Exam 1 - Bleeding in Pregnancy

Question 1

Name the 3 most common bleeding disorders of early pregnancy

Answer 1

(1) Miscarriage
(2) Ectopic pregnancy
(3) Gestational trophoblastic disease (molar/hydatidiform mole)

Question 2

Scant bleeding is a ____ inch stain

Answer 2

1

Question 3

Light bleeding is a ____ inch stain

Answer 3

1-4

Question 4

Moderate bleeding is a ___ inch stain

Answer 4

4-6

Question 5

Heavy bleeding is when…

Answer 5

the pad is saturated in an hour.

Question 6

Loss of pregnancy before the fetus is viable / capable of living outside of the uterus is called what?

Answer 6

Abortion

Question 7

Termination of a pregnancy without action taken by the pregnant person or any other person; natural causes

Answer 7

Spontaneous abortion / Miscarriage

Question 8

Purposeful interruption of a pregnancy

Answer 8

Induced abortion

Question 9

If purposeful interruption of a pregnancy is performed at the patient’s request

Answer 9

Elective abortion

Question 10

If the purposeful interruption of a pregnancy is performed for reasons of maternal or fetal health

Answer 10

Therapeutic abortion

Question 11

What is the primary cause of spontaneous abortion?

Answer 11

Chromosomal abnormalities

Question 12

Frequency of early pregnancy loss will ___ with age

Answer 12

increase

Question 13

Other causes of spontaneous abortion include…

Answer 13

(1) maternal infection
(2) anatomic defects
(3) environmental factors

Question 14

Name at least 3 risk factors for spontaneous abortion

Answer 14

(1) Maternal and paternal age >40
(2) H/o miscarriage
(3) obesity
(4) Chronic disease
(5) infection
(6) environmental toxins
(7) alcohol and drug use
(8) abnormalities of the cervix or uterus

Question 15

What is the management goal of spontaneous abortion?

Answer 15

Empty uterus of products of conception (POC)

Question 16

Expectant emptying of the POC means to…

Answer 16

await spontaneous / complete expulsion

Question 17

Medical emptying of the POC means…

Answer 17

using medication to induce expulsion

Question 18

The 2 types of surgical emptying of the POC are

Answer 18

(1) Dilation and Curettage - T1
(2) Dilation and Evacuation - T2

Question 19

The two complications that nurses should manage for bleeding during pregnancy are what?

Answer 19

(1) Infection
(2) Heavy bleeding

Question 20

vaginal bleeding, closed cervix, may have other symptoms - what type of spontaneous abortion?

Answer 20

Threatened

Question 21

Progressive bleeding, cervical dilation - what type of spontaneous abortion?

Answer 21

Inevitable abortion

Question 22

some but not all products of conception expelled from the uterus. Active bleeding, cramps, cervix open - what type of spontaneous abortion?

Answer 22

Incomplete abortion

Question 23

All products of conception expelled, bleeding stopped, cervix closes. What type of spontaneous abortion?

Answer 23

Complete abortion

Question 24

Fetus dies but is retained in uterus; uterus stops growing; pregnancy symptoms may stop. What type of spontaneous abortion?

Answer 24

Missed abortion

Question 25

3 or more consecutive pregnancy losses is called what?

Answer 25

Recurrent spontaneous abortion

Question 26

Implantation of fertilized ovum outside the uterine cavity

Answer 26

Ectopic pregnancy

Question 27

Lower abdominal / one-sided pain; Vaginal bleeding 5-6 weeks GA; positive pregnancy test. What is this describing?

Answer 27

S/S Ectopic pregnancy

Question 28

Name at least 3 risk factors for ectopic pregnancy

Answer 28

(1) History of PID / STIs (2) Smoking (3) Pelvic surgery (4) History of ectopic (5) IUD in place

Question 29

What is the management goal of ectopic pregnancy?

Answer 29

Preserve the fallopian tube

Question 30

What is the purpose of methotrexate for ectopic pregnancy?

Answer 30

Stops the growth of the pregnancy

Question 31

When is surgical management of ectopic pregnancy necessary?

Answer 31

(1) Hemorrhaging and rupture has already occurred (2) Pregnancy is further along

Question 32

When the placenta of a defective pregnancy transforms into a tumor

Answer 32

Gestational trophoblastic disease

Question 33

______ occurs when trophoblasts form abnormally

Answer 33

hydatidiform mole

Question 34

A complete hydatidiform mole has _____

Answer 34

no fetal parts

Question 35

A partial hydatidiform mole has ____

Answer 35

fetal tissue or membranes present

Question 36

Detailed follow-up after _____ disease is important because it can lead to _____

Answer 36

gestational trophoblastic; cancer

Question 37

In early pregnancy bleeding, name at least 3 things nurses should do.

Answer 37

(1) assess bleeding, vital signs, pain, complications (2) intervene - notify provider, supportive care, education (3) labs - CBC, hcG, blood type & Rh

Question 38

Name the 2 main bleeding conditions of late pregnancy

Answer 38

(1) Placenta previa (2) Placental abruption

Question 39

When the placenta completely or partially covers the cervix

Answer 39

Placenta previa

Question 40

Name 3 risk factors for placenta previa.

Answer 40

(1) previous C-section or uterine surgery (2) 35+ yo (3) Smoking or cocaine use

Question 41

Name the 3 main complications r/t placenta previa

Answer 41

(1) bleed in pregnancy, l&d (2) preterm birth (3) placenta accreta

Question 42

A sudden onset of painless, bright red bleeding. What is this describing?

Answer 42

Placenta previa

Question 43

What is one thing you should NEVER do with placenta previa and why?

Answer 43

Vaginal exams because it can cause further bleeding and tissue trauma

Question 44

When the placenta detaches from the uterine wall before birth

Answer 44

Placental abruption

Question 45

Name at least 3 risk factors for placental abruption

Answer 45

(1) HTN (2) Smoking (3) Multigravida (4) Abdominal trauma (5) IPV (6) Cocaine use (7) Lupus (8) Factor V Leiden

Question 46

rigid taut abdomen d/t uterine irritability is called what?

Answer 46

High uterine resting tone

Question 47

High uterine resting tone and uterine tenderness are signs of what?

Answer 47

Placental abruption

Question 48

If placental abruption is mild and the fetus is <34 weeks, what is the treatment?

Answer 48

Hospitalization, bedrest, Rhogam

Question 49

If placental abruption is an emergency, what should the nurse do?

Answer 49

(1) maternal and fetal monitoring (2) IV insertion