Antepartal Hemorrhagic Disorders

Question 0

List Threatened miscarriage interventions

Answer 0

Bed rest; progesterone injections;

Question 1

Define threatened miscarriage

Answer 1

No miscarriage yet but the threat is real. Some spotting of blood, no dilation or delivery

Question 2

Define inevitable miscarriage

Answer 2

Miscarriage will occur; cervical dilation and possibly body parts are out

Question 3

Inevitable miscarriage interventions

Answer 3

Just let it happen on it’s own; D&C to accelerate the miscarriage- this is only done as a last resort.
However, if mother has an infection or is bleeding heavily, surgical intervention is needed.

Question 4

Define incomplete miscarriage

Answer 4

Bleeding and passage of some parts of gestation but not all

Question 5

Incomplete miscarriage interventions

Answer 5

Same as inevitable- try for mom to pass, maybe even days if no signs of infection or hemorrhage

Question 6

Define complete miscarriage

Answer 6

Mom passes all products of conception own- mostly no interventions- watch for s/s

Question 7

Define missed miscarriage

Answer 7

Still pregnant with baby, but no heartbeat

Question 8

Missed miscarriage interventions

Answer 8

D&C or even dilation and extraction-
If baby is about 16 wks then the baby is a good size, then must bring mom to hospital and give cytotec or pitocin to induce the labor- try to give mom baby to bond

Question 9

What lab value is helpful in diagnosing very early pregnancy loss?

Answer 9

HcG

Question 10

At what rate should HcG increase in normal pregnancy?

Answer 10

Should double every 2 days until day 70

Question 11

What does a drop in HcG indicate?

Answer 11

Miscarriage

Question 12

What does an HcG under 5mlU/ml indicate?

Answer 12

Negative for pregnancy

Question 13

What does an HcG of greater than 25 mlU/ml indicate?

Answer 13

Positive for pregnancy

Question 14

Ultrasounds can measure what about the cervix?

Answer 14

Length and any changes

Question 15

What is the plan of care for miscarriage?

Answer 15

Bed rest ; supportive care ; D&C (always get a blood type and maybe cross match for blood units) ; D&E may be performed after 16 weeks but not usual ; outpatient management with cytotec ; prostaglandins to induce labor 16-20 weeks ; get IV

Question 16

Hemabate usage needs what meds to go along with it?

Answer 16

Limopel for diarrhea
Antipyretic
Antiemetic

Question 17

Methergine shouldn’t be given for post delivery miscarriage to decrease bleeding if the patient has a history of what?

Answer 17

Preeclampsia or hypertensive disorders- cytotec would be better in that case

Question 18

What is the post delivery home care for miscarriage?

Answer 18

Patients must recognize s/s of infection /hemorrhage (onset of pain pain) ;
D/C meds like antibiotics (doxycycline-can cause photosensitivity), methergine (or cytotec) and analgesics
Foods high in iron and protein
Follow up in 2 weeks
No sex for 2 weeks

Question 19

How much bleeding after a D&C is too much?

Answer 19

1 pad per hour- should only see small spots

Question 20

How is incompetent cervix diagnosed?

Answer 20

OB history followed by transvaginal ultrasound (transvaginal ultrasound is the best way to measure the cervix)

Question 21

What are the measurement thresholds for a shortened cervix?

Answer 21

< 25 - 30 mm in length

Question 22

What is medical management for incompetent cervix?

Answer 22

Bed rest; hydration and tocolysis; elective cerclage around 10-14 weeks; urgent or emergent cerclage for high risk of ROM, PTL,
closely observe for labor, bleeding and infection
Cerclage removed at 37 weeks