34 Questions
What is the age of viability for a fetus?
20-24 weeks
What percentage of pregnancies result in spontaneous miscarriage?
15-30%
Which of the following is a cause of recurrent pregnancy losses?
All of the above
What is an early abortion defined as?
Occurring before 16 weeks
Which of the following factors would NOT be assessed in a case of first trimester bleeding?
Mother's blood type
What is the role of maintaining a positive attitude toward fetal outcome?
Supports mother-child bonding
What is the primary goal of nursing care for a patient with placental bleeding?
To prevent premature delivery and hemorrhage
Which of the following is NOT a predisposing factor for placental abruption?
Vaginal delivery
What type of placental hemorrhage is characterized by a partial separation of the placenta?
Overt/Partial/Marginal hemorrhage
Which nursing intervention is recommended to establish a trusting environment for the patient?
Answer the mother's questions honestly
What is a possible complication of placental abruption?
Preterm birth
Which of the following is a clinical manifestation of placental abruption?
All of the above
What is the key intervention for threatened abortion with a viable fetus?
Avoidance of strenuous activity for 24 to 48 hours
What is the purpose of obtaining hCG levels in a case of threatened abortion?
To determine if the placenta is intact
Why is complete bed rest not recommended in cases of threatened abortion with a viable fetus?
It may stop the vaginal bleeding, but only because blood is pooling vaginally
What is the recommended duration for restricting coitus after a threatened abortion episode?
2 weeks
What is the purpose of assessing fetal heart sounds or performing an ultrasound in a case of threatened abortion?
To determine if the fetus is viable
What is the term used to describe a situation where irreversible uterine evacuation has begun?
Inevitable abortion
What is the characteristic of vaginal bleeding in Couvelaire Uterus?
Painful and dark red
What is a symptom of Couvelaire Uterus?
Hard, boardlike uterus with minimal bleeding
What is a nursing intervention for a patient with Couvelaire Uterus?
Avoid vaginal exams and enemas
What is a potential complication of Couvelaire Uterus?
Disseminated intravascular coagulation (DIC)
How is disseminated intravascular coagulation (DIC) managed?
Maintaining ventilator support
Why is fetal and newborn assessment important in cases related to Couvelaire Uterus?
To evaluate the efficiency of placental circulation
What is the first step in the emergency implementation for bleeding during pregnancy?
Alert the health care team of the emergency situation
Which statement is true regarding vaginal examination during bleeding in pregnancy?
Vaginal examination should be omitted to prevent tearing of placenta previa if present
What is the purpose of ordering a type and cross-match for 2 units of whole blood?
To prepare for a potential blood transfusion
What is the significance of monitoring urine output during bleeding in pregnancy?
It enables assessment of renal function
Which vital sign is typically increased during hypovolemic shock due to blood loss?
Pulse rate
What is the purpose of measuring maternal blood loss by weighing perineal pads?
To monitor the progression of bleeding
What is the significance of administering oxygen at 6-10 L/min by face mask during bleeding in pregnancy?
It provides adequate fetal oxygenation despite lowered maternal circulating blood volume
Which of the following is a sign of hypovolemic shock due to blood loss?
Cold, clammy skin
What is the purpose of placing a central venous pressure (CVP) or pulmonary wedge catheter during bleeding in pregnancy?
To provide accurate data on maternal hemodynamic state
What is the significance of saturating a sanitary pad in less than 1 hour during bleeding in pregnancy?
It is considered heavy blood loss and may indicate an abnormal trophoblast tissue
Study Notes
Bleeding During Pregnancy
- Any degree of bleeding during pregnancy is potentially serious and needs to be evaluated for hypovolemic shock.
- Danger to fetal blood supply occurs when the woman's body begins to decrease blood flow to peripheral organs.
- Signs of hypovolemic shock will occur when 10% of blood volume or 2 units of blood have been lost.
- Fetal distress occurs when 25% of blood volume is lost.
Signs and Symptoms of Hypovolemic Shock
- Increased PR (heart rate) to circulate decreased blood volume.
- Decreased BP (blood pressure) due to less peripheral resistance.
- Increased RR (respiratory rate) to increase blood exchange for better oxygenation.
- Cold, clammy skin due to vasoconstriction.
- Decreased urine output due to inadequate blood entering the kidney.
- Dizziness/decreased level of consciousness due to inadequate blood reaching the cerebrum.
- Decreased CVP (central venous pressure) due to decreased blood returning to the heart.
Emergency Implementation for Bleeding in Pregnancy
- LTBB (Labor Triage & Bedside Briefing) Alert healthcare team of emergency situation.
- Place woman flat in bed on her side to maintain optimal and renal function.
- Begin IVF (intravenous fluid) with a 16 or 18 angiocath to replace intravascular fluid volume.
- Administer oxygen as necessary at 6-10 L/min by face mask.
- Monitor uterine contractions and FHR (fetal heart rate) by external monitor.
- Normal needle for IVF: 21-22.
- Normal urine output: 30-40 cc/hr.
Types of Miscarriages
- Threatened Abortion: Unexplained vaginal bleeding with cramping or dilation.
- Inevitable Miscarriage: A situation where irreversible uterine evacuation has begun.
Conditions Associated with First Trimester Bleeding
- Spontaneous Miscarriage: Occurs in 15-30% of pregnancies.
- Age of Viability: 20-24 weeks.
- Causes of Recurrent Pregnancy Losses:
- Abnormal fetal formation.
- Implantation abnormalities.
- Lack of progesterone production.
- Trauma.
- Infection.
- Ingestion of teratogenic drugs.
- Emotional shock/stress.
Conditions Associated with Second Trimester Bleeding
- (Not mentioned in the provided text)
Conditions Associated with Third Trimester Bleeding
- (Not mentioned in the provided text)
Abruptio Placenta / Premature Separation of the Placenta
- Separation of a part or all of the normally implanted placenta after the 20th week of pregnancy or before the birth of the baby.
- Predisposing Factors:
- Chronic hypertensive disorders.
- Cocaine use by the mother.
- Multiple gestation and hydramnios.
- Short umbilical cord.
- Direct trauma.
- Manual manipulation of the uterus during pregnancy.
- Cigarette smoking.
- Clinical Manifestations:
- Painless or painful vaginal bleeding.
- Couvelaire uterus (hard, board-like uterus with no apparent bleeding).
- S/S of shock.
- Absence of fetal heart tones.
- Difficulty of palpating the fetus.
Disseminated Intravascular Coagulation (DIC)
- An acquired disorder of blood clotting in which the fibrinogen level falls to below effective limits.
- Management:
- Monitor respiratory status.
- Maintain ventilator support.
- Administer fluid (IVF) and MIO (massive intravenous oxytocin).
- Monitor vital signs.
- Monitor occult blood in stool.
- Monitor for overt signs of bleeding from gums.
- Measure abdominal girth every 4 hours.
- Evaluation:
- Determining whether a woman's blood coagulation studies are returning to normal.
- Evaluating if any anoxia has occurred, particularly in renal or brain cells from occluded coagulated capillaries.
Test your knowledge on the care of mothers and children at risk or with problems, focusing on acute and chronic conditions during pregnancy. Learn about bleeding during pregnancy in the first, second, and third trimesters.
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