Ch. 28 Hemorrhagic Disorders of Pregnancy Flashcards
1
Q
Are hemorrhagic disorders during pregnancy a medical emergency?
A
Yes
2
Q
Bleeding that is more than spotting is a sign of what during pregnancy?
A
That something is jeopardized and needs investigation
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?
4
Q
Maternal blood loss decreases what to fetus?
A
Oxygen carrying capacity
5
Q
-Hypovolemia
-Anemia
-Infection
-Preterm labor
-Preterm birth
…are all at an increased risk of occurrence with what?
A
Maternal blood loss
6
Q
What are fetal risks when there is maternal blood loss?
A
- Hypoxia
- Anemia
- Anoxia
- Preterm birth
7
Q
A miscarriage is also known as what?
A
Spontaneous abortion
8
Q
A pregnancy that ends as a result of natural causes prior to 20 weeks of gestation is called what?
A
Miscarriage
9
Q
-Threatened
-Inevitable
-Complete
-Missed
-Recurrent
… are all types of what that can happen?
A
Miscarriages
10
Q
What has occurred when the cervical opening (os) is closed but there is some spotting?
A
Threatened miscarriage
11
Q
What has occurred when the cervical opening (os) is open and a moderate amount of bleeding occurs?
A
Inevitable miscarriage
12
Q
What has occurred when the cervix closes after are contents have been expelled?
A
Complete miscarriagae
13
Q
What has occurred when the fetus has died, but contents remain in the uterus?
A
Missed miscarriage
14
Q
What has occurred when a mom has experienced 3 or more miscarriages?
A
Recurrent miscarriages
15
Q
-Cramping
-Abdominal tenderness
-Backache
-ROM
-Fever
-Dilation of cervix
-Passage of tissue
… are S/S that what has occurred?
A
Spontaneous abortion
16
Q
The diagnosis of a spontaneous abortion is done through what?
A
The S/S present or through ultrasound
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
18
Q
What are other risk factors for miscarriages?
A
- Smoking
- Excessive alcohol or caffeine
- Age
19
Q
When does a late miscarriage occur?
A
Second trimester (12-20 weeks)
20
Q
What are late miscarriages usually a result of?
A
Maternal causes
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
22
Q
What is the medical management of a spontaneous abortion?
A
-Misoprostol intravaginally or PO (“cytotec”)
23
Q
What is the primary choice of surgical management of a spontaneous abortion?
A
- D&C
- Oxytocin to prevent hemorrhage (“pitocin”)
24
Q
What is the second drug of choice for surgical management of a spontaneous abortion?
A
-Methergine given IM or oral (“ergot product”)
25
When and why can methergine not be used?
If BP is >140/90 due to risk for stroke
26
What is the third drug of choice for surgical management of a spontaneous abortion?
-Hemabate (means things are serious)
27
When is Rh immune globulin given if Rh negative to prevent complications with future pregnancies?
within 72 hours
28
Painless dilation of the cervix without contractions is known as what?
Incompetent Cervix or Cervical insufficiency
29
Is cervical incompetence a cause of late miscarriages?
Yes
30
Is congenital cervical incompetence common?
Not anymore
31
How is acquired cervical incompetence obtained usually?
- Infection (STI's)
- Trauma
- Increased uterine volume (large babies, multiple gestations= pressure of cervix)
32
What is a subjective S/S of incompetent cervix?
Increased pelvic pressure
33
What are objective S/S of an incompetent cervix?
- ROM
- Contractions
- Expulsion of fetus
- Gush of fluid
34
How is an incompetent cervix diagnosed?
Abdominal or transvaginal ultrasound
35
A cerclage procedure is done for what?
An incompetent cervix
36
-Bedrest
-Avoiding sexual intercourse
-Tocolytic medications
*Education (prevent premature delivery)
...are all part of follow-up care for what type of procedure?
Cerclage
37
When can the Cerclage be removed?
After 37 weeks of gestation
38
What are risks of a Cerclage procedure?
- Infection
- Bleeding
- Fetal loss
- Rupture of fluid
39
What is it called when the fertilized ovum is implanted outside the uterine cavity?
Ectopic pregnancy
40
Where are most ectopic pregnancies located?
Ampulla (tubal pregnancy)
41
Can an ectopic pregnancy be painful and a medical emergency?
Yes
42
Can an ectopic pregnancy survive?
No
43
Can ectopic pregnancies increase risk of maternal death?
Yes
44
Are you less likely to have a successful pregnancy after experiencing a ectopic pregnancy?
Yes
45
What is the leading cause of infertility and increased difficulty conceiving after?
Ectopic pregnancy
46
-STI's (untreated/undiagnosed)
-Recurrent infections
-Smoking
-Reproductive technologies
... are all risk factors for what?
Ectopic pregnancy
47
What are clinical manifestations of an ectopic pregnancy?
- Abdominal pain
- Delayed menses
- Abnormal vaginal bleeding
48
How are ectopic pregnancies diagnosed?
- Elevated HCG
- No normal uterine pregnancy (Ultrasound)
- Decrease in progesterone
- Increase in WBCs
49
What are the two surgical interventions for an ectopic pregnancy?
- Salpingectomy (removing tube)
| - Salpingostomy (opening tube, scraping, and letting heal on own)
50
What is the drug used for a medical intervention of an ectopic pregnancy?
Methotrexate
51
How does methotrexate work when used for an ectopic pregnancy?
Destroys cells/dissolves pregnancy
52
Can methotrexate be used for an ectopic pregnancy if the mom is not in stable condition?
No, due to possible hemorrhage
53
Future fertility after an ectopic pregnancy due to the high rate of what?
Reoccurrence
54
How long should a women be on contraception for at the minimum after an ectopic pregnancy?
3 months to let hormones return to normal
55
Do Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease (GTD) all mean the same thing?
Yes
56
What is the abnormal form of pregnancy where non viable fertilized egg implants in the uterus?
Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease
57
During Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease is there a viable fetus present?
No
58
Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease may be related to what two things?
- Ovular defect
| - Nutritional deficiency
59
Clomid which is a common fertility drug is a risk factor for what?
Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease
60
-Early teens or older than 40
-Hx of miscarriages
-Deficiency of carotene and animal fats
... are also risk factors for what?
Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease
61
May early stages of Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease look like a normal pregnancy?
Yes
62
Bright red or brown vaginal (like prune juice) bleeding is a late stage sign of what?
Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease
63
Does Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease usually cause and excessively enlarged uterus?
Yes
64
Women have anemia from blood loss, n/v, abdominal cramps, and pass vesicles in which complication of pregnancy?
Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease
65
Does Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease cause 75% of women to develop preeclampsia?
Yes
66
How is Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease diagnosed?
- US
| - High levels of HCG
67
Do most vesicles pass spontaneously with Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease?
Yes
68
Is suction curretage safe for the management of Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease?
Yes
69
Is oxytocin induction recommended for the management of Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease?
No (can cause vesicles to break off)
70
Should pregnancy be avoided for 6 months to 1 year due to high HCG levels after Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease?
Yes
71
Are Oral contraceptives recommended after Hydatidifrom Mole, Molar pregnancy, and Gestation Trophoblastic Disease?
Yes (*No IUD)
72
What is it called when the placenta implanted in lower uterine segment near or over internal cervical os?
Placenta previa
73
Is the classification of placenta previa based on the degree to which internal cervical os is covered by the placenta?
Yes
74
Can a complete placenta previa allow for a vaginal delivery?
No
75
Do partial placenta previa and marginal placenta previa commonly resolve on their own?
Yes
76
Can placenta previa be monitored by ultrasound?
Yes
77
Are the following a factor that increase the incidence of placenta previa?
- C-section
- Multiple pregnancies in a row
- Smkoing
Yes
78
What are the clinical manifestations of placenta previa?
- Bright red painless vaginal bleeding
| - Low lying placenta
79
What are the primary nursing interventions if a mom comes in with manifestations of placenta previa?
- Assess fetal HR
| - Assess mom's vital signs
80
Should you do an internal exam if a women is suspected to have placenta previa?
No (may rupture placenta)
81
What is the standard diagnosis technique for placenta previa?
Transabdominal ultrasound
82
Any women with painless vaginal bleeding after 20 weeks of gestation should be tested for what?
Placenta previa
83
Are women with placenta previa often observed frequently and put on bedrest?
Yes
84
Does slight trendelenburg help reduce the pressure on the placenta if placenta previa present?
Yes
85
What is it called when there is premature separation of placenta from uterus?
Placental abruption
86
Is a placental abruption a serious complication and a medical emergency?
Yes, especially if there is a decrease in fetal heart sounds
87
Are there different grades of a placental abruption?
Yes
88
What are the clinical manifestation/classic symptoms of placental abruption?
- Vaginal bleeding
- Abdominal pain
- Uterine tenderness and contractions that are not going away
89
The severity of a placental abruption determines the need for what?
C-section
90
Is it common to not know that a placental abruption has occurred?
Yes (until after delivery)
91
What are causes of placental abruption?
- Maternal HTN
- Cocaine
- Blunt abdominal trauma
92
Can an ultrasound detect all placental abruptions?
No (only about 50%)
93
What is the treatment of choice for placental abruption?
Delivery
94
When is placental abruption diagnosis confirmed?
After birth
95
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?
Velamentous Insertion (Vasa previa)
96
With Velamentous Insertion (Vasa previa) rupture of the membranes or traction of cord may tear one or more fetal vessels causing what?
Fetus may rapidly bleed to death as result
97
What is DIC?
Disseminated intravascular coagulation
98
DIC results from what?
Some problem that is triggered by the clotting cascade
99
DIC is an over activation of the clotting cascade which depletes what?
Clotting factors and platelets
100
What two things may trigger DIC?
- HELLP
| - Preeclampsia
101
Does the need for folate increase with pregnancy?
Yes
102
Is folate a water soluble vitamin?
Yes
103
Where is folate found?
- Dark leafy green veggies
- Citrus fruits
- Legumes
- Whole grains
104
What is a fetal complication that may result due to folate deficiencies?
Neural tube defects
105
How much folate should a mom get per day?
600mcg
106
In what ways can a due date be determined?
- US
- Measurements
- Nagele's rule
107
What is the most common method of determining an expected due date?
Nagele's rule
108
What is Nagele's rule?
- Determine first day of menstrual period (LMP)
| - Subtract 3 months, add 7 days and 1 year
109
What does Nagele's method assume?
A 28 day cycle and conception on day 14
110
Does bleeding in pregnancy jeopardize maternal and fetal well-being?
Yes
111
Cervical competence is determined by what?
cervical length(short cervix is <25mm in length)
112
Cerclage-surgical procedure in which a band is surgically placed around the cervix, typically done when?
11-15 weeks gestation
113
What is the upper limit for cerclage placement?
24 weeks
114
Tocolytic medications decrease UC and prevent further dilation of cervix by doing what?
decreasing UC
115
Risks associated with cerclage include?
- PROM (premature rupture of membranes)
- Infection
- PTL (preterm labor)
116
When does vaginal bleeding typically occur with an ectopic pregnancy?
6-8 weeks
117
An ectopic pregnancy almost always has dull LQ pain that progresses to what?
severe pain with bleeding
118
What do many women with an ectopic pregnancy present to the ED with?
sharp stabbing pain
119
Hydatiform moles are thought to occur from what?
ovular defect or a nutritional deficiency
120
GTC are spectrum of pregnancy related diseases without a viable fetus in which the mole looks like what?
a bunch of white grapes
121
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?
HcG
122
Expedient dx and treatment is essential to reduce maternal and fetal morbidity and mortality with what pregnancy complication?
Placenta previa
123
VS may be normal as a pregnancy woman can loose up to 40% of blood volume before what is seen?
s and S of shock are seen
124
Fetal malpresentation is common due to what?
the low lying placenta
125
With placenta prevue the purpose of expectant management is to allow the fetus what?
time to mature
126
With placental abruption abdominal pain is described as what?
board like abdomen
127
With placental abruption all manifestations may vary from what to what?
mild to severe
128
With placental abruption clotting defects are present in 40% of women who develop what?
a large abruption
129
With placental abruption abdominal pain described as board like pain and you may see what else quickly develop?
fetal distress and maternal shock
130
The hemostatic system stops the flow of bleeding from an injured vessel, first by platelet plug which is followed by a what?
a fibrin clot
131
There is an increased fetal demand for folate and decreased what during pregnancy?
GI absorption during pregnancy
