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Maternal Exam 3 > Hemorrhage Disorders > Flashcards

Hemorrhage Disorders Flashcards

1
Q

What is a miscarriage?

A

Considered a spontaneous abortion from natural causes

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2
Q

What is a major symptom of miscarriage?

A

Early bleeding in first trimester BUT this doesn’t mean an automatic miscarriage yet. Need to go to doctor to check

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3
Q

Legal documentation for miscarriage/spontaneous abortion?

A

Less than 20 weeks.

If you’re not sure how old the fetus is, then if it is less than 500 grams

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4
Q

Induced miscarriage

A

Intentional termination of pregnancy

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5
Q

When do majority of miscarriages happen?

A

Before 12 weeks gestation. Some moms may not even realize they were pregnant to begin with.

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6
Q

Etiology of Miscarriages

A 
Chromosomal abnormalities
Teratogenic drugs 
Faulty implantation
Weak cervix
Placental abnormalities
Chronic maternal disease like diabetes 
Smoking
Alcohol abuse
Advanced maternal age
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7
Q

Explain why chromosomal abnormalities may cause miscarriage

A

A fetus’s chromosomes may not be compatible for life

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8
Q

Explain why teratogenic drugs can cause miscarriage

A

Teratogenic means the drug is able to cross the placenta. And if it can cross, it affects the fetus wellbeing and can cause miscarriage.

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9
Q

Explain why faulty implantation can cause miscarraige

A

A faulty implantation means the egg and sperm implanted in the uterus where they couldn’t survive well enough to develop.

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10
Q

Explain how a weakened cervix can cause miscarriage

A

Weakened or incompetent cervix means the cervix opens too early on in PG despite the baby not being ready for life. If the cervix opens, the uterus contents could be expelled too early and cause miscarriage.

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11
Q

Explain how placental abnormalities could cause a miscarriage

A

Anything regulated to the placenta being abnormal can harm the fetus’s development. The placenta is the life-line to mom.

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12
Q

Explain or list chronic maternal diseases that can cause miscarriage

A

Diabetes or Hypertension are some to name a few

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13
Q

Explain how smoking or alcohol abuse can cause miscarriage

A

Each of these impacts mom and fetus in a negative way.
Smoking leads to decreased oxygenation.
Alcohol abuse can affect the baby’s viability in the womb

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14
Q

Explain how advanced age can cause miscarriage

A

If over the age of 40, they are twice as likely to have a miscarriage than a 20 yr old

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15
Q

Threatened abortion

A

Cervix is closed but there is bleeding, cramping, and backache

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16
Q

Imminent or inevitable abortion

A

Cervix is dilating/opening and it is just a matter time of miscarriage.
Increased bleeding and cramping

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17
Q

Incomplete abortion

A

Fetus is expelled but the placenta is left behind
Heavier bleeding

Mom may need to go back for surgery to remove the placenta

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18
Q

Complete abortion

A

Both the fetus and placenta have expelled as it is supposed to leaving the uterus empty and able to close. Bleeding is dim.

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19
Q

Missed abortion

What are common signs of missed abortion?

What risks happen if mom retains it or it is left in her?

A

When the fetus dies but it remains in the womb.

Mom may notice her PG symptoms going away. Breasts loose engorgement, no n/v.

1) DIC bleeding due to composing tissue releasing toxins that ruin clotting ability
2) Sepsis due to necrosing tissue harvesting bacteria

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20
Q

Recurrent pregnancy loss

Why might this happen?

A

Losing 2 consecutive miscarriages

Hormones or Structural abnormality (fibroids, faulty cervix) going on here

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21
Q

Septic abortion

What is this associated with?

What is indicated here for diagnosis?

A

Miscarriage from infection

Can be associated with IUD or SROM not being septic
A aseptic back-alley abortion

Culture and sensitivity

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22
Q

Threatened abortion Assessment:

What will they do first?

What can aid in evaluation?

Additional labs they may do to rule things out?

Diagnostic testing done to see if baby is till alive?

A

Threatened abortion: possible abortion on the way. Spotting and pain

First, look at her cervix.

HCG qualitative and quantitative

CBC to evaluate sepsis and anemia possibility

Ultrasound bc it can check baby heart

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23
Q

Threatened abortion post assessment if baby is still viable:

Instruct her to do what?

What meds?

What are we hoping for?

A

If baby is still alive:

Tell her bed rest short term but it is to help her emotions bc there’s probably not a way to prevent it .
Vagina rest as well. NOTHING GOES IN LOL

Benadryl for rest
Tylenol for discomfort

Stop spotting and cramping over next days

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24
Q

Incomplete Abortion

Procedure?

Meds to aid (or replace) procedure?

What if mom is at risk for hemorrhage tho and they do main procedure?

Infection risks?

A

Incomplete: when the baby dies but the placenta is left behind

D&C procedure to remove the placenta

Meds like prostaglandins (cytotec) can help to empty uterus if mom is at risk for hemorrhage

Give her oxytocin drugs to help uterus clamp or txa

With procedure mom may be at risk for infection . Give antibiotics

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25
Q

Incomplete abortion

What can they give mom to avoid hemorrhage?

What meds given for infection risk?

A

Oxytocin drugs for prevention
TXA
Oxytocin Methergine Hemabate

antibiotics

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26
Q

Review:
Type of abortion where you’ll have to have a D&C
or be put on prostaglins

A

Incomplete abortion

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27
Q

If mom has a D&C for a ____ abortion, and she is RH- what might she need ?

A

For an incomplete abortion you’ll need the D&C.

And if she is rh- she will need an RHimmune globulin no less than 72 hours later.

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28
Q

Your PG mother reports that she thinks she may have passed a clot in the toilet. What should you as a nurse do?

A
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29
Q

Your PG mother is actively bleeding. What 3 things should you do for mom? What to do for baby?

A

Start IV fluids, monitor for shock, administer O2

For baby monitor FHR

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30
Q

What do you need to do after a period of active bleeding if mom is RH-?

A

Get mom an Rh immune globulin if she is RH- before dismissal

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31
Q

How do women cope with miscarriages?

A

Older women or women who have been trying to get PG may take it hard
Adolescents or women who didn’t even know or want a pG will be ok.
But regardless, help them cope. Bc they need to resolve the grief before becoming PG again .

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32
Q

Foods that mom should eat after going through a miscarriage?

Education?

A

Iron rich diet and supplement for possible anemia

We want them to wait till they get pregnant 4-6 months if they can

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33
Q

What does cervical insufficiency mean?
(which trimester?)

What does this feel like to mom?

A

Painless dilation and effacement of the cervix without contractions in 2nd trimester. And so you don’t even know it is going on.

Again painless but women may feel a heaviness in lower abdomen

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34
Q

Cervical insufficiency causes that are genetic?

A

Grandma having DES (Dyethial Semestral Exposure) which affects their offspring who is now the mom and patient in question

Collagen disorders

Uterine abnormalities
- ex: membranes with heart uterus, bicords

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35
Q

Cervical insufficiency causes that are acquired?

A

Inflammation, infection, trauma

trauma: cone or leep procedures , therapeutic abortions

36
Q

Shape of membranes upon inspection with cervical insufficiency?

Size of cervix in cervical insufficiency?

complaint?

discharge amount?

A

Hour glass - it bulks through cervix
Internal os has a funneling affect on sonogram

less than 25 mm

“something feels different”

discharge amount is increased

37
Q

Common health history of cervical insuffiency?

A 
2nd trimester losses
Previous preterm births
Short labors
Des exposure
Tab
Multipele gestations
38
Q

How will they assess to see if the cervix is shortening in cervical insuffiency?

Type of activity tolerance prescribed?

A

Serial sonograms or done multiple times during the 14-28 week mark

Bed rest

39
Q

With cervical insufficiency, how will they keep the uterus quiet and therefore avoid miscarraige?

A

Progesterone supplementation or hydroxyprogesterone 16-36 weeks

40
Q

What surgical procedure can they do for cervical insufficiency?

What is needed pre-procedure though?

Is elective or emergent more successful?

What is post op cerclage procedure like?

How does mom give birth if her cervix is sutured shut?

A

Cerclage procedure or when they suture the cervix closed

Antibiotics, anti-inflammatory drugs, tocolytic

Elective cerclage are more successful

Post op will be just staying in recovery for a couple hours. but after that she can go home

They’ll just clip the cerclage suture beforehand

41
Q

What product or tool can be used to help with cervical insufficiency?

A

Pessaries or ring that is inserted into vagina to distribute weight of uterus away from the cervix

42
Q

When can pessaries begin being used?

What do pessaries reduce the need of?

A

Mid pregnancy

Reduce need of tocolytic meds and need to go to nicu later on when baby is born

43
Q

Medication that can help with cervical insuffiency?

A

Progesterone therapy that can be used to relax the uterus

44
Q

How do they decide the route of progesterone therapy for cervical insufficiency? What routes are available?

A

Depends on moms compliance

Oral -daily
Vaginally - daily
IM - weekly

45
Q

Education for cerclage?

A

Instruct mom that she needs to go to hospital immediately if she has signs of labor approaching bc her suture needs clipped

46
Q

What is an ectopic pregnancy?

A

Pregnancy where the implantation site was outside the normal zone of the uterine decidual lining

  • we want the back or side wall up high.
  • NOT the anterior or low areas
47
Q

What is the most common type of ectopic pregnancy?

How is this dangerous?

How can this be tricky to diagnose?

A

Tubal or in ampulla
- it can be a lot of places but this is the usual

The embryo will grow in the ampulla tube but when it is too big, the ampulla tube gets ruptured. So you want to dx before this happens!!

Can be tricky bc you can have referred pain going in tubal pregnancy. The cramps will be collachy but you could have it on the opposite side of your abdomen. .

48
Q

What is an abdominal ectopic pregnancy?

A

It is just when there is a pregnancy implantation in the abdominal cavity - and yes a woman has survived this.

49
Q

What type of BC method puts you at higher risk for ectopic pregnancy?

What type of meds?

A

IUD

Ovulation inducing drugs rt fertility drugs

50
Q

High levels of what hormone can increase ectopic pregnancy risk?

A

Progesterone being high

51
Q

What type of infection can cause the ectopic pregnancy?

A

Hx of tubal infections

52
Q

What type of previous surgeries can cause ectopic pregnancy?

A

Pelvic or tubal surgery

53
Q

What kinds of conditions can increase ectopic pregnancy risks?

A

Endometriosis

Congenital anomalies of fallopian tubes

54
Q

What age group is at more risk of ectopic pregnancy?

A

Older or advanced maternal age

55
Q

What type of unhealthy habit can give you increased risk of ectopic pregnancy?

A

Smoking :(

56
Q

T/F

A ruptured appendix can increase risk of ectopic pregnancy

A

True.

Remember, Ectopic PG can really happen anywhere. And a ruptured appendix is a trauma that leaves behind scarring.

57
Q

What may mom say her ectopic pregnancy feels like?

Other symptoms?

A

Dull pain in her lower abdominal quadrant that is colicky pain

positive pregnancy test and delayed menses

58
Q

What labs can they do for ectopic pregnancy?

A

HCG qualitative + and low levels in quantitative

Serum progesterone levels

59
Q

Mom has a positive pregnancy test but she is having pain in her lower abdomen that is colicky in nature. What do you anticipate?

A

Anticipate an ectopic pregnancy.

They may do hcg which will come back positive but low in number.
Progesterone labs will be less than 5 if ectopic.

Also do an ultrasound but her uterus will be empty.

60
Q

If you do have an ectopic pregnancy, what will radiologists call it?

A

Mass w adnexal tenderness

61
Q

What diagnostic test will they do for ectopic pregnancy?

A

Ultrasound )but it will be empty)

62
Q

Mom says she is having shoulder pain and she is dizzy. You saw that radiologist gave the clue she has a mass w adnexal tenderness in her tubes. She says she remembers feeling some pain but didn’t think anything of it.
What do you anticipate?

A

Mom has ruptured already and she is now in shock. And she could die from this now.

63
Q

You notice there is blueness around the umbilicus. What is this called and why does this happen?

A

Happens with ectopic pregnancies and is called the Cullen sign. It is from blood in the abdominal cavity

64
Q

When diagnosing ectopic pregnancies, what will they want to rule out as well?

A 
Miscarriage
UTI
Ruptured cyst
Salpingitis 
Appendicitis 
Ovary torsion
65
Q

When will they use Methotrexate to treat ectopic pregnancy?
What does methotrexate do?
What does it require tho?

Is the catholic church ok with this?

How do they make sure it the Methotrexate killed the embryo?

A

Only use if the diagnosis of ectopic pregnancy was early

Methotextrate is a folic acid antagonist so it inhibits proliferation of rapidly dividing cells in order to kill the embryo

Requires mom to be stable though

Catholic church is ok with Methotrexate

To make sure the Methotrexate worked, they will monitor hcg levels to make sure it drops to undetectable levels. But this can take 2-8 weeks.

66
Q

Surgical options for ectopic treatment ?

Risks with surgical options?

A

Salingostomy where they open the tube and take it out

Salpingectomy where they take the whole tube out and leave it out

Both of these treatment options have hemorrhage risks.
- treat with IV fluids and blood

67
Q

After Salingostomy or Salpingectomy, how soon do they recommend you are allowed to get pregnant again?

And what do they need to do before getting pregnant again?

A

Three months and until hen, you’ll be on some reliable form of BC

Contact HCP for early sonogram to rule out ectopic pregnancy just to make sure

68
Q

What is GTD or gestational trophoblastic disease?

(From what cells?)

Key components of a GTD molar pregnancy?

A

It is a Molar pregnancy meaning you have conceived but it is really only a placental tumor that was implanted and forms grape clusters of chorionic villi from trophoblast cells (hydatiform mole)

From trophoblast cells that are fluid filled vesicles or clusters

Positive pregnancy test, enlarged uterus , but no baby

69
Q

Groups at high risk of getting GTD molar pregnancy?

What does GTD molar pregnancy look likeon sonogram?

A

Nonwhites

Vesicle of snowstorm

70
Q

What is it called when a GTD molar pregnancy becomes cancerous?
Describe it

Where can it metastasize?

A

Choriocarcinoma

Malignant and invasive

Metastasize to lung and brain

71
Q

Diagnostic tests done for Choriocarcinoma (molar PG)?

What will treatment be of?

A

(cancer from GTD molar PG or grape cluster implantation)
Chest x ray for lung traveling
CT for traveling to brain

Chemotherapy Methotrexate

72
Q

For an older woman with Choriocarcinoma (molar Pg) what might they just go ahead and do?

A

Hysterectomy just take her uterus

73
Q

What type of bleeding will you see in GTD molar pregnancy?

What disorder might you see develop too?

A

Dark prune juice vaginal bleeding

Anemia can develop

74
Q

What can be passed in a GTD molar pregnancy?

What size will the uterus be in GTD molar pregnancy?

A

The grape cluster vesicles

The uterus will be large since the woman’s body really thought it was pregnant . instead of baby there will be proliferation of trophoblast cells

75
Q

What will cause the cramping in GTD molar pregnancy?

A

Pain and cramps from uterine distention

76
Q

If you are using the fetal doppler on a mom with GTD molar pregnancy , what will fhr sound like?

A

The fetal heart rate won’t be there…

because there’s no actual fetus. Just a clump of cells.

77
Q

What will Hcg levels be like in GTD molar pregnancy that has no fetus?

A

Hcg levels will be elevated still due to the trophblast cells being able to secrete the hormone however the moms’ alpha fetal protein will be low
(so she might be vomiting more)

78
Q

Can you explain why mom with a GTD molar pregnancy has hyperemesis going on?

A

She is vomiting due to her elevated hcg levels

79
Q

What category of hypertension could mom with a GTD molar pregnancy develop? And when?

A

Pre-eclampsia symptoms at less than 24 weeks

80
Q

What can a GTD molar pregnant mom develop due to the molar tissues?

A

Hyperthyroidism (tachycardia and hot)

81
Q

What is a good indicator of a GTD molar pregnancy?

A

Lack of fhr in the womb on sonogram

82
Q

Methods to empty the uterus for a GTD molar pregnancy?

A

D&C

Hysterectomy for older ladies

83
Q

T/F

Induction of labor with oxytocin is a good option for treatment of GTF molar pregnancy

A

False. Avoid induction of labor with GTD molar pregnancy bc it can cause a pulmonary emboli!!

84
Q

With Choriocarcinoma, how long does mom have to wait before becoming pregnant again?
How long will her hcg levels need to be monitored?

A

1 year and so she will be on BC

1 year hcg testing

85
Q

GTD molar pregnancy education?

A

Follow up is very important especially with Choriocarcinoma.
Help her find emotional support

86
Q

If mom is rh- after a D&C for GTD molar pregnancy, what must you give?

A

Rh immunoglobulin

87
Q

Placenta previa

A

..

Maternal Exam 3 (8 decks)

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