Bleeding in Early Pregnancy
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Questions and Answers

What is a primary cause of early bleeding in pregnancy?

  • Pelvic inflammatory disease
  • Ectopic pregnancy (correct)
  • Uterine fibroids
  • Gestational diabetes

    • Which type of abortion is characterized by a closed cervix and mild vaginal bleeding?

  • Septic abortion
  • Threatened abortion (correct)
  • Missed abortion
  • Inevitable abortion

    • What condition is defined as the termination of pregnancy before 28 weeks gestation?

  • Abortion (correct)
  • Ectopic pregnancy
  • Complete abortion
  • Placenta praevia

    • Which of the following is NOT a type of abortion?

    <p>Placental abruption</p> Signup and view all the answers

    Which of the following symptoms is associated with inevitable abortion?

    <p>Excessive vaginal bleeding</p> Signup and view all the answers

    Which of the following is a potential site for ectopic pregnancy?

    <p>Fallopian tube</p> Signup and view all the answers

    What is a common risk factor that can lead to abortion?

    <p>Exposure to ionizing radiation</p> Signup and view all the answers

    What defines a hydatidiform mole of pregnancy?

    <p>Abnormal growth of placental tissue</p> Signup and view all the answers

    Which type of abortion is marked by three or more successive spontaneous abortions?

    <p>Recurrent abortion</p> Signup and view all the answers

    What type of bleeding can occur after 28 weeks of pregnancy?

    <p>Placenta praevia</p> Signup and view all the answers

    What is the surgical treatment commonly performed for ectopic pregnancy?

    <p>Salpingectomy</p> Signup and view all the answers

    How does the bleeding in ectopic pregnancy differ from abortion?

    <p>Bleeding occurs after pain</p> Signup and view all the answers

    What is a common sign associated with complete vesicular mole?

    <p>Large uterus for the period of amenorrhea</p> Signup and view all the answers

    What is the characteristic urinary test result for vesicular mole diagnosis?

    <p>Positive urine pregnancy test in low dilution</p> Signup and view all the answers

    Which type of placenta previa presents with the placenta covering the internal os completely?

    <p>Type IV (P.P. complete centralis)</p> Signup and view all the answers

    What is a significant complication that may develop in cases of vesicular mole?

    <p>Pre-eclampsia</p> Signup and view all the answers

    What should be avoided during the management of placenta previa at home?

    <p>Oral intake</p> Signup and view all the answers

    Which symptom is NOT typically associated with ectopic pregnancy?

    <p>Bright red vaginal bleeding before pain</p> Signup and view all the answers

    What is the first step in managing a patient with significant bleeding due to placenta previa?

    <p>Ultrasonography to assess condition</p> Signup and view all the answers

    In the case of vesicular mole, what occurs after the evacuation of the mole?

    <p>Sharp curettage of the uterus</p> Signup and view all the answers

    What is the definition of abruptio placenta?

    <p>Premature separation of a normally situated placenta after the 28th week of pregnancy</p> Signup and view all the answers

    Which of the following is NOT a type of hemorrhage associated with abruptio placenta?

    <p>Intermittent hemorrhage</p> Signup and view all the answers

    Which factor is NOT associated with the etiology of abruptio placenta?

    <p>Chronic diabetes</p> Signup and view all the answers

    What is a common symptom of abruptio placenta?

    <p>Severe abdominal pain</p> Signup and view all the answers

    During the diagnosis of abruptio placenta, which of the following signs would be expected during examination?

    <p>Board-like and tender uterus</p> Signup and view all the answers

    Which treatment approach is typically avoided for patients with abruptio placenta?

    <p>Conservative treatment</p> Signup and view all the answers

    What should be monitored closely in a patient with abruptio placenta?

    <p>Amount of blood loss and uterine contractions</p> Signup and view all the answers

    Which of the following laboratory investigations is important for a patient with abruptio placenta?

    <p>Complete blood count</p> Signup and view all the answers

    In the case of abruptio placenta, what is a primary goal of nursing care?

    <p>Providing emotional support and monitoring vital signs</p> Signup and view all the answers

    What change in fetal heart sounds might be observed in severe cases of abruptio placenta?

    <p>Absent fetal heart sounds</p> Signup and view all the answers

    What characterizes a missed abortion?

    <p>Abdominal pain ceases and the uterus remains firm.</p> Signup and view all the answers

    Which symptom is commonly associated with septic abortion?

    <p>Abdominal rigidity and distension.</p> Signup and view all the answers

    What is the treatment approach for an incomplete abortion?

    <p>Surgical evacuation of the uterus.</p> Signup and view all the answers

    How is complete abortion differentiated from incomplete abortion?

    <p>Complete abortion typically has minimal bleeding and a slightly larger uterus.</p> Signup and view all the answers

    What indicates a therapeutic abortion?

    <p>Abortion performed for a medical reason.</p> Signup and view all the answers

    Which of the following is NOT a symptom of incomplete abortion?

    <p>Decrease in abdominal size over time.</p> Signup and view all the answers

    What is a common cause of septic abortion?

    <p>E.Coli infection.</p> Signup and view all the answers

    Which characteristic is observed in the ultrasound of a missed abortion?

    <p>Collapsed gestational sac with no fetal heart motion.</p> Signup and view all the answers

    Which of the following nursing diagnoses is important for a patient undergoing an abortion?

    <p>Dysfunctional grieving.</p> Signup and view all the answers

    What is indicated by the presence of retained products of conception during an incomplete abortion?

    <p>Increased risk for hemorrhage and infection.</p> Signup and view all the answers

    Study Notes

    Bleeding in Early Pregnancy

    • Bleeding in early pregnancy can be caused by abortion, ectopic pregnancy, or vesicular mole.
    • Local gynecological lesions such as cervical ectopy, polyp, dysplasia, carcinoma, or rupture of varicose veins can also cause bleeding.

    Abortion

    • Definition: Termination of pregnancy before fetal viability, which occurs before 28 weeks gestation.
    • Types:
      • Threatened abortion: Vaginal bleeding, closed cervix, viable fetus.
      • Inevitable abortion: Excessive vaginal bleeding, dilated cervix, nonviable fetus.
      • Incomplete abortion: Retention of parts of the products of conception in the uterus, continuous vaginal bleeding, open cervix.
      • Complete abortion: All products of conception expelled from the uterus, minimal vaginal bleeding, closed cervix.
      • Missed abortion: Retention of dead products of conception for 4 weeks or more, regression of pregnancy symptoms, no fetal movement.
      • Septic abortion: Any type of abortion complicated by infection, high fever, tachycardia, abdominal pain, offensive vaginal discharge.
      • Recurrent abortion: Three or more successive spontaneous abortions.

    Ectopic Pregnancy

    • Definition: Implantation of the fertilized ovum outside the normal uterine cavity.
    • Common site: Fallopian tubes (95%)
    • Rare sites: Ovaries, broad ligaments, peritoneum, cervix.
    • Clinical picture:
      • Short period of amenorrhea (usually not exceeding 8-10 weeks).
      • Pain: Aching, colicky, stabbing depending on the stage of the ectopic pregnancy.
      • Vaginal bleeding: Usually slight and follows the pain.
    • Treatment: Surgical intervention depending on the stage and severity of the ectopic pregnancy.

    Vesicular Mole

    • Definition: Benign neoplasm of the chorionic villi.
    • Clinical picture:
      • Short period of amenorrhea (2-3 months).
      • Exaggerated symptoms of pregnancy, especially vomiting.
      • Vaginal bleeding (usually dark brown) with passage of vesicles.
      • Abdominal pain: Dull-aching, colicky.
    • Diagnosis:
      • Positive urine pregnancy test in high dilution.
      • Highly elevated serum β-hCG levels.
      • Ultrasound reveals a characteristic "snow storm" appearance.
    • Treatment:
      • Suction evacuation: Safest and most effective method.
      • Abdominal hysterectomy: Preferred if the patient is over 40 years old.

    Bleeding in Late Pregnancy

    • Definition: Bleeding from the genital tract after the 28th week of pregnancy and before the end of the second stage of labor.
    • Classification:
      • Placenta previa: Bleeding from separation of a placenta wholly or partially implanted in the lower uterine segment.
      • Abruptio placenta: Premature separation of a normally implanted placenta.
      • Marginal separation: Bleeding from the edge of a normally implanted placenta.

    Placenta Previa

    • Definition: Bleeding from a placenta that is partially or totally attached to the lower uterine segment.
    • Types:
      • First degree (Type I = P.P. lateralis = low-lying placenta): The lower edge of the placenta reaches the lower uterine segment but not the internal os.
      • Second degree (Type II = P.P. marginalis): The lower edge of the placenta reaches the margin of the internal os but does not cover it.
      • Third degree (Type III = P.P. incomplete centralis): The placenta covers the internal os when it is closed or partially dilated but not when it is fully dilated.
      • Fourth degree (Type IV = P.P. complete centralis): The placenta covers the internal os completely whether the cervix is partially or fully dilated.
    • Diagnosis:
      • Causeless, painless, and recurrent bright-red vaginal bleeding.
      • Ultrasonography.
    • Treatment:
      • Immediate caesarean section if bleeding is severe.
      • Induction of labor or caesarean section if gestational age is at or beyond 37 weeks.
      • Conservative treatment if gestational age is less than 37 weeks until the end of 37 weeks.

    Abruptio Placenta (Accidental Hemorrhage)

    • Definition: Premature separation of a normally situated placenta after the 28th week of pregnancy and before delivery of the fetus.
    • Types:
      • Revealed hemorrhage: Blood appears externally.
      • Concealed hemorrhage: All blood is retained inside the uterus.
      • Combined or mixed type: The blood is partially concealed and partially revealed.
    • Diagnosis:
      • Acute, constant, severe abdominal pain.
      • Dark vaginal bleeding.
      • Cessation of fetal movement.
    • Treatment:
      • Immediate delivery: Amniotomy + oxytocin if bleeding is not severe and vertex presentation is present.
      • Caesarean section for severe cases.

    Nursing Care in Case of Bleeding During Pregnancy

    • Monitoring amount of blood loss, pain level, and uterine contractions.
    • Assessing maternal vital signs frequently.
    • Uterine massage.
    • Observing color, odor, and amount of blood.
    • Providing emotional support and listening to the patient's fears.
    • Obtaining laboratory investigations: CBC, blood type, coagulation studies.
    • Assisting the patient to remain on bed rest.
    • Following strict aseptic technique to avoid infection.
    • Continuously observing for signs of shock and fetal heart rate.
    • Maintaining accurate recording of intake and output.

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    Description

    This quiz explores the various causes of bleeding in early pregnancy, such as abortion, ectopic pregnancy, and local gynecological lesions. It provides insights into the definitions and types of abortion, including threatened, inevitable, incomplete, complete, and missed abortion. Test your knowledge on the complexities of early pregnancy complications.

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