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Mom & Baby Exam 2 > Ch. 28 Hemorrhagic Disorders of Pregnancy > Flashcards

Ch. 28 Hemorrhagic Disorders of Pregnancy Flashcards

1
Q

Are hemorrhagic disorders during pregnancy a medical emergency?

A

Yes

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2
Q

Bleeding that is more than spotting is a sign of what during pregnancy?

A

That something is jeopardized and needs investigation

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3
Q

What are key points we need to know to determine severity concern when there is bleeding during pregnancy?

A
  • How much?

- When did it start?

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4
Q

Maternal blood loss decreases what to fetus?

A

Oxygen carrying capacity

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5
Q

-Hypovolemia
-Anemia
-Infection
-Preterm labor
-Preterm birth
…are all at an increased risk of occurrence with what?

A

Maternal blood loss

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6
Q

What are fetal risks when there is maternal blood loss?

A
  • Hypoxia
  • Anemia
  • Anoxia
  • Preterm birth
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7
Q

A miscarriage is also known as what?

A

Spontaneous abortion

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8
Q

A pregnancy that ends as a result of natural causes prior to 20 weeks of gestation is called what?

A

Miscarriage

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9
Q

-Threatened
-Inevitable
-Complete
-Missed
-Recurrent
… are all types of what that can happen?

A

Miscarriages

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10
Q

What has occurred when the cervical opening (os) is closed but there is some spotting?

A

Threatened miscarriage

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11
Q

What has occurred when the cervical opening (os) is open and a moderate amount of bleeding occurs?

A

Inevitable miscarriage

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12
Q

What has occurred when the cervix closes after are contents have been expelled?

A

Complete miscarriagae

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13
Q

What has occurred when the fetus has died, but contents remain in the uterus?

A

Missed miscarriage

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14
Q

What has occurred when a mom has experienced 3 or more miscarriages?

A

Recurrent miscarriages

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15
Q

-Cramping
-Abdominal tenderness
-Backache
-ROM
-Fever
-Dilation of cervix
-Passage of tissue
… are S/S that what has occurred?

A

Spontaneous abortion

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16
Q

The diagnosis of a spontaneous abortion is done through what?

A

The S/S present or through ultrasound

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17
Q

-Endocrine imbalances (luteal phase defects)
-Hypothyroidism
-Diabetes (with high glucose levels in first trimester)
-Systemic disorders (lupus)
-Genetic factors
-Varicella infections
… can all contribute to the occurrence of what?

A

Miscarriages

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18
Q

What are other risk factors for miscarriages?

A
  • Smoking
  • Excessive alcohol or caffeine
  • Age
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19
Q

When does a late miscarriage occur?

A

Second trimester (12-20 weeks)

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20
Q

What are late miscarriages usually a result of?

A

Maternal causes

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21
Q

-Advanced maternal age and parity
-Premature cervical dilation
-Reproductive tract anomalies
-Inadequate nutrition
-Alcohol, tobacco, and caffeine use
-Obesity
-Stressful life events
… could all contribute to the occurrence if what?

A

Late miscarriages

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22
Q

What is the medical management of a spontaneous abortion?

A

-Misoprostol intravaginally or PO (“cytotec”)

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23
Q

What is the primary choice of surgical management of a spontaneous abortion?

A
  • D&C

- Oxytocin to prevent hemorrhage (“pitocin”)

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24
Q

What is the second drug of choice for surgical management of a spontaneous abortion?

A

-Methergine given IM or oral (“ergot product”)

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25
Q

When and why can methergine not be used?

A

If BP is >140/90 due to risk for stroke

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26
Q

What is the third drug of choice for surgical management of a spontaneous abortion?

A

-Hemabate (means things are serious)

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27
Q

When is Rh immune globulin given if Rh negative to prevent complications with future pregnancies?

A

within 72 hours

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28
Q

Painless dilation of the cervix without contractions is known as what?

A

Incompetent Cervix or Cervical insufficiency

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29
Q

Is cervical incompetence a cause of late miscarriages?

A

Yes

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30
Q

Is congenital cervical incompetence common?

A

Not anymore

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31
Q

How is acquired cervical incompetence obtained usually?

A
  • Infection (STI’s)
  • Trauma
  • Increased uterine volume (large babies, multiple gestations= pressure of cervix)
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32
Q

What is a subjective S/S of incompetent cervix?

A

Increased pelvic pressure

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33
Q

What are objective S/S of an incompetent cervix?

A
  • ROM
  • Contractions
  • Expulsion of fetus
  • Gush of fluid
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34
Q

How is an incompetent cervix diagnosed?

A

Abdominal or transvaginal ultrasound

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35
Q

A cerclage procedure is done for what?

A

An incompetent cervix

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36
Q

-Bedrest
-Avoiding sexual intercourse
-Tocolytic medications
*Education (prevent premature delivery)
…are all part of follow-up care for what type of procedure?

A

Cerclage

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37
Q

When can the Cerclage be removed?

A

After 37 weeks of gestation

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38
Q

What are risks of a Cerclage procedure?

A
  • Infection
  • Bleeding
  • Fetal loss
  • Rupture of fluid
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39
Q

What is it called when the fertilized ovum is implanted outside the uterine cavity?

A

Ectopic pregnancy

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40
Q

Where are most ectopic pregnancies located?

A

Ampulla (tubal pregnancy)

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41
Q

Can an ectopic pregnancy be painful and a medical emergency?

A

Yes

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42
Q

Can an ectopic pregnancy survive?

A

No

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43
Q

Can ectopic pregnancies increase risk of maternal death?

A

Yes

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44
Q

Are you less likely to have a successful pregnancy after experiencing a ectopic pregnancy?

A

Yes

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45
Q

What is the leading cause of infertility and increased difficulty conceiving after?

A

Ectopic pregnancy

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46
Q

-STI’s (untreated/undiagnosed)
-Recurrent infections
-Smoking
-Reproductive technologies
… are all risk factors for what?

A

Ectopic pregnancy

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47
Q

What are clinical manifestations of an ectopic pregnancy?

A
  • Abdominal pain
  • Delayed menses
  • Abnormal vaginal bleeding
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48
Q

How are ectopic pregnancies diagnosed?

A
  • Elevated HCG
  • No normal uterine pregnancy (Ultrasound)
  • Decrease in progesterone
  • Increase in WBCs
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49
Q

What are the two surgical interventions for an ectopic pregnancy?

A
  • Salpingectomy (removing tube)

- Salpingostomy (opening tube, scraping, and letting heal on own)

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50
Q

What is the drug used for a medical intervention of an ectopic pregnancy?

A

Methotrexate

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51
Q

How does methotrexate work when used for an ectopic pregnancy?

A

Destroys cells/dissolves pregnancy

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52
Q

Can methotrexate be used for an ectopic pregnancy if the mom is not in stable condition?

A

No, due to possible hemorrhage

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53
Q

Future fertility after an ectopic pregnancy due to the high rate of what?

A

Reoccurrence

54
Q

How long should a women be on contraception for at the minimum after an ectopic pregnancy?

A

3 months to let hormones return to normal

55
Q

Do Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease (GTD) all mean the same thing?

A

Yes

56
Q

What is the abnormal form of pregnancy where non viable fertilized egg implants in the uterus?

A

Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease

57
Q

During Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease is there a viable fetus present?

A

No

58
Q

Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease may be related to what two things?

A
  • Ovular defect

- Nutritional deficiency

59
Q

Clomid which is a common fertility drug is a risk factor for what?

A

Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease

60
Q

-Early teens or older than 40
-Hx of miscarriages
-Deficiency of carotene and animal fats
… are also risk factors for what?

A

Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease

61
Q

May early stages of Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease look like a normal pregnancy?

A

Yes

62
Q

Bright red or brown vaginal (like prune juice) bleeding is a late stage sign of what?

A

Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease

63
Q

Does Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease usually cause and excessively enlarged uterus?

A

Yes

64
Q

Women have anemia from blood loss, n/v, abdominal cramps, and pass vesicles in which complication of pregnancy?

A

Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease

65
Q

Does Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease cause 75% of women to develop preeclampsia?

A

Yes

66
Q

How is Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease diagnosed?

A
  • US

- High levels of HCG

67
Q

Do most vesicles pass spontaneously with Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease?

A

Yes

68
Q

Is suction curretage safe for the management of Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease?

A

Yes

69
Q

Is oxytocin induction recommended for the management of Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease?

A

No (can cause vesicles to break off)

70
Q

Should pregnancy be avoided for 6 months to 1 year due to high HCG levels after Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease?

A

Yes

71
Q

Are Oral contraceptives recommended after Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease?

A

Yes (*No IUD)

72
Q

What is it called when the placenta implanted in lower uterine segment near or over internal cervical os?

A

Placenta previa

73
Q

Is the classification of placenta previa based on the degree to which internal cervical os is covered by the placenta?

A

Yes

74
Q

Can a complete placenta previa allow for a vaginal delivery?

A

No

75
Q

Do partial placenta previa and marginal placenta previa commonly resolve on their own?

A

Yes

76
Q

Can placenta previa be monitored by ultrasound?

A

Yes

77
Q

Are the following a factor that increase the incidence of placenta previa?

  • C-section
  • Multiple pregnancies in a row
  • Smkoing
A

Yes

78
Q

What are the clinical manifestations of placenta previa?

A
  • Bright red painless vaginal bleeding

- Low lying placenta

79
Q

What are the primary nursing interventions if a mom comes in with manifestations of placenta previa?

A
  • Assess fetal HR

- Assess mom’s vital signs

80
Q

Should you do an internal exam if a women is suspected to have placenta previa?

A

No (may rupture placenta)

81
Q

What is the standard diagnosis technique for placenta previa?

A

Transabdominal ultrasound

82
Q

Any women with painless vaginal bleeding after 20 weeks of gestation should be tested for what?

A

Placenta previa

83
Q

Are women with placenta previa often observed frequently and put on bedrest?

A

Yes

84
Q

Does slight trendelenburg help reduce the pressure on the placenta if placenta previa present?

A

Yes

85
Q

What is it called when there is premature separation of placenta from uterus?

A

Placental abruption

86
Q

Is a placental abruption a serious complication and a medical emergency?

A

Yes, especially if there is a decrease in fetal heart sounds

87
Q

Are there different grades of a placental abruption?

A

Yes

88
Q

What are the clinical manifestation/classic symptoms of placental abruption?

A
  • Vaginal bleeding
  • Abdominal pain
  • Uterine tenderness and contractions that are not going away
89
Q

The severity of a placental abruption determines the need for what?

A

C-section

90
Q

Is it common to not know that a placental abruption has occurred?

A

Yes (until after delivery)

91
Q

What are causes of placental abruption?

A
  • Maternal HTN
  • Cocaine
  • Blunt abdominal trauma
92
Q

Can an ultrasound detect all placental abruptions?

A

No (only about 50%)

93
Q

What is the treatment of choice for placental abruption?

A

Delivery

94
Q

When is placental abruption diagnosis confirmed?

A

After birth

95
Q

What is it called when some of the fetal umbilical cord blood vessels runs across or very close to the internal opening of the cervix?

A

Velamentous Insertion (Vasa previa)

96
Q

With Velamentous Insertion (Vasa previa) rupture of the membranes or traction of cord may tear one or more fetal vessels causing what?

A

Fetus may rapidly bleed to death as result

97
Q

What is DIC?

A

Disseminated intravascular coagulation

98
Q

DIC results from what?

A

Some problem that is triggered by the clotting cascade

99
Q

DIC is an over activation of the clotting cascade which depletes what?

A

Clotting factors and platelets

100
Q

What two things may trigger DIC?

A
  • HELLP

- Preeclampsia

101
Q

Does the need for folate increase with pregnancy?

A

Yes

102
Q

Is folate a water soluble vitamin?

A

Yes

103
Q

Where is folate found?

A
  • Dark leafy green veggies
  • Citrus fruits
  • Legumes
  • Whole grains
104
Q

What is a fetal complication that may result due to folate deficiencies?

A

Neural tube defects

105
Q

How much folate should a mom get per day?

A

600mcg

106
Q

In what ways can a due date be determined?

A
  • US
  • Measurements
  • Nagele’s rule
107
Q

What is the most common method of determining an expected due date?

A

Nagele’s rule

108
Q

What is Nagele’s rule?

A
  • Determine first day of menstrual period (LMP)

- Subtract 3 months, add 7 days and 1 year

109
Q

What does Nagele’s method assume?

A

A 28 day cycle and conception on day 14

110
Q

Does bleeding in pregnancy jeopardize maternal and fetal well-being?

A

Yes

111
Q

Cervical competence is determined by what?

A

cervical length(short cervix is <25mm in length)

112
Q

Cerclage-surgical procedure in which a band is surgically placed around the cervix, typically done when?

A

11-15 weeks gestation

113
Q

What is the upper limit for cerclage placement?

A

24 weeks

114
Q

Tocolytic medications decrease UC and prevent further dilation of cervix by doing what?

A

decreasing UC

115
Q

Risks associated with cerclage include?

A
  • PROM (premature rupture of membranes)
  • Infection
  • PTL (preterm labor)
116
Q

When does vaginal bleeding typically occur with an ectopic pregnancy?

A

6-8 weeks

117
Q

An ectopic pregnancy almost always has dull LQ pain that progresses to what?

A

severe pain with bleeding

118
Q

What do many women with an ectopic pregnancy present to the ED with?

A

sharp stabbing pain

119
Q

Hydatiform moles are thought to occur from what?

A

ovular defect or a nutritional deficiency

120
Q

GTC are spectrum of pregnancy related diseases without a viable fetus in which the mole looks like what?

A

a bunch of white grapes

121
Q

Hcg levels in molar pregnancy are high and remain high beyond 10-12 weeks where they would not be high in a normal pregnancy, may have excessive vomiting due to what?

A

HcG

122
Q

Expedient dx and treatment is essential to reduce maternal and fetal morbidity and mortality with what pregnancy complication?

A

Placenta previa

123
Q

VS may be normal as a pregnancy woman can loose up to 40% of blood volume before what is seen?

A

s and S of shock are seen

124
Q

Fetal malpresentation is common due to what?

A

the low lying placenta

125
Q

With placenta prevue the purpose of expectant management is to allow the fetus what?

A

time to mature

126
Q

With placental abruption abdominal pain is described as what?

A

board like abdomen

127
Q

With placental abruption all manifestations may vary from what to what?

A

mild to severe

128
Q

With placental abruption clotting defects are present in 40% of women who develop what?

A

a large abruption

129
Q

With placental abruption abdominal pain described as board like pain and you may see what else quickly develop?

A

fetal distress and maternal shock

130
Q

The hemostatic system stops the flow of bleeding from an injured vessel, first by platelet plug which is followed by a what?

A

a fibrin clot

131
Q

There is an increased fetal demand for folate and decreased what during pregnancy?

A

GI absorption during pregnancy

Mom & Baby Exam 2 (5 decks)

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