Flashcards in Bleeding During Pregnancy Deck (67)
Cause of Early bleeding (before 12 weeks)
What is usually the cause of bleeding the 12th week?
Ectopic pregnancy - tubal
What is usually the cause of bleeding 2nd trimester?
Hydatidiform mole, incompetent cervix
What is usually the causes of bleeding 3rd trimester?
Placenta previa, abruptio placenta
What us the definition of abortion?
Loss of baby before 20 weeks
What is the definition of threatened abortion?
Has not lost the baby
The cervix is CLOSED
What are the signs of a threatened abortion?
Bleeding or spotting
What percent of women go on to have a normal baby at term?
What is the definition Inevitable abortion?
Loss will occur
*cervix is OPEN and dilating
What are the signs of inevitable abortion?
Cramping, heaving bleeding, membranes may rupture, products of concepts not expelled, fluid in the cvx
What is the definition of incomplete abortion?
Parts of conceptus are expelled + parts retained
What are the signs of an incomplete abortion?
Cramping + bleeding
Open cervical os
*Bleeds until all parts expelled*
What is the definition of a complete abortion?
All the products of conception are passed
What is the definition of a missed abortion?
Fetus dies in the uterus but is not expelled
What may client complain of when they have a missed abortion?
What takes place after abortion?
Uterine growth ceases
Negative pregnancy test
What may prolonged retention of fetus result in?
Dissemination intra-vascular coagulation (abnormal clots throughout body)
When is the definition of Habitual abortion?
Incompetent cervical os
NO pain, no warning
What is usually the cause of a habitual abortion?
Faulty uterine environment
What is the treatment of a habitual abortion?
Cerclage - stitch to close cervix
What is the definition of therapeutic abortion?
Instrumental termination of pregnancy by physician because of grave maternal disease of fetal defect
What does ETOP stand for?
Elective termination of pregnancy
What is blighted ovum
What is the treatment of slight vaginal bleeding without pain?
Avoid straining - use stool softener
What needs to be counseled when women have slight vaginal bleeding without pain?
That 85% will have normal babies at term
What is the treatment when there is bleeding with pain?
"empty the uterus & make it contract"
Asses coping ability
What kind of pregnancy is any gestation in which implantation of the blastocyst occurs outside the uterine cavity?
What are the symptoms of ectopic pregnancy?
Lower abdominal pain
Symptoms of pregnancy
What is the fold standard for diagnosis for ectopic pregnancy?
What are the laboratory tests results of an ectopic pregnancy?
Low levels of hCG, Beta subunit radioassay
What is found in the physical exam of a ectopic pregnancy?
Movement or cervix = pain
BP may reflect total blood loss
What is takes place in a linear salpinogostomy?
Linear incision to remove embryo from tube - allows future fertility
What is the chemical management of an ectopic pregnancy?
What is methotrexate treatment?
Inhibits DNA synthesis so cells do not grow in ectopic pregnancy
What is a gestational trophoblastic disease (GTD)?
When is there bleeding in Hydatidiform mole?
In 1st or 2nd trimester
What races are Hydatidiform mole fairly common in?
Asians and people from the middle east
What are Hydatidiform moles?
Abnormalities in fertilization - bleeding in 1st or 2nd trimester
What kind of Hydatidiform mole when fertilization of an egg whose nucleus has been lost or inactivated?
2nd sperm starts to multiply, enlarge and become fluid filled
What kind of Hydatidiform mole is triploid karyotype = 69 chromosomes?
What is it when there is 2 sperm and 1 maternal set of chromosomes or 1 paternal and 2 maternal sets?
What becomes swollen in a Hydatidiform mole?
Chorionic villi - becomes fluid filled (hydropic)
What are the symptoms of a Hydatidiform mole?
What is the significance of a Hydatidiform mole?
A malignant neoplasm
What us the treatment of a Hydatidiform mole?
Evacuation of the mole
What is the follow-up after removal of a Hydatidiform mole?
Monitor HcG titer until there is 3 negative
What are HCG levels with a Hydatidiform mole?
Pregnancy in which the placenta is implanted in the lower part of the uterus - can cause bleeding in late pregnancy
Low placenta implantation praevia
Normal just low
Three types of placenta praevia
Low placental implantation
Partial placental praevia
Complete placenta praevia
Covers external os - more common in women with previous c-section
What are the symptoms of placenta praevia?
Uterus stays soft
Bright red bleeding 2nd half of pregnancy
Why does uterus stay soft with a placenta praevia?
Because blood is escaping vaginally
What is the management in a placenta praevia?
NO vaginal exams
Pad count + weigh
36-37 weeks can deliver
When can there be a vaginal birth with a placenta praevia?
If preavia is marginal and head down without much bleeding
What is it called if there is a premature separation of the normally implanted placenta?
What does it mean if there was a marginal abruptio placenta?
Placenta tears away at the edge first and escapes of blood vaginally
What does it mean if there is central abruptio placenta?
Pop in the center of the placenta results in concealed bleeding
What does is mean if there is a complete abruptio placenta?
Whole thing separates
What are the symptoms of abruptio placenta?
Shock disproprotional to estimated blood loss
Changes in FHR
Less resting tone
What kind if bleeding is caused by abruptio placenta?
Uterine bleeding with small to moderate amount or dark red vaginal bleeding
What are the changes in FHR with abruptio placenta?
If woman presents with dark red vaginal bleeding, c/o uterine tenderness what do you need to check?
Check V.S. and FHR promptly
How is abruptio placenta diagnosed?
Blood in amnionic fluid
Fall in H&H
Fall in coagulation factors (10-30%)