Ch28 study guide/PP, exam 3 (Hemorrhagic Disorders)

Question 1

common bleeding disorders of early pregnancy

Answer 1

• Miscarriage (spontaneous abortion)
• Reduced cervical competence (premature cervical dilation)
• Ectopic pregnancy
• Hydatidiform mole (molar pregnancy)

Question 2

common bleeding disorders of late pregnancy

Answer 2

• Placenta previa

- Premature separation of placenta

Question 3

pregnancy that ends as a result of natural causes before 20 weeks of gestation (the point of viability when the fetus may survive outside the uterus)

Answer 3

spontaneous miscarriage (abortion)

Question 4

5 types of spontaneous miscarriage

Answer 4

1. Threatened
2. Inevitable
3. Incomplete
4. Complete
5. Missed

Question 5

term used to refer to 3 or more spontaneous pregnancy losses prior to 20 weeks gestation

Answer 5

recurrent (habitual) miscarriage

Question 6

placental hormone used in the diagnosis of pregnancy and pregnancy loss

Answer 6

human chorionic gonadotropin (hCG)

Question 7

surgical procedure in which the cervix is widened and an instrument is inserted to scrape the uterine walls and remove uterine contents

Answer 7

dilation and curettage (D&C)

Question 8

a cause of late miscarriage

traditionally defined as passive and painless dilation of the cervix during the second trimester

Answer 8

cervical insufficiency

Question 9

procedure in which a suture is placed around the cervix beneath the mucosa to constrict the internal os of the cervix

Answer 9

cerclage

Question 10

pregnancy in which the fertilized ovum is implanted outside the uterine cavity, usually in the ampulla or largest part of the uterine tube

Answer 10

ectopic (tubal) pregnancy

Question 11

an ecchymotic blueness around the umbilicus indicating hematoperitonerm
(may develop in an undiagnosed intraabdominal ectopic pregnancy)

Answer 11

Cullen sign

Question 12

a gestational trophoblastic disease (GTD)

it is a benign proliferative growth of the placental trophoblast

Answer 12

hydatidiform mole (molar pregnancy)

Question 13

a group of pregnancy-related trophoblastic proliferative disorders without a viable fetus
(caused by abnormal fertilization)

Answer 13

gestational trophoblastic disease (GTD)

Question 14

term used to refer to the result of fertilization of an egg with a lost of inactivated nucleus
(it resembles a bunch of white grapes)
- increased risk for persistent GTD

Answer 14

complete hydatidiform mole

Question 15

term used to refer to the result of two or more sperm fertilizing an apparently normal ovum
(embryonic or fetal parts and an amniotic sac are often present in the uterus)

Answer 15

partial hydatidiform mole

Question 16

implantation of the placenta in the lower uterine segment such that it completely or partially covers the cervix or is close enough to the cervix to cause bleeding when dilation or effacement occurs

Answer 16

placenta previa

Question 17

major placental complications involving abnormal attachment to the uterus that inhibits the placental separation process after birth and can result in hemorrhage

Answer 17

• accreta
• increta
• precreta

Question 18

detachment of part or all of a normally implanted placenta from the uterus

Answer 18

premature separation of the placenta (abruption placentae)

Question 19

disorder of the uterus in which blood accumulates between a separating placenta and the uterine wall
(the uterus appears purple or blue and contractility is lost)

Answer 19

couvelaire uterus

Question 20

type of vasa previa when the cord vessels begin to branch at the membranes and then course onto the placenta

Answer 20

velamentou insertion of the cord

Question 21

marginal insertion of the cord into the placenta

Answer 21

Battledore placenta

Question 22

type of vasa previa when the placenta is divided into two or more separate lobes
(fetal vessels run between the lobes)

Answer 22

succenturiate placenta

Question 23

pathologic form of clotting that is diffuse and consumes large amounts of clotting factors, causing widespread external bleeding, internal bleeding, or both, and clotting

Answer 23

disseminated intravascular coagulation (DIC) or consumptive coagulopathy

Question 24

stillbirth gestational age

Answer 24

20 weeks or more

Question 25

treatment of choice for cervical insufficiency

Answer 25

cerclage

Question 26

cerclage procedure

Answer 26

McDonald technique

Question 27

cerclage followup care

Answer 27

best rest, pelvic rest (no sex)

Question 28

disseminated intravascular coagulation (DIC) characteristics

Answer 28

clotting, bleeding, & ischemia

• always a secondary diagnosis

Question 29

disseminated intravascular coagulation (DIC) possible causes

Answer 29

Placental abruption
Retained dead fetus syndrome
Amniotic fluid embolus
Preeclampsia HELLP syndrome
Gram-negative sepsis

Question 30

disseminated intravascular coagulation (DIC) diagnosis

Answer 30

laboratory tests, may see clinical manifestations upon assessment

Question 31

disseminated intravascular coagulation (DIC) management

Answer 31

correct the underlying cause, supportive management, & continue to monitor labs