ch. 28: hemorrhage in pregnancy

Question 1

What is a threatened miscarriage?

Answer 1

cervical opening CLOSED with slight vagina bleeding and mild uterine cramping

Question 2

What is the management for a threatened miscarriage?

Answer 2

-bedrest
-pelvic rest
-monitor hCG levels (↑ is good sign)

Question 3

What is the medical management for inevitable/incomplete miscarriage?

Answer 3

-prostaglandin (misoprostol, Cytotec) may be admin PO, into amniotic sac, or vag sup to augment or induce uterine ctxs to expel remaining tissue

Question 4

What is the surgical management for a miscarriage?

Answer 4

-dilation and curettage (D&C) to dilate and clean uterus

Question 5

What is the discharge teaching after a miscarriage?

Answer 5

-clean peri area after each bm/void and change peri pad
-avoid tub for 2 weeks
-total pelvic rest for 2 weeks
-report foul smelling discharge or elevaterd temp
-eat foods HIGH in IRON and PROTEIN
-grief support

Question 6

What is an incompetent cervix?

Answer 6

painless passive dilation of cervix in absence of uterine ctxs

Question 7

What is the surgical treatment for an incompetent cervix?

Answer 7

cerclage: heavy ligature placed around cervix to strengthen it and prevent premature cervical dialtion

Question 8

When must a cerclage be removed?

Answer 8

before onset of labor

Question 9

What are symptoms of en ECTOPIC pregnancy?

Answer 9

-abd pain (dull to colicky to sharp then stabbing)
-delayed menses
-abnormal vag bleeding (spotting)
-s/s usually 6 to 8 wekks after last normal period

Question 10

What s/s require assessment for ectopic pregnancy?

Answer 10

every women w/
-abd pain (knife like in lower abd quad)
-vag spotting
-positive preg test

Question 11

What is a symptom of a ruptured ectopic pregnancy?

Answer 11

referred shoulder pain occurs bc of diaphragmatic irritation caused by blood in peritoneal cavity

Question 12

What tests are done to dx an ectopic pregnancy?

Answer 12

-hormones: hCG ↑, progesterone ↓
-transvag ultrasound

Question 13

What is the medical management for an ectopic pregnancy?

Answer 13

methotrexate: inhibits rapid cell division and prevents fallopian tube rupture

Question 14

What is the surgical management for an ectopic pregnancy?

Answer 14

-after confirming location:
-laparoscopic removal
OR
-salpingostomy or salpingectomy (if tubal location)

Question 15

What is the criteria for methotrexate?

Answer 15

-hemodynamically stable
-normal/liver kidney
-< 3.5 cm mass
-NOT ruptured
-no fetal cardiac
-B-hCG <1000
-able to comply w/ guidelines

Question 16

What are s/s of a MOLAR PREGNANCY?

Answer 16

-uterus expands faster and reaches landmarks earlier
-morning sickness
-dark brown vag bleeding (can also e bright red, scant, or profuse)
-discharge w/ grapelike vesicles
-earlier signs of PIH

Question 17

What is the surgical treatment for a molar pregnancy?

Answer 17

D&C or suction
-give Rhogam to Rh- moms postop

Question 18

Molar pregnancies have a high association with the development of _____

Answer 18

carcinogenic development (choriocarcinoma)

Question 19

How long is it recommended to wait to get pregnant after a molar pregnancy?

Answer 19

at least 1yr

Question 20

What are women at high risk of developing after a molar pregnancy?

Answer 20

htn and hyperthyroidism

Question 21

What is placenta previa?

Answer 21

placenta abnormally implants in lower seg of uterus, near or over cervical os instead of latching to fundus

Question 22

What does placenta previa result in?

Answer 22

bleeding during 3rd trimester as cervix begins to dilate and efface

Question 23

What are risk factors for placenta previa?

Answer 23

-hx of placenta previa
-uterine scarring
-mom > 35y/o
-multifetal
-multiple gest or closely spaced perg
-previous c section
-smoking/cocaine
-higher altitudes, male fetus, Asian

Question 24

What dx tests are done for placenta previa?

Answer 24

-transabdominal or transvaginal US for placenta location
-fetal monitoring
-CBC
-ABO blood typing and Rh factor
-coagulation

Question 25

What therapeutic procedure is done for placenta previa?

Answer 25

emergency c-section

Question 26

What are the s/s of placental previa?

Answer 26

1)painless, bright red vag bleeding that increases as cervix dilates 2) soft, relaxed, nontender uterus w/ normal tone 3)fundal height may be greater than expected for gest age 4) palpable placenta via vag exam

Question 27

What are the nursing interventions if pt is not term and not in labor (placenta previa)?

Answer 27

-bedrest -pelvic rest -large bore IV w/ IVF -corticosteroids for lung maturity -may need blood replacement -continuous fetal monitoring

Question 28

What are the nursing interventions if pt is at term or in labor (placenta previa)?

Answer 28

-prepare for C-SECTION -have blood replacement products ready

Question 29

What is placenta abruption?

Answer 29

premature separation of the placenta from uterus, can be partial or complete detachment

Question 30

When does placenta abruption occur?

Answer 30

after 20 wks

Question 31

What is the leading cause of maternal death?

Answer 31

placenta abruption

Question 32

What are risk factors for placenta abruption?

Answer 32

-maternal htn -blunt external trauma -cocaine abuse -hx -smoking -PROM -multifetal -coagulation defects

Question 33

How is placenta abruption dx?

Answer 33

-abd pain, uterine tenderness, ctx -higher fundus -elevated uterine resting tone -abnormal FHR pattern -coagulopathy may be present -may develop sym of rigid board like abd & hypovolemic shock

Question 34

What symptoms would make the nurse highly suspect placenta abruption?

Answer 34

sudden onset of intense, usually localized uterine pain, w/ o w/o vag bleeding

Question 35

What is the nursing management for a stable pt w/ only mild separation & 20-34 weeks gest?

Answer 35

-bed rest -pelvic rest -corticosteroids for fetal lung maturity -close monitoring of mom and fetus -reg NSTs & BPP

Question 36

What is the active management for placenta abruption?

Answer 36

IMMEDIATE BIRTH if preg at term or bleeding is mod to severe -vag delivery is preferable (always be ready for emergency c-section) -monitoring -large bore IVs, foley cath for strict I&O -H&H, clotting -type & cross w/ blood products

Question 37

What is DIC?

Answer 37

-diffuse clotting that causes widespread external bleedin, internal bleeding, or both

Question 38

What are common causes of DIC?

Answer 38

-placenta abruption -HELLP -amniotic fluid embolus -PPH -sepsis -retained IUFD

Question 39

What is the management for DIC?

Answer 39

-hemodynamic monitoring -fluid replacement -blood and blood products -O2 -additional coag and -hemostatic agents