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Flashcards in Bleeding During Pregnancy Deck (67):
0

Cause of Early bleeding (before 12 weeks)

Abortions

1

What is usually the cause of bleeding the 12th week?

Ectopic pregnancy - tubal

2

What is usually the cause of bleeding 2nd trimester?

Hydatidiform mole, incompetent cervix

3

What is usually the causes of bleeding 3rd trimester?

Placenta previa, abruptio placenta

4

What us the definition of abortion?

Loss of baby before 20 weeks

5

What is the definition of threatened abortion?

Has not lost the baby
The cervix is CLOSED

6

What are the signs of a threatened abortion?

Bleeding or spotting
Cramps

7

What percent of women go on to have a normal baby at term?

85%

8

What is the definition Inevitable abortion?

Loss will occur
*cervix is OPEN and dilating

9

What are the signs of inevitable abortion?

Cramping, heaving bleeding, membranes may rupture, products of concepts not expelled, fluid in the cvx

10

What is the definition of incomplete abortion?

Parts of conceptus are expelled + parts retained

11

What are the signs of an incomplete abortion?

Cramping + bleeding
Open cervical os
*Bleeds until all parts expelled*

12

What is the definition of a complete abortion?

All the products of conception are passed

13

What is the definition of a missed abortion?

Fetus dies in the uterus but is not expelled

14

What may client complain of when they have a missed abortion?

Malaise
Headache
Anorexia

15

What takes place after abortion?

Uterine growth ceases
Negative pregnancy test
Ultrasound confirmation

16

What may prolonged retention of fetus result in?

Dissemination intra-vascular coagulation (abnormal clots throughout body)

17

When is the definition of Habitual abortion?

Incompetent cervical os
NO pain, no warning

18

What is usually the cause of a habitual abortion?

Thyroid disorder
Faulty uterine environment

19

What is the treatment of a habitual abortion?

Cerclage - stitch to close cervix

20

What is the definition of therapeutic abortion?

Instrumental termination of pregnancy by physician because of grave maternal disease of fetal defect

21

What does ETOP stand for?

Elective termination of pregnancy

22

What is blighted ovum

Nature's abortion

23

What is the treatment of slight vaginal bleeding without pain?

Bed-rest
Avoid coitus
Count pads
Avoid straining - use stool softener

24

What needs to be counseled when women have slight vaginal bleeding without pain?

That 85% will have normal babies at term

25

What is the treatment when there is bleeding with pain?

"empty the uterus & make it contract"
Ultrasound
Asses coping ability

26

What kind of pregnancy is any gestation in which implantation of the blastocyst occurs outside the uterine cavity?

Ectopic pregnancy

27

What are the symptoms of ectopic pregnancy?

Menstrual abnormality
Lower abdominal pain
Symptoms of pregnancy

28

What is the fold standard for diagnosis for ectopic pregnancy?

Laproscopy

29

What are the laboratory tests results of an ectopic pregnancy?

Low levels of hCG, Beta subunit radioassay

30

What is found in the physical exam of a ectopic pregnancy?

Small uterus
Movement or cervix = pain
H&H LOW
BP may reflect total blood loss

31

What is takes place in a linear salpinogostomy?

Linear incision to remove embryo from tube - allows future fertility

32

What is the chemical management of an ectopic pregnancy?

Methotrexate

33

What is methotrexate treatment?

Inhibits DNA synthesis so cells do not grow in ectopic pregnancy

34

What is a gestational trophoblastic disease (GTD)?

Hydatidiform Mole

35

When is there bleeding in Hydatidiform mole?

In 1st or 2nd trimester

36

What races are Hydatidiform mole fairly common in?

Asians and people from the middle east

37

What are Hydatidiform moles?

Abnormalities in fertilization - bleeding in 1st or 2nd trimester

38

What kind of Hydatidiform mole when fertilization of an egg whose nucleus has been lost or inactivated?

Complete mole

39

2nd sperm starts to multiply, enlarge and become fluid filled

Complete mole

40

What kind of Hydatidiform mole is triploid karyotype = 69 chromosomes?

Partial mole

41

What is it when there is 2 sperm and 1 maternal set of chromosomes or 1 paternal and 2 maternal sets?

Partial mole

42

What becomes swollen in a Hydatidiform mole?

Chorionic villi - becomes fluid filled (hydropic)

43

What are the symptoms of a Hydatidiform mole?

Vaginal bleeding
Anemia
Excessive N&V
Abdominal cramps

44

What is the significance of a Hydatidiform mole?

Choriocarcinoma
A malignant neoplasm

45

What us the treatment of a Hydatidiform mole?

Evacuation of the mole

46

What is the follow-up after removal of a Hydatidiform mole?

Monitor HcG titer until there is 3 negative

47

What are HCG levels with a Hydatidiform mole?

High

48

Pregnancy in which the placenta is implanted in the lower part of the uterus - can cause bleeding in late pregnancy

Placenta Praevia

49

Low placenta implantation praevia

Normal just low

50

Three types of placenta praevia

Low placental implantation
Partial placental praevia
Complete placenta praevia

51

Covers external os - more common in women with previous c-section

.

52

What are the symptoms of placenta praevia?

Painless
Uterus stays soft
Bright red bleeding 2nd half of pregnancy

53

Why does uterus stay soft with a placenta praevia?

Because blood is escaping vaginally

54

What is the management in a placenta praevia?

CBC
18th cathlon
NO vaginal exams
Pad count + weigh
36-37 weeks can deliver

55

When can there be a vaginal birth with a placenta praevia?

If preavia is marginal and head down without much bleeding

56

What is it called if there is a premature separation of the normally implanted placenta?

Abruptio Placenta

57

What does it mean if there was a marginal abruptio placenta?

Placenta tears away at the edge first and escapes of blood vaginally

58

What does it mean if there is central abruptio placenta?

Pop in the center of the placenta results in concealed bleeding

59

What does is mean if there is a complete abruptio placenta?

Whole thing separates

60

What are the symptoms of abruptio placenta?

Pain
Firm uterus
Uterine hypertonicity
Shock disproprotional to estimated blood loss
Changes in FHR

61

Uterine hypertonicity

Less resting tone

62

What kind if bleeding is caused by abruptio placenta?

Uterine bleeding with small to moderate amount or dark red vaginal bleeding

63

What are the changes in FHR with abruptio placenta?

Bradycarida
Repetitive decels

64

If woman presents with dark red vaginal bleeding, c/o uterine tenderness what do you need to check?

Check V.S. and FHR promptly

65

How is abruptio placenta diagnosed?

Retroplacental clot
Blood in amnionic fluid
Fall in H&H
Fall in coagulation factors (10-30%)

66

Why may mother develop coagulopathies with an abruptio placenta?

Because myometrial tissue is damaged resulting in thromboplastin release