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NURS 320 - Exam 1 > Bleeding in Pregnancy > Flashcards

Bleeding in Pregnancy Flashcards

1
Q

Spontaneous abortion is also known as ______

A

Miscarriage

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2
Q

What is are the qualifications for fetal expulsion to be considered abortion? (2)

A
  • < 20 weeks
  • < 500 grams
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3
Q

The incidence of spontaneous abortion ______ after the first trimester

A

Declines

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4
Q

What are the types of abortions? (6)

A
  • Threatened
  • Imminent
  • Incomplete
  • Complete
  • Missed
  • Recurrent
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5
Q

Describe threatened abortion (3)

A
  • Bleeding / cramping
  • Cervix does NOT dilate (remains closed)
  • May resolve OR result in loss of pregnancy
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6
Q

How is a threatened abortion diagnosed?

A

Vaginal ultrasound / blood tests

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7
Q

Describe the management of a threatened abortion

A

Bedrest

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8
Q

Describe imminent abortion (3)

A
  • Bleeding / cramping increase
  • Cervix dilates
  • Membranes rupture
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9
Q

Describe the management of an imminent abortion (2)

A
  • Allow natural evacuation of uterus
  • May need D&C incomplete expulsion
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10
Q

Describe incomplete abortion (2)

A
  • Cervix dilates
  • Not all contents are expelled
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11
Q

Describe the management of an incomplete abortion (2)

A
  • D&C
  • If past 14 weeks - induce labor
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12
Q

After treatment of an incomplete abortion, there is a risk of ______

A

Infection

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13
Q

Describe complete abortion (3)

A
  • All contents are expelled
  • Signs of pregnancy subside
  • No additional intervention needed
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14
Q

Describe missed abortion (2)

A
  • Fetus dies during first half of pregnancy
  • Signs of pregnancy subside
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15
Q

How is a missed abortion diagnosed?

A

Ultrasound / blood tests to confirm fetal death

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16
Q

Describe recurrent spontaneous abortion

A

3 or more spontaneous abortions

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17
Q

Describe dilation and curettage (D&C) (3)

A
  • Monitor for 12-24 hours after
  • Educate about future pregnancy
  • Offer support groups for grief
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18
Q

What is an ectopic pregnancy?

A

Implantation of a fertilized ovum outside of the uterine cavity (usually in fallopian tube)

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19
Q

Ectopic pregnancies are primarily caused by ______

A

Scarring of the fallopian tubes

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20
Q

What are the causes of scarred fallopian tubes that may lead to an ectopic pregnancy? (4)

A
  • Infection
  • Inflammation
  • Endometriosis
  • Surgery
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21
Q

What are the manifestations of ectopic pregnancy? (4)

A
  • Missed period
  • Vaginal spotting
  • Abdominal pain
  • Ruptured fallopian tube
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22
Q

Describe the pain from a ruptured fallopian tube

A

Sudden severe abdominal pain - may radiate to scapula

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23
Q

Describe the diagnosis of an ectopic pregnancy (4)

A
  • Pelvic exam
  • Transvaginal ultrasound
  • Blood test - hCG / H&H
  • Laparoscopy - blue swelling in fallopian tube
24
Q

Describe the therapeutic management of ectopic pregnancy (3)

A
  • Methotrexate - inhibits embryo cell division
  • Save tube if possible - future fertility
  • If tube is ruptured - control bleeding / prevent hypovolemic shock
25
What is placenta previa?
The placenta covers the opening of the cervix
26
Once a woman has placenta previa ...
She is more likely to have another
27
Describe placenta previa during labor (2)
- Profuse vaginal bleeding - placenta cannot attach to uterus as the cervix opens - Emergency - requires c-section
28
What is the primary manifestation of placenta previa?
PAINLESS, frank (bright red) blood
29
Describe the diagnosis of placenta previa
Ultrasound - visualization of the placenta covering the cervical opening
30
Why is it important to avoid vaginal examination of placenta previa?
Risk of maternal / fetal blood loss
31
What are the risk factors of placenta previa? (4)
- Multiparity - Multiple pregnancy - Advancing maternal age - Previous c-section
32
Name the type of placenta previa
Marginal
33
Name the type of placenta previa
Complete
34
Name the type of placenta previa
Low-lying
35
What is abruptio placentae?
The placenta prematurely pulls away from the uterine wall
36
Abruptio placentae is a ______
Life threatening condition
37
Severity of abruptio placentae depends on ______
Amount of bleeding
38
What are the manifestations of placental abruption? (2)
- Dark red / occult bleeding - Board-like, rigid abdomen - due to bleeding behind the placenta
39
What are the major concerns associated with placental abruption? (6)
- Hemorrhage - Hypovolemic shock - Clotting abnormalities (DIC) - Fetal asphyxia - Fetal blood loss - Fetal prematurity
40
What are the risk factors of placental abruption? (3)
- Smoking / cocaine - poor circulation / vasoconstriction - Hypertension - Uterine trauma
41
Describe the diagnosis of placental abruption (2)
- May be difficult to distinguish from heavy bloody show - NO vaginal exams / oxytocin
42
Describe the management of abruptio placentae (2)
- If fetus is immature / no active bleeding --> bedrest - IV Lactated Ringers
43
Upon admission to L&D for placental abruption, it is most important to ______
Evaluate bleeding
44
Describe the evaluation of bleeding associated with placental abruption (2)
- Assess amount - pad count - Hgb / Hct
45
If a patient is bleeding vaginally for any reason ...
DO NOT perform cervical / vaginal assessments
46
What are the manifestations of concealed hemorrhage? (3)
- Increased fundal height - Board-like abdomen - Hypovolemic shock
47
What are the manifestations of hypovolemic shock? (4)
- Altered LOC - Tachycardia - Hypotension - Oliguria
48
Aprubtio placentae requires immediate ______
C-section
49
Fetal indicators assessed in the case of abruptio placentae are based on ...
Response to uterine contractions
50
Describe late decelerations
Decreased fetal HR following contraction
51
Describe gestational trophoblastic disease (hydatdiform mole) (3)
- Abnormal trophoblast proliferation - Fluid-filled clusters - No embryonic / fetal tissue
52
What are the manifestations of gestational trophoblastic disease (hydatdiform mole)? (6)
- Anemia - Vaginal bleeding - Enlarged uterus - No fetal HR - Elevated hCG - Decreased maternal serum alpha-fetoprotein
53
Describe Rh sensitization (2)
- Rh- mother carries an Rh+ baby - Mother develops antibodies against Rh+
54
Describe the management when antibodies against Rh+ are formed
Rhogam injection at 28 weeks - may repeat within 72 hours after delivery
55
How does the Rhogam injection work?
Contains immunoglobulin antibody - stops the mother's immune system from making antibodies against Rh+

NURS 320 - Exam 1 (9 decks)

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