ATI: Bleeding During Pregnancy Flashcards
What are the top 2 reasons for bleeding during the first trimester?
- Spontaneous Abortion
- Ectopic Pregnancie
What are some diagnostic and therapeutic procedures used in spontaneous abortion?
There are 5
- Ultrasound-visualizes whether the fetus is alive or dead
- Exam of cervix-Observe wheter it is opened or closed
- Dilation and Cutterage-dilate and scrape the uterine walls to remove urine contents
- Dilation and Evacuation-uterine contents are evacuated after 16 weeks of gestation
- Prostaglandins and oxytocin-augment or induce contractions to expulse products out
What client education do you give after a spontaneous abortion?
- Dont have any sex for 2 weeks
- Dont go into hottubs or hot baths
- Dont put anything into vagina
Patient has unilateral stabbing pain and tenderness in lower abdominal segment and is early in pregnancy, what can this be an indication of?
Possible ectopic pregnancy
What is ectopic pregnancy?
What complication can this cause?
Implantation of a fertilized ovum outside the uterine cavity, usually in the fallopian tubes
Fatal hemorrhage
What specific expected finding / symptom may you expect in a woman experiencing in a worsening ectopic pregnancy?
Referred shoulder pain
When would medical management be used in an ectopic pregnancy?
When rupture has not occured and tuube preservation is desired
Salpingostomy
Done to save fallopian tube if not ruptured
What is methotrexate used for?
It ends ectopic pregnancy by inhibiting cell division and embryo enlargement
Laparoscopic salpingectomy
Removal of the tube, used when the tube has already ruptured
What are contraindications to taking methotrexate?
Client cannot take vitamins w/ folic acid
What are some risk factors for molar pregnancies?
- Prior molar pregnancies
- Teenagers or older than 40
Molar pregnancies can eventually lead to what?
Choriocarcinoma
What expected findings can we see in a client w/ gestational trophoblastic disease
Hyperemesis Gravidarum
What physical assessment findings can we see in a client with trophoblastic disease?
- Increased uterine growth
- Bleeding that is prune juice or dark brown
- Anemia from blood loss
- Preeclampsia before 24 weeks of gestation
What will an ultrasound reveal in a trophoblastic disease pregnancy?
Dense growth w/ vesicles, but no fetus in utero
What follow up advise is important in molar pregnancies?
Client should follow up due to potential choricarcinoma risk
What are the most common causes of bleeding in the second trimester of pregnancy?
Gestational trophoblastic disease
What are the most common causes of bleeding in the third trimester of pregnancy?
- Placenta previa
- Abruptio placentæ
- Vasa previa
How would you expect the uterus to be in placenta previa?
Soft, relaxed, nontender
How would you expect FHR and VS to be in placenta previa?
Normal and within baseline
How can placenta previa be diagnosed w/ certainty?
Transabdominal or transvaginal ultrasound
Can we do a vaginal manual exam w/ a client w/ suspected placenta previa?
No, because this may worsen the bleeding
Client education for placenta previa?
- Adhere to bedrest
- Do not instert anything into the vagina
What coagulation defect is assoc. w/ moderate to severe Abruptio placentæ?
Disseminated intravascular coagulopathy (DIC)
What are some risk factors for Abruptio placentæ?
- Maternal hypertension
- Blunt trauma (car accident)
- Cocaine use
- Smoking
- Previous Abruptio placentæ
How is the uterus tone in Abruptio placentæ?
Firm and rigid
What type of bleeding do we see in Abruptio placentæ?
Dark, port-wine red
Do we see fetal distress in Abruptio placentæ?
Yes
What is the management for Abruptio placentæ?
Birth
