Bleeding Disorders

Question 1

Antepartal Bleeding Disorders

Answer 1

Maternal Risk:
* Hypovolemia
* Anemia
* Infections
* Preterm Labor

Fetal Risk:
* Blood loss anemia
* Hypoxemia
* Hypoxia
* Anoxia
* Preterm Birth

Question 2

Ectopic Pregnancy

Early Bleeding Conditions

Answer 2

Fertilized ovum implants outside uterus ( commonly fallopian tubes)
OB Emergency !!! -> must be treated
Risk Factors: PID (pelvic inflammatory dieases), scarring tubes, fertilized w/ IUD in
S/S: missed menses, full feeling in abdomen, lower quad tenderness, positive preg test, shoulder pain
D/X: quant HCG level > 1500 w/ out uterine preg seen
Complication: fallopian tube rutpure -> emergency !!
Intervention: admit pt, mom VS, check vag bleeding, IV fluids (order), tell provider STAT!!

Locations: ovarian, cerivcal, interstitial, ampullar, abdominal, fimbrial

Question 3

Intervention for Ectopic Preg

Answer 3

• Provide gentle abd palpation. percussion ( to see if there is a mass)
• prepare for US or laparotomy ( to see …)
• Labs: CBC w/ diff, type & crossmatch blood

Question 4

Treatment for Ecptopic Preg

Answer 4

chemo drug (methotrexate) kills rapidly growing cells, surgical remove
* pt has to be in good standing to get methotrexate (meaning compliant, come back)

Question 5

Placenta Previa

Late Bleeding Conditions

Answer 5

Abnormal implantation of placenta into lower segment of uterus that covers or almost covers cervix
! Always need a c-section!
* Marginal: placenta against rim of cervical os ( may migrate as GA contin)
* Partial: placenta lies over part of cervical os
* Complete: placenta lies over entire cervical os

Risk factors: previous uterine scars, surgery, fibroid tumors
s/s: BRIGHT RED, PAINLESS vag bleeding starting in 3rd trimester
* soft uterus, FHT usually normal/ reassuring

d/x: US

Question 6

DO NOT PERFORM

Answer 6

Vag or rectal exams, lepodlo maneuvers, enemas, suppositories, internal monitoring

Don’t want to stimulate ctxs

Question 7

Intervention of Placenta Previa

Answer 7

bed rest until fetal lungs mature (L:S ratio 2:1), monitor BP & HR q15min, IV fuild w/ large bore IV (fill w/ fluids fast), monitor ctxs & FHT via EFM ONLY, monitor blood loss ( save pads/linens)

pelvic rest: nothing in vag
CBC w/ diff, PT, PTT, Rh type & cross
prepare client for US & c-section

Question 8

Placenta Abruption

Late Bleeding Condition

Answer 8

Partial or complete premature detachment of placenta from uterine wall
* occurs w/ bleed & formation of hematoma on mom’s side of placenta, clot expands & seperates
* usually in** 3rd trimester**

High infant/mom mortality rate
MEDICAL EMERGENCY -> MAY NEED STAT C-SECTION
* need for complete abruption, but may not if only partial

Risk factors: BLUNT ABD TRAUMA, cocaine, > 10 cigs/day, HTN

S/S: Vag bleeding (DARK RED/BROWN), persistent abd & lower back pain, RIGID “BOARD-LIKE” ABD, increase in fundal height, FHR decel & non-reassuring pattern

Question 9

Interventions for Abruptio Placenta

Answer 9

Bed rest, lateral recumbent to increase perfusion, notify provider STAT, monitor mom VS including BP, look for shock s/s, monitor FHT & ctxs, IV fluids

Labs: CBC w/diff, clotting factors, Rh type & screen

Observe DIC s/s: bleed at IV site/gums/nose ecchymosis, low PLT & PTT