Haemorrhagic Conditions of Late Pregnancy Flashcards
What are the three types of placenta previa and can you differentiate between them?
Complete, Partial, and Marginal or Low-lying – the difference is in how much of the internal cervical is covered by the placenta.
What is the characteristic manifestation of placenta previa?
Painless vaginal bleeding in the latter half of the pregnancy
A woman who has experienced excessive vaginal bleeding at 32 weeks of gestation has come into the emergency room. A newly qualified nurse is taking care of the patient and is preparing for manual examination to see if the cervix has fully dilated. What would you do?
Stop the nurse. Until placenta previa can be ruled out by ultrasound, manual examinations should not be done for patients coming into the hospital with vaginal bleeding because this may interrupt connection between the maternal and placental blood vessels.
Give at least three factors that need to be considered when determining whether delivery should be delayed or fast-tracked for a woman with confirmed placenta previa.
Age of gestation
Fetal well-being
Cardiovascular status of the woman
What signs and symptoms should the nurse watch out for in a patient with placenta previa who is having conservative management?
Any significant change in FHR, episode of increased vaginal bleeding, signs of pre-term labor and rupture of membranes should be reported immediately.
A lot of these disorders cause bleeding and the possibility of hypovolemic shock. What are the s/s of hypovolemic shock caused by blood loss (name at least four)?
Vital signs changes: decreased BP, increased RR and HR
Weak, thready pulse
Cool, moist skin, pallor or cyanosis (late sign\0
Decreased urine output (most sensitive indicator of cardiac output)
Decreased Hb and Hct levels
Change in mental status i.e. restlessness, agitation, difficulty concentrating
Which FHR pattern, if found in a woman with s/s of abruptio placentae, is a major concern and may necessitate prompt delivery of the baby?
Persistent late decelerations
What are the five classic signs of abruptio placentae?
Vaginal bleeding (which may not reflect the true amount of blood loss)
Abdominal and low back pain, often described as aching or dull
Uterine irritability with frequent low-intensity contractions
High uterine resting tone, as determined using an intrauterine pressure catheter
Uterine tenderness that may be localized to the site of the abruption
What characteristic finding would you expect to see in the amniotic fluid of a woman with abruptio placentae?
Port-wine color
What are the s/s of concealed bleeding with abruptio placentae?
Remember, blood could be HIDING:
Hard, tender uterus
Haemorrhage, early signs and symptoms of
Increased fundal height
Decreased fetal movement
Intense, persistent abdominal pain
Non-reassuring FHR: late decelerations, decreased baseline variability
Greater/higher tone of uterus on electronic monitoring strip
Name the major danger of abruptio placentae to the mother (3Hs) and fetus (3 Ps)
Mother
Haemorrhage: fetal vessels will be disrupted as placental separation occurs causing bleeding in both the mother and the fetus
Hypovolemic shock
Hypercoagulation (DIC)
Fetus
Premature birth:
Poor oxygenation: hematoma can expand and obliterate intervillous spaces where fetal gas and nutrient exchange occurs
Profuse blood loss:
What position would best promote oxygenation to a woman experiencing bleeding in the third trimester of pregnancy?
Lateral with head of bed flat
