Bleeding During Pregnancy

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Questions and Answers

What is a key characteristic of placental previa during assessment?

Uterine tenderness

Fetal distress indicators

Sustained sharp pain

Bright red bleeding (correct)

Which risk factor is specifically associated with placental abruption?

Increased maternal age

Hypertension and trauma (correct)

Previous placenta previa

Maternal obesity

How does placental abruption typically present in terms of pain and onset?

Sharp pain in the third trimester (correct)

Dull pain in the second trimester

No pain with a sudden onset in the third trimester

Continuous mild cramping in the first trimester

Which nursing care intervention is essential for a client with suspected vasa previa?

Perform a continuous fetal heart rate monitoring Signup and view all the answers

What type of cord insertion is associated with an increased risk of vasa previa?

Velamentous insertion of the cord Signup and view all the answers

Which of the following is a risk factor for abruptio placentae?

Multiple fetal pregnancies Signup and view all the answers

What symptom is commonly associated with abruptio placentae?

Intense localized uterine pain with dark red vaginal bleeding Signup and view all the answers

Which diagnostic procedure is appropriate for assessing placental complications?

Ultrasound Signup and view all the answers

What is an essential nursing care intervention for a client with suspected abruptio placentae?

Monitor vital signs for signs of hemodynamic instability Signup and view all the answers

What lab tests are indicated for a patient with abruptio placentae?

Hgb and Coagulation factors Signup and view all the answers

Which type of placenta previa is characterized by the cervical os being completely covered by the placental attachment?

Total previa Signup and view all the answers

Which of the following is NOT a risk factor for placenta previa?

Maternal age less than 30 Signup and view all the answers

What clinical finding is commonly associated with partial moles?

Elevated Hcg levels Signup and view all the answers

Which nursing care measure is important for a patient with suspected placenta previa?

Assessing for bleeding Signup and view all the answers

What diagnostic procedure is typically used to assess the placement of the placenta?

Transabdominal or transvaginal ultrasound Signup and view all the answers

Which symptom is a typical finding in patients with placenta previa during the second or third trimester?

Painless, bright red vaginal bleeding Signup and view all the answers

What laboratory test is commonly performed to evaluate potential complications in placental issues?

Kleihauer-Betke test Signup and view all the answers

Which of the following is a risk factor specifically associated with partial moles?

Prior molar pregnancy Signup and view all the answers

Study Notes

Spontaneous Abortion

Spontaneous abortion is the natural loss of a pregnancy before 20 weeks
Possible causes of bleeding in the first trimester include ectopic pregnancy, gestational trophoblastic disease
Possible causes of bleeding in the second trimester include placenta previa, abruptio placentae, and vasa previa
Expected findings include abdominal cramping or pain, rupture of membranes, dilation of the cervix, and fever
Manifestations of hemorrhage can be seen as low hemoglobin/hematocrit levels (Hgb and Hct), clotting factor deficiencies and/or elevated white blood cell count (WBC)
hCG (serum human chorionic gonadotropin) levels can be used in testing
Types of spontaneous abortion include threatened (possible mild cramping, slight spotting), inevitable (moderate cramping, moderate bleeding, cervical opening usually dilated (3cm)), incomplete (severe cramping, heavy bleeding, tissue passed), and complete (mild cramping, minimal bleeding, tissue passed, no dilation), missed (no cramping)

Spontaneous Abortion Procedures

Determine if the fetus is viable or non-viable
Examine the cervix
Assess whether the cervix is open or closed
Dilation and Currettage (D&C) to dilate and scrape the uterine walls to remove uterine contents
Dilation and Evacuation (D&E) to dilate and evacuate uterine contents
Prostaglandins and oxytocin to induce contractions and expel products

Spontaneous Abortion Care

Emotional support
Medications (analgesics and sedatives, prostaglandins, oxytocin, broad-spectrum antibiotics, Rho(D) immune globulin)
Client education (no tub baths, notify provider of heavy bleeding, take antibiotics, small amount of discharge is normal, no sex or placing anything in the vagina for 1-2 weeks)

Ectopic Pregnancy

Abnormal implantation of the fertilized ovum outside the uterine cavity
Risk factors include tubal patency (STI), tubal surgery, contraceptive intrauterine device (IUD)
Findings include unilateral sharp pain in lower abdomen, delayed or irregular menses, lighter than normal bleeding, and scant dark brown/red vaginal spotting (sometimes red if rupture occurs). Symptoms may include referred shoulder pain, hemorrhage and shock, and dizziness
Diagnostic tests may include Transvaginal UA, medical management (if rupture hasn't occurred, methotrexate to dissolve the pregnancy, or salpingectomy if the tube is ruptured), surgical management (laparoscopic salpingectomy)
Nursing care includes replacing fluids and maintaining electrolytes, providing psychological support, and preparing the client for surgery

Gestational Trophoblastic Disease

Gestational trophoblastic disease
Complete mole
Characteristics of complete mole: genetic material from father, no fetus, no placenta, fluid is absent, genetic material is absent in the ovum, genetic material is present in paternal portion

Placenta Previa

Placenta completely covers the cervical os (total)
Partially covers the cervical os (incomplete)
Marginally covers the cervical os, but not the os
Risk factors are previous placenta previa and uterine scarring
Client education should include saving any clots, bed rest
Signs/symptoms include painless, bright red vaginal bleeding during the 2nd or 3rd trimester, soft uterus, relaxed, and nontender, fundal height is greater than would be expected for that time of pregnancy, fetus in a breech, oblique, or transverse position

Abruptio Placentae

Premature separation of the placenta from the uterus
Risk factors include maternal hypertension, blunt external abdominal trauma, cocaine use, a history of previous abruptio placentae, smoking
Sudden onset of severe pain, dark red vaginal bleeding
Nursing care includes monitoring, assessment, assessment of vital signs

Vasa Previa

Velamentous insertion of the umbilical cord
Succenturiate insertion of the umbilical cord
Battledore insertion of the umbilical cord

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Description

This quiz covers the important aspects of spontaneous abortion, including its definition, causes, expected findings, and types. Participants will explore the physiological and clinical parameters associated with first and second trimester bleeding, as well as relevant laboratory tests. Gain a deeper understanding of this significant health topic.