Bleeding During Pregnancy

Question 0

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

Answer 0

Ectopic pregnancy - tubal

Question 1

Cause of Early bleeding (before 12 weeks)

Answer 1

Abortions

Question 2

What is usually the cause of bleeding 2nd trimester?

Answer 2

Hydatidiform mole, incompetent cervix

Question 3

What is usually the causes of bleeding 3rd trimester?

Answer 3

Placenta previa, abruptio placenta

Question 4

What us the definition of abortion?

Answer 4

Loss of baby before 20 weeks

Question 5

What is the definition of threatened abortion?

Answer 5

Has not lost the baby

The cervix is CLOSED

Question 6

What are the signs of a threatened abortion?

Answer 6

Bleeding or spotting

Cramps

Question 7

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

Answer 7

85%

Question 8

What is the definition Inevitable abortion?

Answer 8

Loss will occur

*cervix is OPEN and dilating

Question 9

What are the signs of inevitable abortion?

Answer 9

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

Question 10

What is the definition of incomplete abortion?

Answer 10

Parts of conceptus are expelled + parts retained

Question 11

What are the signs of an incomplete abortion?

Answer 11

Cramping + bleeding
Open cervical os
Bleeds until all parts expelled

Question 12

What is the definition of a complete abortion?

Answer 12

All the products of conception are passed

Question 13

What is the definition of a missed abortion?

Answer 13

Fetus dies in the uterus but is not expelled

Question 14

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

Answer 14

Malaise
Headache
Anorexia

Question 15

What takes place after abortion?

Answer 15

Uterine growth ceases
Negative pregnancy test
Ultrasound confirmation

Question 16

What may prolonged retention of fetus result in?

Answer 16

Dissemination intra-vascular coagulation (abnormal clots throughout body)

Question 17

When is the definition of Habitual abortion?

Answer 17

Incompetent cervical os

NO pain, no warning

Question 18

What is usually the cause of a habitual abortion?

Answer 18

Thyroid disorder

Faulty uterine environment

Question 19

What is the treatment of a habitual abortion?

Answer 19

Cerclage - stitch to close cervix

Question 20

What is the definition of therapeutic abortion?

Answer 20

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

Question 21

What does ETOP stand for?

Answer 21

Elective termination of pregnancy

Question 22

What is blighted ovum

Answer 22

Nature’s abortion

Question 23

What is the treatment of slight vaginal bleeding without pain?

Answer 23

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

Question 24

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

Answer 24

That 85% will have normal babies at term

Question 25

What is the treatment when there is bleeding with pain?

Answer 25

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

Question 26

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

Answer 26

Ectopic pregnancy

Question 27

What are the symptoms of ectopic pregnancy?

Answer 27

Menstrual abnormality Lower abdominal pain Symptoms of pregnancy

Question 28

What is the fold standard for diagnosis for ectopic pregnancy?

Answer 28

Laproscopy

Question 29

What are the laboratory tests results of an ectopic pregnancy?

Answer 29

Low levels of hCG, Beta subunit radioassay

Question 30

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

Answer 30

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

Question 31

What is takes place in a linear salpinogostomy?

Answer 31

Linear incision to remove embryo from tube - allows future fertility

Question 32

What is the chemical management of an ectopic pregnancy?

Answer 32

Methotrexate

Question 33

What is methotrexate treatment?

Answer 33

Inhibits DNA synthesis so cells do not grow in ectopic pregnancy

Question 34

What is a gestational trophoblastic disease (GTD)?

Answer 34

Hydatidiform Mole

Question 35

When is there bleeding in Hydatidiform mole?

Answer 35

In 1st or 2nd trimester

Question 36

What races are Hydatidiform mole fairly common in?

Answer 36

Asians and people from the middle east

Question 37

What are Hydatidiform moles?

Answer 37

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

Question 38

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

Answer 38

Complete mole

Question 39

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

Answer 39

Complete mole

Question 40

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

Answer 40

Partial mole

Question 41

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

Answer 41

Partial mole

Question 42

What becomes swollen in a Hydatidiform mole?

Answer 42

Chorionic villi - becomes fluid filled (hydropic)

Question 43

What are the symptoms of a Hydatidiform mole?

Answer 43

Vaginal bleeding Anemia Excessive N&V Abdominal cramps

Question 44

What is the significance of a Hydatidiform mole?

Answer 44

Choriocarcinoma | A malignant neoplasm

Question 45

What us the treatment of a Hydatidiform mole?

Answer 45

Evacuation of the mole

Question 46

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

Answer 46

Monitor HcG titer until there is 3 negative

Question 47

What are HCG levels with a Hydatidiform mole?

Answer 47

High

Question 48

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

Answer 48

Placenta Praevia

Question 49

Low placenta implantation praevia

Answer 49

Normal just low

Question 50

Three types of placenta praevia

Answer 50

Low placental implantation Partial placental praevia Complete placenta praevia

Question 51

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

Answer 51

.

Question 52

What are the symptoms of placenta praevia?

Answer 52

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

Question 53

Why does uterus stay soft with a placenta praevia?

Answer 53

Because blood is escaping vaginally

Question 54

What is the management in a placenta praevia?

Answer 54

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

Question 55

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

Answer 55

If preavia is marginal and head down without much bleeding

Question 56

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

Answer 56

Abruptio Placenta

Question 57

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

Answer 57

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

Question 58

What does it mean if there is central abruptio placenta?

Answer 58

Pop in the center of the placenta results in concealed bleeding

Question 59

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

Answer 59

Whole thing separates

Question 60

What are the symptoms of abruptio placenta?

Answer 60

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

Question 61

Uterine hypertonicity

Answer 61

Less resting tone

Question 62

What kind if bleeding is caused by abruptio placenta?

Answer 62

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

Question 63

What are the changes in FHR with abruptio placenta?

Answer 63

Bradycarida | Repetitive decels

Question 64

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

Answer 64

Check V.S. and FHR promptly

Question 65

How is abruptio placenta diagnosed?

Answer 65

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

Question 66

Why may mother develop coagulopathies with an abruptio placenta?

Answer 66

Because myometrial tissue is damaged resulting in thromboplastin release