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High Risk

Bleeding

TermDefinition
Threatened abortion findings Mild cramping, little spotting, NOT PASSING TISSUE, cervix NOT dilated
Threatened abortion management Put her on bedrest. If 1st Tri, won't stop it because can't. Have her labs checked (progest/HCGs) and US for fetal heartbeat.
Inevitable abortion findings MODERATE bleeding, cramping, cervix IS dilating, has NOT passed tissue but may start
Inevitable abortion management Watch how much POC (products of conception) is there. If POC expelled, does bleeding ease or cont? If POC expelled, do a D&Curettage
Incomplete abortion findings HEAVY/PROFUSE bleeding, dilation yes, NOT everything has passed... but most
Incomplete abortion management First Tri: EMERGENT D&C, d/t risk of bleeding out. Second Tri: Dilation & Evacuation
Complete abortion findings UTERUS EMPTY, bleeding will go down, pain will resolve
Complete abortion management No further interventions unless cont. to bleed
Missed abortion findings Fetus has expired, NO SIGNS OF MISCARRIAGE, during prenatal visit NO fetal HR, "stone baby", risk for D.I.C.
Missed abortion management 1st Tri: D&C 2nd/3rd Tri: Induce labor to allow body to empty uterus Good pain control If SEPTIC --> D&Evacuation + antibiotics
Habitual abortion findings Has 3+ recurring miscarriages; unable to maintain pg
Habitual abortion management Check her progesterone levels. If cervix dilates too quickly then cerelage (suture) cervix closed, release during 3rd Tri.
Placenta previa findings BRIGHT red vaginal bleeding; PAINLESS; can partially or completely block cervical oss
Placenta previa low-lying management Observe for bleeding, BEDREST to decrease risk of bleed; observe fetal well-being. If not much bleeding, will try v-birth
Placenta previa complete management Bedrest last wks of pg, C-S necessary
Mild abruption findings None to minimal bleeding, usu absent pain, uterus acts normal, baby generally not impacted
Mild abruption management Monitor; may not have known there was abruption until expelled
Moderate abruption findings May or may not be concealed vs. partial. Absent to moderate DARK RED bleeding (1000-1500), pain present, uterus fails to relax btwn cx and is firm
Moderate abruption management V-birth until baby/mom tells otherwise (showing distress/bleeding)
Severe/complete (concealed) abruption findings Dark red bleeding (>1500cc), rigid painful abd/uterus, tetanic/persistent uterine cx
Severe/complete (concealed) abruption management C-Section; need to get baby out since no O2, no heart tones, variability.
Methotrexate is used to Tx ______ Unruptured ectopic pg
______ is one of the leading causes of maternal death. 2nd leading cause is _____ Hemorrhage #1; HTNsive disorders #2
Maternal exsanguiation can occur in less than ___ minutes 10
Missed abortion is defined as ______ Nonviable embyro remaining in uterus for AT LEAST 6 weeks
Retained expired fetus is a risk factor for __ DIC
What is the difference between D&C (dilation and curettage) and D&E (dilation and evacuation) D&C is a procedure where cervix is widened (dilated) uterine lining is scraped to remove tissue after abortion. D&E refers to dilation of cervix and
What is a cerclage? Suturing close cervix around 11-15 weeks
Management of cerclage Bedrest, progesterone, anti-inflammatory drugs, antibiotics
When should cerclage be removed? At 37-39 weeks or when labor begins. Depends on cervix.
Define an ectopic pregnancy Fertilized ovum implanted OUTSIDE uterine cavity
95% of ectopic pregnancies occur in the outer __ of the ___ 1/3 (ampullar) of fallopian tube
Leading cause of infertility is _____ Ectopic pregnancies
Clinical manifestations of ectopic pregnancies include (list 5) 1) Dull to acute abd (often lower quadrant) pain, 2) delayed menses, 3) abnormal vaginal bleeding, 4) referred shoulder pain, 5) signs of shock
Management of ectopic pg: Salpingostomy/salpingectomy, methotrexate, contraception, discussion of future fertility (d/t high rate of reoccurrence)
________ is a sign of ruptured ectopic pregnancy Referred shoulder pain
Methotrexate will cause _____ to shrink and should be given if mother presents with ____ shock Embyro/fetus; no
Molar pregnancy is also known as ______ ______ Hydatidiform mole
Molar pg is defined as Spectrum of pg-related trophoblastic disorders without a viable fetus
Complete molar pg is defined as Fertilization of egg with lost/inactivated nucleus. NO fetus/placenta/amniotic membrane
Partial mole pg is defined as Result of 2 sperm fertilizing a normal ovum. Embyronic parts present and an amniotic sac.
Sx of molar pg Severe hyperemesis, excessive abd/uterus growth, + pg test, NO FETAL HEARTBEAT HEARD, bright red/brown vaginal bleeding
True or false: molar pregnancies will show false negatives on pg test False. Will show + pg test
True or false: in early stages, molar pg will present with abnormal sx False. Early stages may look like normal pg
Management of molar pg Most pass spontaneously. Suction curettage is safe. If unattended, could rupture uterus. Monitor 1 year afterword since high risk of choriocarcinoma (complication of molar pg)
Best place for a placenta to attach is ___ to the ___ Close to the fundus
True or false: right shoulder pain and possible fetal changes are common sx of abruption True
Greater than ___ of abruption-related bleeding is of high concern. 500
If large partial/concealed abruption, management is to... DELIVER
4Ts (causes) of intrapartum bleeding Tone (uterine atony), tissue (retained placental tissue), trauma (uterine/cervical/vaginal lacerations), thrombin (coag disorders)
PP hemorrhage plan of care: 1) ASSESS FUNDUS, 2) massage boggy fundus, 3) Trendelenburg/supine position, 4) O2 non-breather 10-12 L/min, 5) LOC/O2 sat, 6) meds, 7) VS/blood loss, 8) breath sounds before fluid bolus
For PP hemorrhage, you will give medications in this order 1) Pitocin, 2) methergine, 3) hemabate, 4) Cytotec
Methergine is contraindicated in ____ HTN
Cytotec is contraindicated in ____ Moderate-severe asthma
Created by: lapio-obgyn