class 2: antepartum bleeding

Question 1

what are the causes of early pregnancy bleeding

Answer 1

miscarriage/spontaneous abortion
premature dilation of cervix
ectopic pregnancy
(always non-viable)

Question 2

what are the main causes of late pregnancy bleeding

Answer 2

placenta previa
placental abruption
variations in cord insertion

Question 3

what classifies a misscarriage

Answer 3

loss less than 20 weeks

Question 4

what are the clinical manifestations of a miscarriage

Answer 4

bleeding, uterine cramping, low back pain (similar to uterine cramps)

Question 5

what is expectant management

Answer 5

nothing you can do, just let it happen
mother may need D&C if there is extra products left in the uterus

Question 6

go through 4 types of abortion

Question 7

when should you give a mother Anti-D (the Rh immunisation) after miscarriage

Answer 7

if fetal hemmorhage occurs
if miscarriage

Question 8

what does cerclage do

Answer 8

stitch to keep Cervix closed if there is premature dilation of cervix

Question 9

what are the symptoms of premature dilation of cervix and how do we manage

Answer 9

literally just painless dilation
manage by restricting activity, hydration and assessing amniotic fluid levels

Question 10

what is placenta prevue

Answer 10

when placenta implants in lower uterine segment near or over the internal cervix

Question 11

what is one random risk factor for placenta previa

Answer 11

living at a higher altitude

Question 12

what are the main clinical manifestations of placenta previa

Answer 12

PAINLESS bright red vaginal bleeding in the second and third trimester
uterus will be soft relaxed and non tender (will feel normal)
fundal height may be larger than expected

Question 13

when is placenta previa diagnosed

Answer 13

Around 20 weeks

Question 14

what are the main complications with placenta previa

Answer 14

hemmorhage, hypovolemic shock (monitor vitals closely they decompensated very quickly)
preterm birth
stillbirth
IUGR

Question 15

what are important things a nurse should do with a patient with placenta previa

Answer 15

NO VAGINAL EXAM
no sex
manage plan depending on how baby is doing
active bleeding requires immediate caesarian
if PP is marginal you may attempt vaginal birth if head is an ok size
also give antepartum steroids to promote fetal lung maturity if between 24-34 weeks when delivery is expected within 7 days

Question 16

when should Caesarian absolutely happen for Placenta previa

Answer 16

at 37 weeks

Question 17

when can placental abruption occur

Answer 17

any time after 20 weeks

Question 18

what are the clinical manifestations of placental abruption

Answer 18

sudden intense, localise pain with or without vaginal bleeding
dark non clotting bleeding
abdominal pain or blowback pain
board like abdomen - will feel hard between contractions
port wine stained amniotic fluid
FHR: loss of variability and late decelerations

Question 19

what are the main complicaiton s for placental abruption

Answer 19

look at slide 115