Complications during Pregnancy: Bleeding Flashcards
True or false: Vaginal bleeding during pregnancy may be normal.
False
Vaginal bleeding during pregnancy is always abnormal and must be carefully investigated to determine the cause.
Causes of bleeding during the first trimester of pregnancy (2 answers)
- Spontaneous abortion
- Ectopic pregnancy
Causes of bleeding during the second trimester of pregnancy (2 answers)
- Gestational trophoblastic disease
- Incompetent cervix
Causes of bleeding during the third trimester of pregnancy (3 answers)
- Placenta previa
- Abruptio placenta
- Preterm labor
Spontaneous abortion is when a pregnancy is terminated when? (2 answers)
- Before 20 weeks gestation (point of fetal viability)
- Fetal weight is less than 500 g
Risk factors for spontaneous abortion (8 answers)
S.A.T.C.C.A.M.M.
- Substance abuse
- Advancing maternal age
- Trauma or injury
- Chromosomal abnormalities (most common cause; 50% of cases)
- Chronic maternal infections
- Anomalies in the fetus or placenta
- Maternal illness (e.g., insulin-dependent DM)
- Maternal malnutrition
Diagnostic procedures for spontaneous abortion (5 answers)
C.W.U.S.H.
- Clotting factors (monitor for disseminated intravascular coagulopathy)
- WBC (check for infection)
- Ultrasound of cervix (to check if opened or closed)
- Serum human chorionic gonadotropin (hCG)
- Hgb, Hct if considerable blood loss
Types of miscarriages (6 answers)
- Threatened
- Inevitable
- Incomplete
- Complete
- Missed
- Recurrent
Spontaneous abortion / Miscarriage assessment
Give the status of each assessment parameter. Char!
Threatened miscarriage
a. Cramps
b. Bleeding
c. Tissue passed
d. Cervix
a. Slight cramps
b. Spotting - moderate
c. None
d. Closed
Spontaneous abortion / Miscarriage assessment
Give the status of each assessment parameter.
Inevitable miscarriage
a. Cramps
b. Bleeding
c. Tissue passed
d. Cervix
a. Moderate
b. Mild to severe
c. None
d. Dilated
Spontaneous abortion / Miscarriage assessment
Give the status of each assessment parameter.
Incomplete miscarriage
a. Cramps
b. Bleeding
c. Tissue passed
d. Cervix
a. Severe
b. Continuous and severe
c. Partial fetal tissue or placenta
d. Dilated
Spontaneous abortion / Miscarriage assessment
Give the status of each assessment parameter.
Complete miscarriage
a. Cramps
b. Bleeding
c. Tissue passed
d. Cervix
a. None
b. Minimal
c. Complete expulsion of uterine contents
d. Open then closes after passage of tissues
Spontaneous abortion / Miscarriage assessment
Give the status of each assessment parameter.
Missed miscarriage
a. Cramps
b. Bleeding
c. Tissue passed
d. Cervix
a. None
b. Brownish discharge
c. None
d. Closed
Spontaneous abortion / Miscarriage assessment
Recurrent miscarriage
Habitual abortion; three consecutive miscarriages
Nursing interventions for clients with spontaneous abortion
a. Immediate management (3 answers)
b. Medications (3 answers)
a.
- Perform pregnancy test
- Bed rest with sedation for threatened, inevitable, and incomplete abortions
- Determine how much tissue has passed; save passed tissue for examination
b.
- Administer:
- blood products as prescribed
- IV oxytocin as prescribed to expulse products of conception
- broad spectrum antibiotics
- RhoGRAM to Rh-negative clients
Nursing interventions for clients with spontaneous abortion
c. Procedures (2 answers)
d. Health teaching (3 answers)
c.
- Assist with termination of pregnancy (e.g., D&C, D&E) as indicated
- Avoid vaginal exam
d.
- Use lay term for miscarriage with clients
- Advise clients with threatened abortion to avoid coitus
- Provide client education and support
Defined as the abnormal implantation of the fertilized ovum outside of the uterine cavity
Ectopic pregnancy
Where does implantation usually occur during ectopic pregnancy?
Fallopian tube (this results in a fatal hemorrhage)
Risk factors for ectopic pregnancy (8 answers; from quizlet + SLRC)
E.C.T.O.P.I.C.S.
- Endometriosis
- Contraceptives (IUD)
- Tubal surgery
- Other abdominal surgery
- Pelvic inflammatory disease (PID)
- Infertility treatment
- Can’t find a reason (idiopathic)
- Smoking/STD
Diagnostic procedures for ectopic pregnancy (3 answers)
- Transabdominal ultrasound
- Culdocentesis (if utz not available)
- WBC count elevated to 15,000 mm^3
Nursing assessment for ectopic pregnancy
N.O.U.R.S.S. ,,, naurrrr saurri
- Nausea and vomiting
- One or two missed menses
- Unilateral stabbing pain and tenderness in lower abdominal quadrant
- Referred shoulder pain
- Scant, dark red, or brown vaginal spotting
- Symptoms of hemorrhage and shock (e.g., hypotension, tachycardia, pallor)
Medication used to inhibit cell division and enlargement of embryo; also prevents rupture of fallopian tube; used in ectopic pregnancy
Methotrexate
Surgical management for ectopic pregnancy
This procedure is done to salvage the fallopian tube if not ruptured
Linear salpingostomy
Surgical management for ectopic pregnancy
This procedure is done when the fallopian tube has ruptured
Laparoscopic salpingostomy (removal of the tube)
Nursing management for ectopic pregnancy
- Replacement fo fluids and electrolytes
- Provide client education and support
- Prepare client for surgery and postoperative nursing care
The proliferation and degeneration of trophoblastic villi in the placenta which takes on the appearance of grape-like clusters
Gestational trophoblastic disease (H-mole)
Nursing assessment for GTD (4 answers)
R.E.V.S.
- Rapid uterine growth larger than expected
- Excessive vomiting
- Vaginal bleeding at approx 16 weeks gestation
- Symptoms of pregnancy-induced hypertension that occur prior to 20 weeks gestation (e.g., hpn, edema, proteinuria)
Nursing interventions for GTD (4 answers)
- Advise client to bring any passed clots or tissue for examination
- Administer RhoGAM to RH-negative clients
- Instruct client to use reliable contraception for 6-12 months
- Emphasize importance of follow-up because of risk of choriocarcinoma
The painless passive dilation of the cervix in the absence of uterine contractions, occurs around week 20 of gestation
Incompetent cervix
Risk factors of incompetent cervix (4 answers)
I.C.H.I.
- Increased maternal age
- Congenital structural defects
- History of cervical trauma
- In utero exposure to diethylstilbestrol
Nursing assessment for incompetent cervix (4 answers)
- Pink-stained vaginal discharge or bleeding
- Increase in pelvic pressure
- Possible gush of fluid
- Uterine contractions with expulsion of fetus
Nursing interventions (6 answers)
- Activity restrictions/bed rest
- Hydration
- Administer tocolytic prophylactically to inhibit uterine contractions
- No intercourse
- No standing for more than 90 mins
- No heavy lifting
Condition in which the placenta abnormally implants in the lower segment of the uterus near or over the cervical os instead of attaching to the fundus.
Placenta previa
Three types of placenta previa (with descriptions)
- Complete or total - cervical os is completely covered by placental attachment
- Incomplete or partial - cervical os is only partially covered by placental attachment
- Marginal - placenta is attached in the lower uterine segment but does not reach cervical os
Nursing assessments for placenta previa (5 answers)
- Palpable placenta
- Painless, bright red vaginal bleeding
- Fundal height greater than expected
- Soft, relaxed, nontender uterus
- Breech or transverse position of fetus
may pagka rude ako na think na mnemonics ani,,, placenta previa fookin sooks bools BAHAHAHA
Nursing interventions for placenta previa (5 answers)
- IV fluids
- Corticosteroids for fetal lung maturity
- Nothing inserted vaginally
- Bed rest
- Blood replacement as prescribed
in case no baby born…
The premature separation of the placenta from the uterus (can be partial or complete detachment)
Abruptio placenta
Nursing assessment for abruptio placenta (6 answers)
- Sudden onset of intense localized uterine pain
- Vaginal bleeding (bright or dark red)
- Tender, board-like abdomen
- Firm rigid uterus with contractions (uterine hypertonicity)
- Fetal distress
- Symptoms of hypovolemic shock
svt, ffs!!!!! char haixt another not wholesome mnemonic
Nursing interventions for abruptio placenta
- Avoid vaginal exams (may exacerbate bleeding)
- Blood products administration
- Rh-negative clients should be given immune globulin
- Provide emotional support
- Corticosteroids for fetal lung maturity
- Deliver fetus (treatment of choice)
- Fluid volume replacement
ABRPCDF
ABRP from abruptio, then CDF nlang dayon kay wla ko ma think memomik
Group of conditions wherein the placenta attaches itself too deeplt into the wall of the uterus
Placenta accerta spectrum
This occurs when the placenta attaches too deep into the uterine wall but does not penetrate the uterine muscle; most common of the three, occuring in 75% of all cases
Placenta accreta
This occurs when the placenta attaches even deeper into the uterine wall and penetrates into the uterine muscle; accounts for 15% of the cases
Placenta increta
This occurs when the palcena penetrates through the entire uterine wall and attaches to another organ such as the bladder; accounting for 5% of the cases
Placenta percreta
Risk factors of placenta accreta (2 answers)
- Placenta previa
- Previous cesarean deliveries
Surgical management of placenta accreta (2 answers)
- Premature delivery of fetus
- Hysterectomy to prevent damage to neighboring organs
Nursing interventions for placenta accreta (7 answers)
- Blood product administration
- Immune globulin for Rh-negative clients
- Fluid volume replacement
- Corticosteroids for fetal lung maturity
- Avoid vaginal exams
- Schedule for C section before 37 weeks
- Emotional support
BIFCASE… :(
