Abnormal Vaginal Bleeding/Ectopic Pregnancy/Endometriosis Flashcards
(26 cards)
Abnormal Vaginal Bleeding (4 types)
- aka uterine bleeding, common gynecological conern. Types of irregularities
a) oligomenorrhea
b) amenorrhea
c) menorrhagia
d) metrorrhagia
Causes of abnormal vaginal/uterine bleeding
Causes may vary from anovulatory menstrual cycles to more serious causes such as ectopic pregnancy or endometrial cancer
Menorrhagia
- common cause
- excessive bleeding characterized as an increased duration (>7 days), increased amount (>80ml) or both
- the most common cause -> anovulatory uterine bleeding
- For young women with excessive bleeding, clotting disorders must be considered
Metrorrhagia
- possible causes (2)
- Also referred to as spotting, or breakthrough bleeding, is bleeding between menstrual periods
- For women of reproductive age, spontaneous abortion or ectopic pregnancy must be considred
- for women who are postmenopausal, endometrial cancer must be considered whenever spotting is experienced
Amenorrhea
- primary vs secondary?
Aside from pregnancy - the most common cause for missing menses is anovulation
- Primary: failure of menstrual cycles to begin by 16 years (or 14 years with secondary sex characteristics)
- Secondary: cessation of menstrual cycle once established
Oligomenorrhea
Refers to long intervals between menses, generally > 35 days
Oligomenorrhea owing to anovulation is common for women at the beginning and end of menstruation
Nursing Management of Abnormal Vaginal Bleeding: Teaching
Teach them about characteristics of menstrual cycle:
- will assist to identify normal variation
- if menstrual cycle does not fall within the normal range, seek health care provider
Nursing Management of Abnormal Vaginal Bleeding: Decrease risk of Toxic Shock Syndrome
- what is it? S&S?
- TSS is acute condition caused by staph aureus
- avoid prolonged use of superabsorbent tampons & pads
- initially flu-like symptoms - high fever, N/V, diarrhea, dizziness, fainting and disorientation
Nursing Management of Abnormal Vaginal Bleeding (2)
- excessive amount of vaginal bleeding should be assessed accurately
- anemia & hypovolemia may be present - assess variations in BP, HR
Surgical Therapy for Abnormal Vaginal Bleeding (3)
Surgery is indicated depending on underlying cause of abnormal vaginal bleeding
- D&C (dilation and curettage. used for miscarriage)
- Hysterectomy (if fibroids)
- Myomectomy (removal of fibroid without removing the uterus)
Methods for performing surgeries (3)
- Laparotomy
- Laparoscopy
- Hysteroscopy (up through the vagina)
Ectopic Pregnancy
- implantation of the fertilized ovum anywhere outside uterine cavity
- Result of fibrosis or damage to cilia in the tube following infection or inflammation of the Fallopian tube
- eventually the tube ruptures - peritoneal symptoms
- Is a life-threatening condition
- A women suspected of ectopic pregnancy should always be treated as an emergency
Ectopic Pregnancy: Risk Factor
- history of pelvic inflammatory disease, prior ectopic pregnancy, progestin-releasing IUD, progestin-only birth control failure, and prior pelvic or tubal surgery
Clinical manifestations of ectopic pregnancy
- if tube ruptures?
- Abdominal or pelvic pain - almost always present d/t distention of the fallopian tube
- missed menses
- irregular vaginal bleeding
- If tube ruptures, pain is intense -> risk for hemorrhage & hypovolemic shock. suspected rupture is treated as an emergency
Diagnosis of Ectopic Pregnancy
- difficult d/t similarities to other pelvic and abdominal disorders
- a serum pregnancy test would be positive
-KEY - serum BhCG level >1,500 and transvaginal U/S shows no intrauterine gestational sac.
Symptoms of Tube rupture
sudden, severe pain, vaginal bleeding, shoulder pain while laying down, bleeding into peritoneal cavity: pallor, signs of shock and blood loss and a distended abdomen
management of ectopic pregnancy
- surgery remains the primary approach and should be performed immediately
- for hemodynamically stable pt with the size of gestation <3cm, tx of IM injection of methotrexate is being used with increasing success.
- laparoscopy is preferable to laparotomy because of less blood loss, and decreased length of stay
Laparoscopy: for ectopic pregnancy 2 types
- how do they choose which one?
- Salpingotomy - the ectopic pregnancy is removed; tube is left to heal on its own
- Salpingectomy - both ectopic pregnancy & the tube are removed
The choice depends on
- pts age
- tubes condition
- Serum bHCG levels
- pts future fertility desire
Endometriosis
- presence of endometrial epithelial tissue (usually lines uterus) found outside the uterine cavity
- endometrial tissues undergoes a mini-menstrual cycle
- Blood collects in cyst-like nodules blue/black in color -> causes inflammation -> scarring & adhesions
Endometriosis: most frequent sites
near ovaries, broad ligament, uterosacral ligaments, bowel, bladder
Endometriosis and fertility
A common cause of infertility, increased risk for ovarian cancer.
Typically occurs in those who have never had a full-term pregnancy
Clinical Manifestations of Endometriosis
symptoms and pain vary considerably and does not correlate with extent of endometriosis
most common manifestations: dysmenorrhea, infertility, pelvic pain, dyspareunia, and irregular bleeding
Diagnosis and treatment of endometriosis
Laparoscopy for a definitive diagnosis
Treatment influenced by pts age, desire for pregnancy, symptom severity, and the extent and location of disease
Conservative Surgery for Endometriosis
- to confirm diagnosis or to remove implants. lysing or excision of adhesion by laparoscopic laser surgery or laparotomy. For women wishing to get pregnant
