Chapter 28 Flashcards by Fatima Avila

ANTEPARTAL HEMORRHAGIC DISORDERS
-What are the fetal risks from maternal hemorrhage? (4)

Blood loss –> anemia
Hypoxia & hypoxemia
Anoxia
Preterm birth

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ANTEPARTAL HEMORRHAGIC DISORDERS
-Hemorrhagic disorders in pregnancy are _____ _____
-The incidence & type of bleeding varies by _____

-medical emergencies
-trimester

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ANTEPARTAL HEMORRHAGIC DISORDERS
-Prompt ____ & ____ is needed

assessment & intervention

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EARLY PREGNANCY BLEEDING
-What is a miscarriage also called?
-What is it?

-Spontaneous abortion
-a pregnancy that ends as a result of natural causes BEFORE fetal viability

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EARLY PREGNANCY BLEEDING
-Approximately ____-____% of pregnancies end in miscarriage

10-15

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EARLY PREGNANCY BLEEDING
-The majority (greater than 80%) of miscarriages occur before ___ weeks of gestation

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EARLY PREGNANCY BLEEDING
-What are the 6 types of miscarriage?

Threatened
Inevitable
Incomplete
Complete
Missed
Recurrent

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THREATENED ABORTION
-What is this?
-This is usually what brings them into what?

-Cervix is NOT dilated; placenta is attached to uterine wall, but some bleeding occurs
-the ER or office –> potential for miscarriage

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INEVITABLE ABORTION
-What is this?
-Can we stop this?

-Cervix is dilated; placenta has SEPARATED from the uterine wall; amount of bleeding increases
-NO

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INCOMPLETE ABORTION
-What is this?
-What does the patient need? Why?

-Embryo & fetus have passed out of the uterus, HOWEVER, placenta remains
-D&C to clean out products of conception; woman will end up with sepsis if they stay inside

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EARLY PREGNANCY BLEEDING: Interprofessional Care Management
-What will you obtain from the patient when they come in for early pregnancy bleeding? (6)

Pregnancy hx
VS
Type & location of pain
Quantitiy & nature of bleeding
Emotional status
Lab tests

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EARLY PREGNANCY BLEEDING: Interprofessional Care Management
-What would be a normal cause of bleeding?

When the pregnancy implants into the uterine wall, it can cause spotting (still needs to be ruled out)

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EARLY PREGNANCY BLEEDING: Interprofessional Care Management
-The initial care depends on what two things?

Classification of miscarriage
S/S

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EARLY PREGNANCY BLEEDING: Interprofessional Care Management
-What is the medical management?

Misoprostol (Cytotec) –> prostaglandin

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EARLY PREGNANCY BLEEDING: Interprofessional Care Management
-What is the surgical management?

Dilation & curettage (D&C)

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EARLY PREGNANCY BLEEDING: Interprofessional Care Management
-Once discharged, you should emphasize the need for _____
-Address questions about attempting another ____
-Follow-up with what?

-rest
-pregnancy
-phone calls & support groups

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CERVICAL INSUFFICIENCY
-What is this?
-What are possible causes of this?

-When the cervix opens due to weak cervical tissue
-Hx miscarriage or D&C

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CERVICAL INSUFFICIENCY
-It is a ____ & ______ ______ of the cervix during which trimester?
-It can be _____ or _____

-passive & painless dilation; 2nd
-acquired or congenital

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CERVICAL INSUFFICIENCY
-What is this diagnosed by?

Measurement of cervical length

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CERVICAL INSUFFICIENCY
-We want to identify women who have cervical changes due to impaired cervical ______ before ______ or in _____ pregnancy rather than when they are what?

-strength
-conception
-early
-beginning the process of preterm labor

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CERVICAL INSUFFICIENCY
-You may also use what three things to diagnose?

Speculum
Digital pelvic exams
Transvaginal US

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CERVICAL INSUFFICIENCY
-How do you want the cervix to be?

Long & closed

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CERVICAL INSUFFICIENCY
-With cervical insufficiency, the cervix will be…?
-This increases risk of ______

-short –> less than 25 mm
-dilation

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CERVICAL INSUFFICIENCY
-What is the treatment?

Cervical serologue (sewing the cervix) to keep it closed

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**EARLY PREGNANCY BLEEDING**: *Follow-Up Care* -Has bed rest been scientifically proven? -______ therapy may be recommended for some women -Watch for & report signs of what?

-NO -Progesterone -preterm labor, ROM, & infection

**EARLY PREGNANCY BLEEDING**: *Follow-Up Care* -What two kinds of rest are important?

Bed rest & pelvic rest

**ECTOPIC PREGNANCY** -What is this? -What is it also called?

-When the fetilized ovum implants **OUTSIDE** the uterine cavity -Tubal pregnancies

**ECTOPIC PREGNANCY** -The embryo implants where? -What is this considered?

-In the fallopian tubes -Medical emergency

**ECTOPIC PREGNANCY** -Why would surgery be needed?

The tubes are very vascular --> if they erupt then surgery is needed

**ECTOPIC PREGNANCY** -_______ can be used to dilute the pregnancy before it erupts

Methotrexate

**ECTOPIC PREGNANCY** -What are the three most classic symptoms of an ectopic pregnancy?

1. Abdominal pain 2. Delayed menses 3. Abnormal vaginal bleeding or spotting

**ECTOPIC PREGNANCY** -Look at ipad for sites of ectopic pregnancies

**ECTOPIC PREGNANCY** -Is it easy to diagnose?

No, it is difficult --> many conditions have the same symptoms

**ECTOPIC PREGNANCY** -What can we do to diagnose this?

1. Quantitative B-hCG levels 2. Transvaginal ultrasound examination

**ECTOPIC PREGNANCY** -What is the descriminatory zone?

Normally, hCG rises steadily BUT in ectopic pregnancies, it is not rising properly (still high)

**ECTOPIC PREGNANCY** -What is the medical management? -Describe it

-Methotrexate -Antimetabolite & folic acid antagonist that *DESTROYS** rapidly dividing cell

**ECTOPIC PREGNANCY** -The type of surgery needed depends on what? (3)

1. Location & cause of the ectopic pregnancy 2. Extent of tissue involvement 3. Woman's desires

**ECTOPIC PREGNANCY** -What is the removal of the entire tube called?

Salpingectomy

**ECTOPIC PREGNANCY** -_____ care is important

Follow-up

**MOLAR PREGNANCY** -What is this also known as?

Hydatidiform Mole

**MOLAR PREGNANCY** -This is a type of ______ _____ disease -They are at risk for what?

-gestational trophoblastic -uterine cancer

**MOLAR PREGNANCY** -What will they usually have at home?? -Why?

-A positive pregnancy test even though they are NOT pregnant -Due to increased hCG levels

**MOLAR PREGNANCY** -What is this?

Benign proliferative growth of the placental trophoblast

**MOLAR PREGNANCY** -How does this happen?

The chorionic villi develop into edematous, cystic, avascular transparent vesicles that hang in a grapelike cluster

**MOLAR PREGNANCY** -This occurs in ___ in ____ pregnancies in the United States

1 in 1000

**MOLAR PREGNANCY** -Cause? -What may it be related to?

-unknown -an ovular defect or nutritional deficiency

**MOLAR PREGNANCY** -What are the two types?

1. Complete 2. Partial

**MOLAR PREGNANCY** -What is complete?

No embryonic or fetal parts

**MOLAR PREGNANCY** -What is partial?

Often have embryonic or fetal parts & an amniotic sac

**MOLAR PREGNANCY** -What is the treatment?

Uterus must be cleaned to make sure there are no products of conception

**MOLAR PREGNANCY** -What are the symptoms? (5)

1. Abnormally large uterus 2. Vaginal bleeding 3. Excessive N/V 4. Abnormally high hCG 5. Anemia

**MOLAR PREGNANCY** -______ occurs in 70% of women with large, rapidly growing hydatidiform moles -It occurs (earlier/later) than usual in pregnancy

-Preeclampsia -Earlier

**MOLAR PREGNANCY** -What is the diagnosis?

Transvaginal US & serum hCG levels

**MOLAR PREGNANCY** -What is the care management?

1. Most abort spontaneously 2. Suction curettage can be used

**MOLAR PREGNANCY** -What will you monitor in terms of follow-up care?

B-hCG levels

**MOLAR PREGNANCY** -What is the recommendation for women?

To avoid pregnancy for at least a year

What are the two major causes of bleeding in early pregnancy?

1. Spontaneous abortion 2. Ectopic Pregnancy

Vaginal bleeding in pregnancy requires what?

Immediate attention!!

**LATE PREGNANCY BLEEDING** -What are the two types?

1. Placenta Previa 2. Placental Abruption

**PLACENTA PREVIA** -What is this?

Placenta impants in the lower uterine segment near OR over internal cervical os

**PLACENTA PREVIA** -Placenta previas are classified to the degree in which the _____ _____ ____ is covered by the placenta -What are the three?

-internal cervical os 1. Complete placenta previa 2. Marginal placenta previa 3. Low-lying placenta previa

**PLACENTA PREVIA** -What is complete placenta previa?

Placenta **COMPLETELY** blocks the cervix --> baby CANNOT be delivered vaginally

**PLACENTA PREVIA** -What is marginal placenta previa?

Edge of the placenta extends to the cervix but may move out of the way in time

**PLACENTA PREVIA** -What is low-lying placenta previa?

Placenta is near or by the cervix --> monitor it

**PLACENTA PREVIA** -If the placenta hasn't moved by the end of the pregnancy, what will happen?

the mom will have a c-section

**PLACENTA PREVIA** -This occurs in ____ in ____ pregnancies

1 in 200

**PLACENTA PREVIA** -Risk factors include what? (5)

1. Previous c-section 2. AMA (>35) 3. Multipary 4. Hx of prior suction curettage d/t incomplete abortion 5. Smoking

**PLACENTA PREVIA** -What are the clinical manifestations? -When does this occur?

-**PAINLESS** bright red vaginal bleeding --> no cramping or pain -During the second or third trimester

**PLACENTA PREVIA** -What is a major complication of this?

Hemorrhage

**PLACENTA PREVIA** -Morbidly ____ placenta can occur. What does this mean?

-adherent; abnormally **firm** placental attachment

**PLACENTA PREVIA** -Risk for _______ exists

Surgery

**PLACENTA PREVIA** -What two additional outcomes can occur?

Preterm birth & IUGR

**PLACENTA PREVIA** -What is the diagnosis?

Transabdominal ultrasound

**PLACENTA PREVIA** -Most cases are diagnosed by ____ before signifcant ____ ____ occurs

-US -vaginal bleeding

**PLACENTA PREVIA** -Care is depedent on what? (3)

1. GA 2. Quantity of bleeding 3. Fetal condition

**PLACENTA PREVIA** -What is the expectant management?

The patient is in L&D getting labs, EFM, IV, T&S, betamethasone if preterm, serial ultrasounds BUT NO vaginal exams

**PLACENTA PREVIA** -What is the home care goal? -What should the mom do?

-No bleeding for 48 hours -Bedrest w/ bathroom privileges & pelvic rest

**PLACENTA PREVIA** -What is the active management?

If there is active bleeding during 36 or more weeks, c-section occurs

**PLACENTAL ABRUPTION** -This is a ____ ____!!!! -What does it mean?

-MEDICAL EMERGENCY -Premature separation of placenta

**PLACENTAL ABRUPTION** -This is what?

Detachment of part of all of placenta from implanation site **AFTER** 20 weeks of gestation

**PLACENTAL ABRUPTION** -What is a primary risk factor?

Maternal HTN

**PLACENTAL ABRUPTION** -Other risk factors include what? (4)

1. Cocaine use 2. Blunt external abdominal trauma 3. Cigarette smoking 4. Hx of abruption in a previous pregnancy

**PLACENTAL ABRUPTION** -What are the clinical manifestations? (5)

-PAINFUL dark red vaginal bleeding -abdominal pain -Uterine tenderness -Contractions -Board-like abdomen

**PLACENTAL ABRUPTION** -Prognosis depends on what?

Many factors

**PLACENTAL ABRUPTION** -What are the complications? (7)

1. Maternal hemorrhage 2. Hypovolemic shock 3. Fetal hypoxia/hypoxemia 4. IUGR 5. Oligohydramnios 6. PTB 7. Stillbirth

**PLACENTAL ABRUPTION** -What is the diagnosis for most cases?

**PLACENTAL ABRUPTION** -What is the expectant management?

Fetal wellbeing assessments between 20-34 weeks

**PLACENTAL ABRUPTION** -______ medications can be used

Corticosteroids

**PLACENTAL ABRUPTION** -What is the active management?

Immediate delivery at term OR due to moderate/severe bleeding, maternal/fetal status

**VASA PREVIA** -Normally, the umbilical cord plugs where? -What is inside the umbilical cord?

-DIRECTLY into the placenta -Blood vessels that are protected by Wharton's jelly

**VASA PREVIA** -What is this?

Rare condition where fetal vessels lie over the cervical os

**VASA PREVIA** -Where are the vessels implanted into?

The fetal membranes rather than into the placenta

**VASA PREVIA** -What are the two types?

1. Velamentous insertion of the cord 2. Succenturiate placenta

**VASA PREVIA** -What is velamentous insertion of the cord?

Cord vessels insert into membranes FIRST & then onto placenta --> vessels travel exposed to the placenta

**VASA PREVIA** -What is succenturiate placenta?

Placenta has divided into two or more lobes

**VASA PREVIA** -What are we worried about for these two conditions?

The amount of blood & oxgyen the baby is getting & how they are growing

**DISSEMINATED INTRAVASCULAR COAGULATION (DIC)** -What is this?

An acute blood-clotting disorder that results in excessive bleeding

**DISSEMINATED INTRAVASCULAR COAGULATION (DIC)** -Is DIC a primary diagnosis?

NO --> it results from an event that triggered coagulation

**DISSEMINATED INTRAVASCULAR COAGULATION (DIC)** -Usually this is the end result of what?

Preeclampsia

**DISSEMINATED INTRAVASCULAR COAGULATION (DIC)** -In the obstetric population, DIC is most often triggered by what?

The release of large amounts of tissue factor as a result of placental abruption

**DISSEMINATED INTRAVASCULAR COAGULATION (DIC)** -What are the s/s? (5)

1. Signs of thrombosis (confusion, cyanosis) 2. Bleeding from at least three sites, epistaxis, oozing from venipuncture 3. Petechiae or ecchymosis 4. HYPOtension 5. Tachycardia

**DISSEMINATED INTRAVASCULAR COAGULATION (DIC)** -How are platelet levels? -Why?

-Basically nothing -they are losing blood as it is being replaced

**DISSEMINATED INTRAVASCULAR COAGULATION (DIC)** -It usually results in what?

Death

**DISSEMINATED INTRAVASCULAR COAGULATION (DIC)** -We want to do what?

Correct the underlying cause --> remove abrupted placenta or deceased fetus, OR treat existing infection

**DISSEMINATED INTRAVASCULAR COAGULATION (DIC)** -This usually requires what?

Massive transfusion

**DISSEMINATED INTRAVASCULAR COAGULATION (DIC)** -Assess for signs of what?

Bleeding & complications of blood products

**DISSEMINATED INTRAVASCULAR COAGULATION (DIC)** -What will you administer? -What must be done upon admission?

-IV fluid & blood products as ordered -Consent

**DISSEMINATED INTRAVASCULAR COAGULATION (DIC)** -Monitor what?

VS & urine output (they are at risk for renal failure --> anything under 30 mL/hour isn't good)

**DISSEMINATED INTRAVASCULAR COAGULATION (DIC)** -____ should be done before delivery

EFM

**DISSEMINATED INTRAVASCULAR COAGULATION (DIC)** -What position should you put them in? -Administer ____

-Side-lying -Oxygen

**DISSEMINATED INTRAVASCULAR COAGULATION (DIC)** -Provide ____ ____

emotional support

Chapter 28 Flashcards

Antepartum Hemorrhagic Disorders (111 cards)