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Nursing N366 OB > Bleeding Disorders > Flashcards

Flashcards in Bleeding Disorders Deck (58):
1

when do you want to report bleeding during pregnancy

every trimester

2

every time a mother bleeds she is going to be physiologically

at risk for anemia, hypovolemia, increased risk of infection (low hemoglobin), risk for preterm labor.

3

if baby not getting enough oxygen

polycythemia (over producing RBC to make up for O2), hypoxemia, hypoxia (low O2 brain), and preterm birth

4

bleeding may occur normally in small amounts when

implantation

5

2nd trimester bleeding you worry about

preterm labor
incompetent cervix
placenta previa

6

in third trimester worry about bleeding cause?

preterm labor
bloody show of labor
placental abruption
placenta previa
or bleeding could be from sexual intercourse

7

1st trimester SAB, EAB, TAB

spontaneous abortion - bc natural causes
Elective abortion

8

10 to 20% of all pregnancies are

early miscarriages, which 50% of them before 12 wks due to genetic abnormality

9

an embryo with genetic problem aborts _____% of the time

95%

10

most spontaneous abortions occur before what wk

8th wk

11

luteal insufficicency

women in early 40s late 30s may not put out enough progesterone

12

early trimester miscarriage causes

infection
systemic disorder
genetic factors
hormone deficiency - i.e. progesterone

13

later trimester miscarriage causes

MATERNAL FACTORS:
advanced maternal age
advanced parity (many births)
incompetent cervix
inadequate nutrition
recreational drug uses
chronic disease

14

if past 10 wks and bleeding leading to abortion you will do what intervention

listen for fetal heart tones

15

incomplete abortion

Heavy/profuse bleeding, severe cramping, there is passage of tissue and the cervix is dilated and there is tissue visible in the cervix

16

missed baby

fetus dies, no bleeding, no cramping, fetus doesn't come out, placenta doesn't come out, cervix is closed, and mother may not be aware of it, but may feel bad an feverish.

17

if baby has died inside what happens?

will start to put antibodies out to itself and lyse itself

18

septic abortion

results from a missed or incomplete abortion and remaining tissue becomes infected.

19

recurrent pregnancy loss

3 or more losses before 20 wks, is it a fetal factor, genetic factor, maternal physiology factor. this is a person we do a workup on

20

1st trimester fetal demise

hx
last menstrual period
quantity and nature of bleeding
emotional state
ultrasound
serial hcg
surgical management

21

threatened baby you look at what?

serial Hcg

22

Late incomplete AB (16-20 weeks):


Prostaglandins may be used to induce or augment labor and cause the products of conception to be expelled. IV oxytocin may be used. Meds may cause nausea, vomiting, diarrhea.
High risk of postpartum bleeding in late miscarriage delivery
Rh determination and Rhogam as indicated within 72 hours of AB
Psychosocial aspects
drugs give nausea and fever, can't do C-section bc small uterus, and usually don't have to dilate to 10, high risk of infection

23

anytime there is a miscarriage we need to know what status?

Rh status and need to give rophylac

24

ectopic pregnancies increased in incidence over the past several decades due to?

increase in STIs, anything that can scar the tubes, so doesn't move quickly from fertilization to uterus, and implants in place

25

ectopic pregnancy

slow transit of the conceptus through the fallopian tubes, and trophoblastic cells implant in fallopian tubes or elsewhere and can cause rupture of tubes

26

risk factors of ectopic pregnancy

surgery to tubes
surgery to pelvis bc adhesions
endometriosis (tissue that should be inside uterus but grows outside
IUD
high levels of progesterone
>35 advanced maternal age
douching
previous ectopic
use of ovulation inducing drugs i.e., CLOMID
smoking

27

ectopic pt sx

acute abdominal pain (lower abdomen pain)
amenorrhea
positive pregnancy test
dark red bleeding
referred shoulder pain due to blood in perineal cavity
may present with shock
decreased BP, elevated pulse

28

if fallopian tube ruptures then?

exquisite pain - exponentially severe pain

29

majoring of ectopic pregnancies will

implant in tube, but can implant in cervix or elsewhere in abdomen other than uterus

30

once dx, ectopic pregnancy

Salpingostomy

31

Salpingostomy

remove contents and put back, risk of subsequent ectopic pregnancies

32

methotrexate may sometimes be used for what type of pregnancy?

ectopic, bc methotrexate kills rapidly growing cells since cancer drug

33

refers to the surgical removal of a Fallopian tube. It is often related to tubal pregnancies and is a procedure that is preferred over its ovarian tube-sparing counterparts due to the high rate of recurrence in said ectopic pregnancies.

Salpingectomy

34

if have ectopic pregnancy then chance of having normal pregnancy later down the road?

only 50%

35

HYDATIDIFORM MOLE definition

Etiology uncertain but - A pathologic proliferation of trophoblasitic cells. The trophoblast is the outer most portion of embryonic cells that gives rise to the chorion. This results in fluid filled grape-like structures. Etiology unknown; two types: complete and partial mole pregnancy

36

Partial mole

is karotype of 69XXY, 69XXX, or 69XYY, when two sperm fertilize an apparently normal ovum. This may have embryonic or fetal parts and an amniotic sac

37

mole pregnancy more common with?

advanced maternal age s big in US

38

S/S of mole pregnancy

• Early signs are identical to normal pregnancy, although may have increased N/V d/t high levels of beta hCG
• On serial laboratory evaluation, beta hCG remains high past point it usually begins to fall (70-100 days into pregnancy)
• Ultrasound shows diffuse “snowstorm” pattern
• Later, in 95% of cases, there is vaginal bleeding (may be dark brown, bright red, scant, or profuse, persistent or intermittent
• Preeclampsia occurs in 15% of cases, between weeks 9-12 weeks
• Hyperthroidism and pulmonary embolism are rare but dangerous complications
• Partial moles may be mistaken for an incomplete or misses AB

39

Tx of mole pregnancy

suction of contents
rhophylac if RH-

40

coriocarcinoma occurs what percent of time in mole pregnant women

20% of time, so important to keep track of hog because the cells if left in there can replicate and become a cancer of corion

41

mole pregnancy you don't want to get pregnant again for how long

1 yr, w/ birth control, no IUDs

42

if coriocarcinoma tx how?

aggressively because can metastasize easily and so any suspicion and will have hysterectomy.

43

incompetent cervixes causes

anything that's done trauma
mother taken DES (given in 60s daughters of these mother's have cervical anomalies)

44

TX for incompetent cervix

surgical placement of cerclage
placed 12-16 wks, rarely past 25 wks
removed at 36 wks
PT may have to be on bed rest
topolytic drug may need to be used to prevent contraction
home monitoring and educate how to detect contractions

45

Placenta Previa

• The placenta implants in the lower uterine segment near or over the internal cervical os. So baby can't get out without going through placenta
*occur in 0.5% of births, more common of

46

types of placenta previa

• Partial covers part of the os
• Marginal indicates that only the edge of the placenta extends to the margin of the os
• Low-lying placenta is near the os but not touching the os

47

risk for placenta previa

ednometrial scarring, multiple gestations, C-sections, closely spaced pregnancies, advanced maternal ages, african or asian,

48

how does placenta previa

painless
bright red bleeding assoc w/ contractions
soft uterus no tenderness, normal tone
fetus in longitudinal lie

49

DX of complete previa high risk because

can hemorrhage and die
mortality 1%
risk of premature delivery
congenital anomalies
IUGR
small for age
*not do vaginal exam before ultrasound performed - because don't want to hit up against open placental blood vessels
need to know rh(-)
Ultrasound 95% accurate, if don't see it then might due speculum exam

50

prognosis of previa

C-section
if preterm and fetus is stable, they may do expected management

51

placental abruption

• Detachment of part or all of the placenta from the wall of uterus. Separation occurs at the decidua basalis after 20 weeks but before the infant’s birth.

complete detachment - massive hemorrhage
marginal abruption - at margins of placenta with variable amounts of bleeding

detachment can be central. concealed bleeding

occult

occur in 1 in 120 births

52

abruption S/S

board-like abdomen
uterus irritable/pain
bleeding may be darker red, but can be bright

53

types of abruption

complete detachment - massive hemorrhage
marginal abruption - at margins of placenta with variable amounts of bleeding

detachment can be central. concealed bleeding

occult

occur in 1 in 120 births

54

risk factors of abruption

HTN - leading cause
previous h/o abruption

cocaine causes massive vasospasm causing a rupturing between placenta and uterine wall

blunt trauma - the mom who smacks into steering wheel

Multiple pregnancy then increased risk

55

DX

platelet count
CBC
ultrasound but may not see like you would previa
start a couple IV sites
keep an eye on the baby's FHR

56

velamentous insertion

more common w/ twins
vessels stand up like root of tree
so can have cord accidents
• Umbilical vessels separate in the membranes at a distance from the placental margin, which they reach surrounded only be a fold of amnion. 1.1 % of all singleton pregnancies present with this type cord insertion, it is more common with twins, and almost the rule with triplets.
• Vasa Previa is when the fetal vessels in the membrane cross the internal cervical os.
• Associated with placenta previa and multiple gestations

57

BATTLEDORE PLACENTA

BATTLEDORE PLACENTA
Definition:
• Also called a marginal cord insertion, the cord is inserted at the margin of the placenta. Occurs in approx. 7% of term placentas
Risks:
• Rarely of clinical significance
• May increase risk of fetal hemorrhage if there is a marginal separation of the placenta
• May increase risk for the cord being pulled off during the delivery of the placenta

marginal insertion
occurs 7% of term placentas
can increase risk of fetal hemorrhage
sometimes smaller baby

58

SUCCENTURIATE PLACENTA

Definition:
• The placenta is divided into two separate lobes, each having its own distinct circulation. This is a rare condition.
Risks:
• Vessels between lobes may be supported only be fetal membranes and have risk of tearing during labor, birth, and delivery of the placenta
• One or more lobes may be retained, remaining attached to the decidua basalis, preventing uterine contraction and increasing the risk of postpartum hemorrhage and infection.