Bleeding Complications

Question 1

Abnormal implantation of the placenta blocking cervix =

Answer 1

placenta previa

Question 2

Premature separation of the placenta from the uterus=

Answer 2

Abruptio Placentae (Abruption)

Question 3

low lying vs complete placenta previa

Answer 3

low lying= near cervix

Complete= placenta covers all of cevix, can be emergent!

Question 4

when do you see bleeding from placenta previa?

Answer 4

3rd trimester

Question 5

risk factors for placenta previa

Answer 5

• can happen to anyone for no reason!

Question 6

interventions for placenta previa

Answer 6

• Pelvic rest – No vaginal exams, nothing inserted vaginally, no intercourse
◦ do not want to cause disruption to cervical blood vessels or cause premature separating of the placenta from uterus
• Monitor fetus for distress –> mom can lose 40% of blood before seeing s/s of shock
• C-section

Question 7

anytime a client has bleeding after 24 weeks we suspect….

Answer 7

placenta previa

Question 8

s/s of placenta previa

Answer 8

• Painless Bright Red Bleeding
• Relaxed soft uterus, non-tender
• Episodes of bleeding (mild-profuse) (End of 2nd and 3rd Trimester)
• Visible bleeding
• Intercourse post bleeding
• Abnormal fetal position

Question 9

When does placental abruption usually occur?

Answer 9

3rd trimester

Question 10

Types of placental abruption?

Answer 10

• Partial or Complete

* Concealed or Apparent

Question 11

Risk factors for placental abruption?

Answer 11

• **Hypertension
• Substance abuse – cocaine use
• Smoking
• Trauma
• Multifetal pregnancy

Question 12

s/s of placental abruption?

Answer 12

◦ D – dark red bleeding 
◦ E – extended fundal height due to bleeding 
◦ T – tender uterus 
◦ A – abdominal pain / contractions 
◦ C – concealed bleeding 
◦ H – hard abdomen 
◦ E – experience DIC
◦ D – distressed baby, decels

Question 13

Lab/diagnostics for placental abruption

Answer 13

H&H, type and cross for transfusion, ultrasound

Question 14

Nursing interventions for placental abruption

Answer 14

ontinuous monitoring of fetus, large bore IV to administer blood/fluids, 8-10 L to fetus, mom v/s , urinary catheter for I&O

Question 15

s/s of DIC

Answer 15

Watch for oozing from IV sites, petechiae, especially under the blood pressure cuff,
spontaneous bleeding from the gums and nose, signs of bruising, and hematuria

Question 16

What is DIC? what can it lead to ?

Answer 16

= Disseminated intravascular coagulation

• happens when body breaks down clots faster than it can form them –> hemorrhage –> death

Question 17

◦ Fertilized egg implants in tissue outside of the uterus=

Answer 17

ectopic preg

Question 18

s/s of ectopic preg

Answer 18

• unliateral pain in lower quadrant

◦ Cullen’s sign - Ruptured ectopic pregnancy - blue discoloration around belly button

Question 19

what is cullens sign?

Answer 19

• Ruptured ectopic pregnancy - blue discoloration around belly button

Question 20

◦ overproduction of tissue that would normally develop into placenta –> no developing fetus =

Answer 20

• Hydatidiform mole

Question 21

s/s of Hydatidiform mole

Answer 21

◦ severe N/V, hyperthyroidism, pre-eclampsia

Question 22

a miscarriage occurs when you lose fetus before ____ weeks

Answer 22

20 weeks

Question 23

types of miscarriages?

Answer 23

◦ complete/incomplete/missed

Question 24

post miscarriage education?

Answer 24

vaginal rest after d&c of fetus