristics)
- Secondary: cessation of menstrual cycle once established
Oligomenorrhea
Refers to long intervals between menses, generally > 35 days
Oligomenorrhea owing to anovulation is common for women at the beginning and end of menstruation
Nursing Management of Abnormal Vaginal Bleeding: Teaching
Teach them about characteristics of menstrual cycle:
- will assist to identify normal variation
- if menstrual cycle does not fall within the normal range, seek health care provider
Nursing Management of Abnormal Vaginal Bleeding: Decrease risk of Toxic Shock Syndrome
- what is it? S&S?
- TSS is acute condition caused by staph aureus
- avoid prolonged use of superabsorbent tampons & pads
- initially flu-like symptoms - high fever, N/V, diarrhea, dizziness, fainting and disorientation
Nursing Management of Abnormal Vaginal Bleeding (2)
- excessive amount of vaginal bleeding should be assessed accurately
- anemia & hypovolemia may be present - assess variations in BP, HR
Surgical Therapy for Abnormal Vaginal Bleeding (3)
Surgery is indicated depending on underlying cause of abnormal vaginal bleeding
- D&C (dilation and curettage. used for miscarriage)
- Hysterectomy (if fibroids)
- Myomectomy (removal of fibroid without removing the uterus)
Methods for performing surgeries (3)
- Laparotomy
- Laparoscopy
- Hysteroscopy (up through the vagina)
Ectopic Pregnancy
- implantation of the fertilized ovum anywhere outside uterine cavity
- Result of fibrosis or damage to cilia in the tube following infection or inflammation of the Fallopian tube
- eventually the tube ruptures - peritoneal symptoms
- Is a life-threatening condition
- A women suspected of ectopic pregnancy should always be treated as an emergency
Ectopic Pregnancy: Risk Factor
- history of pelvic inflammatory disease, prior ectopic pregnancy, progestin-releasing IUD, progestin-only birth control failure, and prior pelvic or tubal surgery
Clinical manifestations of ectopic pregnancy
- if tube ruptures?
- Abdominal or pelvic pain - almost always present d/t distention of the fallopian tube
- missed menses
- irregular vaginal bleeding
- If tube ruptures, pain is intense -> risk for hemorrhage & hypovolemic shock. suspected rupture is treated as an emergency
Diagnosis of Ectopic Pregnancy
- difficult d/t similarities to other pelvic and abdominal disorders
- a serum pregnancy test would be positive
-KEY - serum BhCG level >1,500 and transvaginal U/S shows no intrauterine gestational sac.
Symptoms of Tube rupture
sudden, severe pain, vaginal bleeding, shoulder pain while laying down, bleeding into peritoneal cavity: pallor, signs of shock and blood loss and a distended abdomen
management of ectopic pregnancy
- surgery remains the primary approach and should be performed immediately
- for hemodynamically stable pt with the size of gestation <3cm, tx of IM injection of methotrexate is being used with increasing success.
- laparoscopy is preferable to laparotomy because of less blood loss, and decreased length of stay
Laparoscopy: for ectopic pregnancy 2 types
- how do they choose which one?
- Salpingotomy - the ectopic pregnancy is removed; tube is left to heal on its own
- Salpingectomy - both ectopic pregnancy & the tube are removed
The choice depends on
- pts age
- tubes condition
- Serum bHCG levels
- pts future fertility desire
Endometriosis
- presence of endometrial epithelial tissue (usually lines uterus) found outside the uterine cavity
- endometrial tissues undergoes a mini-menstrual cycle
- Blood collects in cyst-like nodules blue/black in color -> causes inflammation -> scarring & adhesions
Endometriosis: most frequent sites
near ovaries, broad ligament, uterosacral ligaments, bowel, bladder
Endometriosis and fertility
A common cause of infertility, increased risk for ovarian cancer.
Typically occurs in those who have never had a full-term pregnancy
Clinical Manifestations of Endometriosis
symptoms and pain vary considerably and does not correlate with extent of endometriosis
most common manifestations: dysmenorrhea, infertility, pelvic pain, dyspareunia, and irregular bleeding
Diagnosis and treatment of endometriosis
Laparoscopy for a definitive diagnosis
Treatment influenced by pts age, desire for pregnancy, symptom severity, and the extent and location of disease
Conservative Surgery for Endometriosis
- to confirm diagnosis or to remove implants. lysing or excision of adhesion by laparoscopic laser surgery or laparotomy. For women wishing to get pregnant
Definitive surgery for Endometriosis
Removal of uterus, fallopian tubes, ovaries, and as many endometrial implants as possible
- Postop care similar as abdominal hysterectomy
Surgical Procedures for Female Reproductive System (7)
- Abdominal hysterectomy
- Vaginal hysterectomy
- Laparoscopic hysterectomy
- Robot-Assisted Surgery
- Vulvectomy
- Vaginectomy
- Pelvic Exenteration
