ch. 28: hemorrhage in pregnancy Flashcards
What is a threatened miscarriage?
cervical opening CLOSED with slight vagina bleeding and mild uterine cramping
What is the management for a threatened miscarriage?
-bedrest
-pelvic rest
-monitor hCG levels (↑ is good sign)
What is the medical management for inevitable/incomplete miscarriage?
-prostaglandin (misoprostol, Cytotec) may be admin PO, into amniotic sac, or vag sup to augment or induce uterine ctxs to expel remaining tissue
What is the surgical management for a miscarriage?
-dilation and curettage (D&C) to dilate and clean uterus
What is the discharge teaching after a miscarriage?
-clean peri area after each bm/void and change peri pad
-avoid tub for 2 weeks
-total pelvic rest for 2 weeks
-report foul smelling discharge or elevaterd temp
-eat foods HIGH in IRON and PROTEIN
-grief support
What is an incompetent cervix?
painless passive dilation of cervix in absence of uterine ctxs
What is the surgical treatment for an incompetent cervix?
cerclage: heavy ligature placed around cervix to strengthen it and prevent premature cervical dialtion
When must a cerclage be removed?
before onset of labor
What are symptoms of en ECTOPIC pregnancy?
-abd pain (dull to colicky to sharp then stabbing)
-delayed menses
-abnormal vag bleeding (spotting)
-s/s usually 6 to 8 wekks after last normal period
What s/s require assessment for ectopic pregnancy?
every women w/
-abd pain (knife like in lower abd quad)
-vag spotting
-positive preg test
What is a symptom of a ruptured ectopic pregnancy?
referred shoulder pain occurs bc of diaphragmatic irritation caused by blood in peritoneal cavity
What tests are done to dx an ectopic pregnancy?
-hormones: hCG ↑, progesterone ↓
-transvag ultrasound
What is the medical management for an ectopic pregnancy?
methotrexate: inhibits rapid cell division and prevents fallopian tube rupture
What is the surgical management for an ectopic pregnancy?
-after confirming location:
-laparoscopic removal
OR
-salpingostomy or salpingectomy (if tubal location)
What is the criteria for methotrexate?
-hemodynamically stable
-normal/liver kidney
-< 3.5 cm mass
-NOT ruptured
-no fetal cardiac
-B-hCG <1000
-able to comply w/ guidelines
What are s/s of a MOLAR PREGNANCY?
-uterus expands faster and reaches landmarks earlier
-morning sickness
-dark brown vag bleeding (can also e bright red, scant, or profuse)
-discharge w/ grapelike vesicles
-earlier signs of PIH
What is the surgical treatment for a molar pregnancy?
D&C or suction
-give Rhogam to Rh- moms postop
Molar pregnancies have a high association with the development of _____
carcinogenic development (choriocarcinoma)
How long is it recommended to wait to get pregnant after a molar pregnancy?
at least 1yr
What are women at high risk of developing after a molar pregnancy?
htn and hyperthyroidism
What is placenta previa?
placenta abnormally implants in lower seg of uterus, near or over cervical os instead of latching to fundus
What does placenta previa result in?
bleeding during 3rd trimester as cervix begins to dilate and efface
What are risk factors for placenta previa?
-hx of placenta previa
-uterine scarring
-mom > 35y/o
-multifetal
-multiple gest or closely spaced perg
-previous c section
-smoking/cocaine
-higher altitudes, male fetus, Asian
What dx tests are done for placenta previa?
-transabdominal or transvaginal US for placenta location
-fetal monitoring
-CBC
-ABO blood typing and Rh factor
-coagulation
What therapeutic procedure is done for placenta previa?
emergency c-section
What are the s/s of placental previa?
1)painless, bright red vag bleeding that increases as cervix dilates
2) soft, relaxed, nontender uterus w/ normal tone
3)fundal height may be greater than expected for gest age
4) palpable placenta via vag exam
What are the nursing interventions if pt is not term and not in labor (placenta previa)?
-bedrest
-pelvic rest
-large bore IV w/ IVF
-corticosteroids for lung maturity
-may need blood replacement
-continuous fetal monitoring
What are the nursing interventions if pt is at term or in labor (placenta previa)?
-prepare for C-SECTION
-have blood replacement products ready
What is placenta abruption?
premature separation of the placenta from uterus, can be partial or complete detachment
When does placenta abruption occur?
after 20 wks
What is the leading cause of maternal death?
placenta abruption
What are risk factors for placenta abruption?
-maternal htn
-blunt external trauma
-cocaine abuse
-hx
-smoking
-PROM
-multifetal
-coagulation defects
How is placenta abruption dx?
-abd pain, uterine tenderness, ctx
-higher fundus
-elevated uterine resting tone
-abnormal FHR pattern
-coagulopathy may be present
-may develop sym of rigid board like abd & hypovolemic shock
What symptoms would make the nurse highly suspect placenta abruption?
sudden onset of intense, usually localized uterine pain, w/ o w/o vag bleeding
What is the nursing management for a stable pt w/ only mild separation & 20-34 weeks gest?
-bed rest
-pelvic rest
-corticosteroids for fetal lung maturity
-close monitoring of mom and fetus
-reg NSTs & BPP
What is the active management for placenta abruption?
IMMEDIATE BIRTH if preg at term or bleeding is mod to severe
-vag delivery is preferable (always be ready for emergency c-section)
-monitoring
-large bore IVs, foley cath for strict I&O
-H&H, clotting
-type & cross w/ blood products
What is DIC?
-diffuse clotting that causes widespread external bleedin, internal bleeding, or both
What are common causes of DIC?
-placenta abruption
-HELLP
-amniotic fluid embolus
-PPH
-sepsis
-retained IUFD
What is the management for DIC?
-hemodynamic monitoring
-fluid replacement
-blood and blood products
-O2
-additional coag and
-hemostatic agents
