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Maternity & Women's Health > Antepartum bleeding & premature labor > Flashcards

Antepartum bleeding & premature labor Flashcards

1
Q

Early AP Bleeding could be indicative of?

A

Spontaneous Abortion
Incompetent Cervix
Ectopic Pregnancy
Hydatidiform Mole

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2
Q

Late AP Bleeding could be indicative of?

A

Placenta Previa
Placental Abruption
Placenta Accreta

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3
Q

Classifications of spontaneous abortions?

A

threatened, inevitable, complete

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4
Q

What is Rhogam?

A

medication given to Rh negative mothers for spontaneous abortion management

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5
Q

S/S of spontaneous abortion?

A

Cramping, Backache, Bleeding, Passing tissue

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6
Q

S/S of an Ectopic Pregnancy?

A 
No menses or spotting (6-8wk)
Rt. shoulder pain
Breast tenderness
Nausea
Lower abdominal pain
Slow chronic bleeding
Fainting/Light headedness
Signs of shock
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7
Q

What is Methotrexate?

A
  • chemo drug used as medical management for ectopic pregnancy
  • used only if tube is in tact
  • folic acid antagonist = inhibits cell division
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8
Q

S/S of a Molar Pregnancy?

A
  • Almost always before 18 wks gestation
  • Bleeding: Brownish
  • Passage of grapelike clusters - very bloody
  • Uterus large for dates
  • Absence fetal parts on u/s
  • No FHTs
  • hCG - elevated
  • Hyperemesis common
  • Pre-eclampsia earlier in gestation-1st trimester
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9
Q

What are the strongest indicators of preterm delivery? (4)

A
  • Shortened cervix (use transvaginal US)
  • Cervicovaginal fibronectin
  • Previous PTD
  • Infection (e.g. BV)
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10
Q

Management of Incompetent Cervix?

A
  • Cerclage (about 14-15 weeks)
  • Prior to procedure:
    • GBS, Chlamydia, and GC cultures
    • Trendelenberg position
  • Suture cut at 36-37 weeks
  • Instruct in symptoms of PTL
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11
Q

S/S of Preterm Labor?

A
  • may be asymptomatic
  • Fatigue
  • Menstrual like cramps or contractions ≥ 6/ hr
  • Dull low backache
  • Heaviness in pelvis
  • Increase in vaginal discharge
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12
Q

Assessment for PTL: Fetal Fibronectin Testing

A
  • positive = > .05mcg/mL
  • A negative test is highly predictive that preterm labor will not occur.
  • can be done by a trained RN
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13
Q

When is Fibrinolactin present?

A

< 20 wks of preggo and as labor approaches

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14
Q

Progressive cervical change accompanied by contractions <37 weeks gestation is indicative of?

A

Preterm labor

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15
Q

What are tocolytic drugs?

A

anti-contraction meds or labor suppressants

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16
Q

Why would corticosteroids be given during for preterm labor?

A
  • to accelerates fetal lung maturation, helps with the development of surfactant
  • decreases intraventricular hemorrhage
17
Q

Corticosteroid administration is recommended for all women who threaten preterm labor between?

A

24-34 wks

18
Q

Corticosteroid tx for preterm labor?

A
  • Betamethasone 12 mg IM x 2 doses 24 hours apart

- Dextramethasone 6mg IM x 4 doses 12 hour apart

19
Q

When is the fetal surfactant completely developed?

A

35th wk

20
Q

Tocolytic drugs?

A
  • Magnesium Sulfate

- Nifedipine (CCB)

21
Q

Placenta Previa

A
  • when the placenta lies close to, or on top of the cervix
22
Q

Signs and Symptoms of Placenta Previa?

A
  • 2nd / 3rd trimester bleeding that is:
    • Unrelated to labor
    • Painless
    • Bright red bleeding
    • Uterus relaxed (not contracting)
    • Often starts as spotting
    • Subsequent bleeding often much heavier
23
Q

Nursing Care for Placenta Previa?

A
  • No vaginal examinations
  • Bedrest
  • Monitor blood loss / color
  • Monitor VS
  • Anticipate orders (IV, U/S )
  • Electronic Fetal Monitoring
  • Type and cross-match
24
Q

Signs and Symptoms of Placental Abruption?

A
  • Usually 3rd trimester
  • Usually associated with labor onset
  • Painful
  • Rigid uterus
  • Dark red bleeding
  • Bleeding may not be visible (occult bleeding)
  • Rapid change in VS ( P & BP due to shock)
  • OUTCOME DEPENDS ON:
    Rapid Dx & Rx
25
Q

Nursing Care for Placental Abruption?

A
  • No Vag exam
  • Start large bore IV
  • Careful Monitoring
  • Emotional support
  • Labs: H&H& type/cross
26
Q

Grades of Placental Abruption:

1) Grade 1
2) Grade 2
3) Grade 3

A

1) mild
2) moderate
3) severe

27
Q

Signs and Symptoms of a Grade 1 Placental Abruption?

A
  • Vaginal bleeding
  • Uterine tenderness
  • Mild tetany
  • 10-20% of placenta affected
28
Q

Signs and Symptoms of a Grade 2 Placental Abruption?

A
  • Uterine tenderness
  • Uterine tetany
  • May have overt bleeding
  • Possible shock
  • Fetal distress
  • 20-50% of placenta
29
Q

Signs and Symptoms of a Grade 3 Placental Abruption?

A
  • Uterine tetany severe
  • Shock
  • Fetus dead
  • Coagulopathy
  • > 50% of placenta
30
Q

NURSING INTERVENTIONS: Late Pregnancy Hemorrhage (ORDER)

A
  • Oxygenate (8-10 L.min
  • Restore circulatory volume
  • Drug therapy
  • Evaluate response to therapy
  • Remedy the basic problem
31
Q

COMPLICATIONS: ABRUPTIO PLACENTA

A
  • DIC
  • Precipitous labor
  • Uterine atony (PPH)
  • Acute renal failure
  • Infant mortality (preterm, hypoxic, anemic)
  • Maternal morbidity or mortality
32
Q

Disseminated Intravascular Coagulation (DIC) S/S?

A
  • Pathologic form of clotting
    • Severe preeclampsia, HELLP, and gram-negative sepsis can trigger
    • Consumes large amounts of clotting factors
      Results in widespread bleeding
  • Clinical picture is hemorrhage, anemia, and ischemia

Maternity & Women's Health (18 decks)

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