Exam 1 - Bleeding in Pregnancy Flashcards
Exam 1
Name the 3 most common bleeding disorders of early pregnancy
(1) Miscarriage
(2) Ectopic pregnancy
(3) Gestational trophoblastic disease (molar/hydatidiform mole)
Scant bleeding is a ____ inch stain
1
Light bleeding is a ____ inch stain
1-4
Moderate bleeding is a ___ inch stain
4-6
Heavy bleeding is when…
the pad is saturated in an hour.
Loss of pregnancy before the fetus is viable / capable of living outside of the uterus is called what?
Abortion
Termination of a pregnancy without action taken by the pregnant person or any other person; natural causes
Spontaneous abortion / Miscarriage
Purposeful interruption of a pregnancy
Induced abortion
If purposeful interruption of a pregnancy is performed at the patient’s request
Elective abortion
If the purposeful interruption of a pregnancy is performed for reasons of maternal or fetal health
Therapeutic abortion
What is the primary cause of spontaneous abortion?
Chromosomal abnormalities
Frequency of early pregnancy loss will ___ with age
increase
Other causes of spontaneous abortion include…
(1) maternal infection
(2) anatomic defects
(3) environmental factors
Name at least 3 risk factors for spontaneous abortion
(1) Maternal and paternal age >40
(2) H/o miscarriage
(3) obesity
(4) Chronic disease
(5) infection
(6) environmental toxins
(7) alcohol and drug use
(8) abnormalities of the cervix or uterus
What is the management goal of spontaneous abortion?
Empty uterus of products of conception (POC)
Expectant emptying of the POC means to…
await spontaneous / complete expulsion
Medical emptying of the POC means…
using medication to induce expulsion
The 2 types of surgical emptying of the POC are
(1) Dilation and Curettage - T1
(2) Dilation and Evacuation - T2
The two complications that nurses should manage for bleeding during pregnancy are what?
(1) Infection
(2) Heavy bleeding
vaginal bleeding, closed cervix, may have other symptoms - what type of spontaneous abortion?
Threatened
Progressive bleeding, cervical dilation - what type of spontaneous abortion?
Inevitable abortion
some but not all products of conception expelled from the uterus. Active bleeding, cramps, cervix open - what type of spontaneous abortion?
Incomplete abortion
All products of conception expelled, bleeding stopped, cervix closes. What type of spontaneous abortion?
Complete abortion
Fetus dies but is retained in uterus; uterus stops growing; pregnancy symptoms may stop. What type of spontaneous abortion?
Missed abortion
3 or more consecutive pregnancy losses is called what?
Recurrent spontaneous abortion
Implantation of fertilized ovum outside the uterine cavity
Ectopic pregnancy
Lower abdominal / one-sided pain; Vaginal bleeding 5-6 weeks GA; positive pregnancy test. What is this describing?
S/S Ectopic pregnancy
Name at least 3 risk factors for ectopic pregnancy
(1) History of PID / STIs
(2) Smoking
(3) Pelvic surgery
(4) History of ectopic
(5) IUD in place
What is the management goal of ectopic pregnancy?
Preserve the fallopian tube
What is the purpose of methotrexate for ectopic pregnancy?
Stops the growth of the pregnancy
When is surgical management of ectopic pregnancy necessary?
(1) Hemorrhaging and rupture has already occurred
(2) Pregnancy is further along
When the placenta of a defective pregnancy transforms into a tumor
Gestational trophoblastic disease
______ occurs when trophoblasts form abnormally
hydatidiform mole
A complete hydatidiform mole has _____
no fetal parts
A partial hydatidiform mole has ____
fetal tissue or membranes present
Detailed follow-up after _____ disease is important because it can lead to _____
gestational trophoblastic; cancer
In early pregnancy bleeding, name at least 3 things nurses should do.
(1) assess bleeding, vital signs, pain, complications
(2) intervene - notify provider, supportive care, education
(3) labs - CBC, hcG, blood type & Rh
Name the 2 main bleeding conditions of late pregnancy
(1) Placenta previa
(2) Placental abruption
When the placenta completely or partially covers the cervix
Placenta previa
Name 3 risk factors for placenta previa.
(1) previous C-section or uterine surgery
(2) 35+ yo
(3) Smoking or cocaine use
Name the 3 main complications r/t placenta previa
(1) bleed in pregnancy, l&d
(2) preterm birth
(3) placenta accreta
A sudden onset of painless, bright red bleeding. What is this describing?
Placenta previa
What is one thing you should NEVER do with placenta previa and why?
Vaginal exams because it can cause further bleeding and tissue trauma
When the placenta detaches from the uterine wall before birth
Placental abruption
Name at least 3 risk factors for placental abruption
(1) HTN
(2) Smoking
(3) Multigravida
(4) Abdominal trauma
(5) IPV
(6) Cocaine use
(7) Lupus
(8) Factor V Leiden
rigid taut abdomen d/t uterine irritability is called what?
High uterine resting tone
High uterine resting tone and uterine tenderness are signs of what?
Placental abruption
If placental abruption is mild and the fetus is <34 weeks, what is the treatment?
Hospitalization, bedrest, Rhogam
If placental abruption is an emergency, what should the nurse do?
(1) maternal and fetal monitoring
(2) IV insertion
