Bleeding during pregnancy

Question 1

signs of hypovolemic shock occur when?

Answer 1

10% of blood volume (2 units of blood) have been lost

Question 2

fetal distress occurs when?

Answer 2

25% of blood volume is lost

Question 3

primary causes of bleeding during pregnancy

first trimester

Answer 3

1. Threatened spontaneous miscarriage
2. Imminent (inevitable miscarriage)
   3.Missed miscarriage
   4.Incomplete spontaneous miscarriage
3. Complete spontaneous miscarriage
   6.Ectopic (tubal) pregnancy

Question 4

primary causes of bleeding during pregnancy

second trimester

Answer 4

1. Gestational trophoblastic disease (hydatidiform mole)
   2.Incompetent cervix

Question 5

primary causes of bleeding during pregnancy
third trimester

Answer 5

1. Placenta previa
2. Premature separation of placenta (abruptio placentae)
3. Pre term labor

Question 6

unknown reasons but possibly poor placental attachment

Answer 6

Imminent (inevitable miscarriage)

Question 7

Threatened spontaneous miscarriage assessment

Answer 7

vaginal spotting, perhaps slight cramping.
cervix closed

Question 8

Threatened spontaneous miscarriage cautions

Answer 8

do not use tampons (can lead to infection)

Question 9

Imminent (inevitable miscarriage)

Answer 9

vaginal spotting, cramping.
cervical dilation

Question 10

Missed miscarriage

Answer 10

vaginal spotting, slight cramping, no apparent loss of pregnancy. Fetus dies in utero but is not expelled brownish vaginal discharge.
cervix closed

Question 11

Missed miscarriage cautions

Answer 11

Disseminated intravascular coagulation is associated that may lead to multiple organ disfunction

Question 12

Incomplete spontaneous miscarriage assesment

Answer 12

vaginal spotting, cramping.
cervical dilation and passage of clots or pieces of tissue

Question 13

Incomplete spontaneous miscarriage cautions

Answer 13

high risk for uterine infection

Question 14

Complete spontaneous miscarriage assessment

Answer 14

vaginal spotting, cramping.
cervical dilation and complete expulsion of uterine contents

Question 15

implantation of zygote at site other than in uterus associated with tubal constrictures

Answer 15

Ectopic (tubal) pregnancy

Question 16

Ectopic (tubal) pregnancy assesment

Answer 16

sudden unilateral lower quadrant pain, minimal vaginal bleeding

Question 17

Ectopic (tubal) pregnancy cautions

Answer 17

may have ectopic pregnancy in future if tubal scarring is bilateral

Question 18

abnormal proliferation of trophoblast cells; fertilization or division defect

Answer 18

Gestational trophoblastic disease (hydatidiform mole)

Question 19

Gestational trophoblastic disease (hydatidiform mole) assesment

Answer 19

overgrowth of uterus
highly + HCG test
no bleeding from vagina of old or fresh blood accompanied by cyst formation

Question 20

Gestational trophoblastic disease (hydatidiform mole) cautions

Answer 20

retained trophoblast tissue may become malignant ( choriocarcinoma)

follow for 6mos to 1 yr with hcg testing

Question 21

Cervix begins to dilate and pregnancy is lost at about 20 weeks; unknown cause, but cervical trauma from dilation and curettage (D&C) may be associated

Answer 21

incompetent cervix

Question 22

incompetent cervix assesment

Answer 22

painless bleeding leading to expulsion of fetus

Question 23

incompetent cervix cautions

Answer 23

can have cervical sutures placed to ensure a second pregnancy

Question 24

low implantation of placenta possible because of uterine abnormality

Answer 24

Placenta previa

Question 25

Placenta previa assesment

Answer 25

painless bleeding at beginning of cervical dilation

Question 26

Placenta previa cautions

Answer 26

don’t allow vaginal examination to minimize placental trauma

Question 27

Unknown cause; associated with hypertension; placenta separations from uterus before birth of fetus.

Answer 27

Premature separation of placenta (abruptio placentae)

Question 28

Premature separation of placenta (abruptio placentae) assesment

Answer 28

Sharp abdominal pain followed by uterine tenderness,
vaginal bleeding; signs of maternal hypovolemic shock fetal distress.

Question 29

Premature separation of placenta (abruptio placentae) cautions

Answer 29

Disseminated intravascular coagulation is associated with condition.

Question 30

pre term labor cause

Answer 30

Many possible etiologic factors such as trauma,
substance abuse,
hypertension of pregnancy, or cervicitis; increased chance in multiple gestation, maternal illness.

Question 31

pre term labor assesment

Answer 31

Show (pink - stained vaginal discharge)
accompanied by uterine contractions becoming regular and effective.

Question 32

pre term labor cautions

Answer 32

if the cervix is less than 4 cm dilated and the membrane are intact,

corticosteroids are administered to aid fetal lung maturity.

Question 33

pathophysiology of bleeding

Answer 33

1.Blood Loss
2. Decreased intravascular volume
3. Decreased venous return, decreased cardiac output, and lowered blood pressure
4. Body compensating by increasing heart rate to circulated the decreased volume faster; vasoconstriction of peripheral vessels (to save blood for vital organs). Increased respiratory rate and a feeling of apprehension at body changes also occur.

5.Cold, clammy skin; decreased uterine perfusion. In the face of continued blood loss, although the body shifts fluid from interstitial spaces into intravascular spaces, blood pressure will continue to fall.

6.Reduced renal, uterine and brain perfusion

7.Lethargy, coma, decreased renal output.

8. Renal failure
9. Maternal and fetal death

Question 34

sign and symptoms of hypovolemic shock

Answer 34

1. increased pulse rate
2. decreased blood pressure
3. increased respiratory rate
4. cold,clammy skin
5. decreased urine output
6. dizziness or decreased level of consciousness
7. decreased central venous pressure

Question 35

emergency intervention for bleeding in pregnancy

Answer 35

1. Alert health care team of emergency situation.
2. Place woman flat in bed on her side.
3. Begin intravenous fluid such as ringer’s lactate with a 16 or 18 gauge angiocath.
4. Administer oxygen as necessary at 6 - 10 L/min by face mask.
5. Monitor uterine contractions and fetal heart rate by external monitor.
6. Omit vaginal examination.
7. Withhold oral fluid.
8. Order type and cross - match of 2 units of whole blood.
   9.Measure intake and output.
9. Assess vital signs (pulse, respirations and blood pressure every 15 minutes; apply oximeter and automatic blood pressure cuff as necessary).

11.Assist with placement of central nervous pressure or pulmonary artery catheter and blood determinations

12. Measure maternal blood loss by weighing perineal pads; save any tissue passed.

13.Assist with ultrasound examination.

14. Maintain a positive attitude about fetal outcome.
15. Support woman’s self - esteem; provide emotional support to woman and her support person.