Nursing Management for Abruptio Placentae

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which of the following instructions should a patient be given upon returning home after stabilization?

Avoid douching (correct)

Engage in regular exercise

Participate in sexual activity

Increase dietary fiber intake

Under what conditions should immediate delivery be implemented regardless of gestational age?

In case of excessive bleeding (correct)

If the patient experiences mild cramping

If the patient is feeling well

When the fetus is moving less frequently

What type of delivery is indicated if a patient has a partial or complete placenta previa?

Assisted delivery

Vaginal birth

Cesarean birth (correct)

Home birth

What is a primary nursing intervention for a patient experiencing abruptio placentae?

Place the patient on complete bed rest Signup and view all the answers

What complication arises from a retro-placental clot during abruptio placentae?

Increased placental separation Signup and view all the answers

What type of abruptio placentae involves external hemorrhage?

Revealed abruption Signup and view all the answers

What is a significant risk associated with abruptio placentae?

Compromised fetal blood supply Signup and view all the answers

Which of the following best describes the etiology of abruptio placentae?

Degenerative changes in maternal arterioles Signup and view all the answers

What is the primary therapeutic management for abruptio placentae?

Assessment, control, and restoration of blood loss Signup and view all the answers

Which symptom is commonly associated with abruptio placentae?

Dark red vaginal bleeding Signup and view all the answers

Which of the following is NOT a nursing management strategy to improve tissue perfusion in cases of abruptio placentae?

Physical therapy exercises Signup and view all the answers

What characterizes gestational hypertension during pregnancy?

Elevation of blood pressure after 20 weeks without proteinuria Signup and view all the answers

What condition progresses from preeclampsia and involves generalized seizures?

Eclampsia Signup and view all the answers

What is a risk factor associated with hypertensive disorders during pregnancy?

Previous history of hypertension Signup and view all the answers

Which of the following statements about eclampsia is true?

It involves seizures that follow preeclampsia. Signup and view all the answers

What is the primary concern with hypertensive disorders in pregnancy?

Maternal and prenatal mortality and morbidity Signup and view all the answers

What is the most likely type of placenta previa when the internal cervical os is completely covered by the placenta?

Total placenta previa Signup and view all the answers

What is a possible risk factor that may lead to placental bleeding?

Uterine scar disruption Signup and view all the answers

What is the primary goal of expectant management for placenta previa?

Obtain maximum fetal maturity Signup and view all the answers

Which procedure is typically performed between 34 and 36 weeks of gestation to assess fetal lung maturity?

Amniocentesis Signup and view all the answers

What should be monitored for due to the risk of preterm contractions in patients with placenta previa?

Signs of fetal distress Signup and view all the answers

What percentage of placental site bleeding cases are attributed to placenta previa?

95% Signup and view all the answers

What type of placenta previa occurs when the placental edge does not reach the internal os but is close to it?

Low-lying placenta Signup and view all the answers

Which medication may be ordered to enhance fetal pulmonary maturity in cases of placenta previa?

Betamethasone Signup and view all the answers

What should be monitored to assess the amount of vaginal bleeding after an abortion?

Pad counts Signup and view all the answers

When is it necessary to administer RhoGam?

If the woman is Rh-negative and not sensitized Signup and view all the answers

What is the most common site for an ectopic pregnancy?

Fallopian tube Signup and view all the answers

Which condition is NOT a predisposing factor for ectopic pregnancy?

Previous cystic fibrosis Signup and view all the answers

What is a clinical manifestation before the rupture of a tube in an ectopic pregnancy?

Intermittent dark mild vaginal bleeding Signup and view all the answers

What diagnostic method confirms an extra-uterine pregnancy?

Ultrasound Signup and view all the answers

Which management option is used only if the ectopic fetus is under a specific size?

Administration of Methotrexate Signup and view all the answers

Which clinical sign occurs after the rupture of a tube in an ectopic pregnancy?

Referred shoulder pain Signup and view all the answers

What is a common diagnostic tool for Gestational Trophoblastic Disease?

Serial Beta – subunit for HCG Signup and view all the answers

What serious complication is associated with Gestational Trophoblastic Disease?

Choriocarcinoma Signup and view all the answers

Which management step is recommended if a patient has Rh negative blood?

Administer RhoGam Signup and view all the answers

What should be monitored for patients after evacuation of Gestational Trophoblastic Disease?

B-hCG levels Signup and view all the answers

What is a noted symptom of Cervical Insufficiency?

Pink-tinged vaginal discharge Signup and view all the answers

What is a common treatment for Cervical Insufficiency?

Bed rest, pelvic rest, and cervical cerclage Signup and view all the answers

What should patients avoid after achieving normal B-hCG levels following evacuation?

Pregnancy for at least 6 months to 1 year Signup and view all the answers

What does late bleeding during pregnancy refer to?

Bleeding after the 28th week of pregnancy or during the 1st stage of labor Signup and view all the answers

What characterizes a high-risk pregnancy?

A pregnancy where conditions jeopardize the health of the mother or fetus. Signup and view all the answers

What is classified as spontaneous abortion?

Abortion that occurs without any medical means. Signup and view all the answers

Which of the following is NOT a cause of spontaneous abortion?

Legal medical termination. Signup and view all the answers

What describes an inevitable abortion?

An abortion that cannot be prevented and is in progress. Signup and view all the answers

What is the most common cause of first-trimester spontaneous abortions?

Fetal genetic and chromosomal abnormalities. Signup and view all the answers

When does early abortion typically occur?

Before 12 weeks of gestation. Signup and view all the answers

Which type of abortion is characterized by a retained dead fetus?

Missed abortion. Signup and view all the answers

What vital sign is essential to assess in pregnant women experiencing bleeding?

Blood pressure. Signup and view all the answers

Study Notes

Objectives: Students will be able to evaluate high-risk pregnancies, differentiate between early and late pregnancy bleeding, outline nursing assessments and management for vaginal bleeding, discuss the assessment and management of pregnancy-related bleeding, identify the classification of hypertension in pregnancy, differentiate between mild and severe preeclampsia, discuss eclampsia and HELLP syndrome, and explain the management of preeclampsia, eclampsia, and HELLP syndrome.

High-Risk Pregnancy

Definition: A pregnancy in which a condition exists that jeopardizes the health of the mother, fetus, or both. The condition may result from the pregnancy or may be pre-existing.

1- Early Bleeding during Pregnancy

Spontaneous abortion: A termination of pregnancy before viability. (Fetus <20 weeks gestation and <500g)
Types of Abortion: Threatened, Inevitable, Incomplete, Complete, Missed, Habitual
Causes of Spontaneous Abortion: Fetal genetic/chromosomal abnormalities, environmental factors (smoking, alcohol, X-ray, radiation, chemotherapy), infections (viral/bacterial/parasitic), uterine abnormalities (malformations, fibroids, intrauterine adhesions, retroverted uterus, cervical incompetence), inherited thrombophilia, uteroplacental ischemia, progesterone deficiency, diabetes, polycystic ovary syndrome, and hypothyroidism.

Ectopic Pregnancy

Definition: Fertilized ovum implants outside the uterine cavity, typically in the fallopian tube.
Risk Factors: Pelvic inflammatory disease (PID), previous ectopic pregnancy, congenital anomalies, stimulation of ovulation, contraceptive failure, intrauterine device (IUD).
Common Site: Fallopian tube (95%).
Clinical Manifestations (Before Rupture): Intermittent dark mild vaginal bleeding, abdominal pain (dull – unilateral or bilateral), abdominal tenderness, signs of blood loss.
Clinical Manifestations (After Rupture): Faintness (dizziness during bleeding), unilateral abdominal pain, referred shoulder pain, signs of shock, febrile state
Diagnosis: Beta subunit in blood, ultrasound will confirm the extra-uterine pregnancy.
Management: Surgical (laparoscopy or laparotomy for salpingectomy, removal of fallopian tube, or removal of ectopic pregnancy from other sites), Medical (Methotrexate – only if fetus <2.5-3.5 cm, single dose, follow-up with ultrasounds and beta-HCG)
Additional Management Measures: IV fluids, blood transfusion, emotional support, RhoGAM administration if Rh-negative, monitor for hemorrhage and infection, discharge instructions, follow up care

Gestational Trophoblastic Disease

Definition: Benign proliferative growth of trophoblast. (Chorionic villi develop into cystic transparent vesicles - hanging in grape-like clusters)
Incidence: Occurs in approximately 1 in every 1000 pregnancies
Risk Factors: Clients of Southeast Asia, Japanese or Taiwan descent, mothers over 40, possible vitamin A and protein deficiency, previous gestational trophoblastic disease (GTD).
Clinical Manifestations: Vaginal bleeding (red to prune color), severe nausea and vomiting, uterine size greater than dates, passing grape-like vesicles, no fetal parts palpated, no fetal heart rate detected, hyperthyroidism, abnormal lab values (very high hCG levels, possible low RBCs, Hct, and Hb).
Diagnosis: Serial Beta–subunit for HCG, ultrasound (snow-storm)
Complications: Hemorrhage, infection, choriocarcinoma, and disseminated intravascular coagulation (DIC).
Management: Evaluate for co-existing conditions (history, CBC, coagulation profile, serum chemistry, thyroid function, blood type and cross-match, chest radiography, pelvic ultrasonography), evacuation of mole (suction curettage, hysterectomy if completed childbearing), follow-up care (80% of patients cured by evacuation, follow B-hCG levels every two weeks until 3 consecutive tests negative, then monthly B-hCG every month for 6-12 months).
Additional Management Measures: Rh negative patients receive RhoGAM prophylactically. If necessary, prophylactic chemotherapy.

Cervical Insufficiency

Definition: A medical condition of pregnancy in which a weak, structurally defective cervix spontaneously dilates in the absence of contractions in the second or early third trimester, resulting in the loss of the pregnancy.
Therapeutic Management: Bed rest, pelvic rest, avoidance of heavy lifting, cervical cerclage
Nursing Assessment: Risk factors, pink-tinged vaginal discharge or pelvic pressure, cervical shortening via transvaginal ultrasound
Nursing Management: Continuing surveillance; close monitoring for preterm labor, emotional support, education

2- Late Bleeding during Pregnancy (Antepartum)

Placental Site Bleeding (95%): Placenta previa (placenta implanted in lower segment of the uterus), abruption (premature separation of the normally located placenta), ruptured vasa previa (blood vessels of the umbilical cord pass through the membrane), uterine scar disruption
Extra-placental Bleeding (5%): Cervical polyp, cervicitis or cervical ectropion, vaginal trauma, cervical cancer, rupture of varicose veins in the cervix.

Placenta Previa

Definition: A placenta implanted partially or completely in the lower segment of the uterus.
Incidence: Approximately 1 in 200 pregnancies
Types: Total, partial, marginal, low-lying
Management (Expectant): Gestational age <36 weeks, mild bleeding (<250ml), not in labor; hospitalization, bed rest 72 hours, close observation of bleeding, continuous fetal monitoring, IV infusion if needed, maternal blood sample for transfusion, betamethasone to enhance fetal pulmonary maturity, amniocentesis (at 34-36 weeks), tocolytic therapy (magnesium sulfate), teach patient to report signs of infections and/or blood loss to healthcare provider, and any specific care regarding anemia.
Management (Delivery): Immediate delivery to be implemented if fetus is mature, severe bleeding occurs, active labor begins (unresponsive to tocolysis), intra-amniotic infection, coagulation defect, fetal distress, fetal demise or anomalies.

Abruptio Placentae

Definition: Premature separation of a normally located placenta after the 20th week of gestation and prior to birth.
Etiology: Unknown, but could involve degenerative changes in the small maternal arterioles, resulting in thrombosis, degeneration of the decidua, and possible rupture of the vessel.
Types: Revealed (external hemorrhage), Concealed (blood clots behind the placenta), Mixed (combination of both)
Clinical Manifestations: Bleeding (dark red), pain (knife-like), uterine tenderness, contractions, decreased fetal movement and activity, decreased fetal heart rate
Management: Assessment, control and restoration of blood loss, prevention of DIC, left lateral position, strict bed rest, oxygen therapy, vital Signs, fundal height, continuous fetal monitoring, support and education

Hypertensive Disorders During Pregnancy

Categories: Gestational hypertension (replacement for PIH), preeclampsia, eclampsia, preeclampsia superimposed on chronic hypertension, chronic hypertension.
Preeclampsia: Elevated blood pressure after 20 weeks of gestation accompanied by significant proteinuria.
Eclampsia: Progression of preeclampsia to seizures.
HELLP Syndrome: Severe sequelae of preeclampsia, an acronym for hemolysis, elevated liver enzymes, and low platelet count.
Management: Prevent seizures MgSO4 (anticonvulsant), Control hypertension with medications like Hydralazine, Monitor fetal wellbeing (close monitoring for preterm labor and uterine contractions), emotional support.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz focuses on the nursing interventions and management strategies for patients experiencing abruptio placentae and related complications during pregnancy. It also covers the assessment and treatment of gestational hypertension and placenta previa. Test your knowledge on these critical topics in maternal-fetal nursing care.