N113 - Placental/Bleeding problems
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| Placenta previa | Improperly implanted placenta in lower uterine segment. Can cause painless bleeding.
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| Low placenta previa | Does not cover the cervical opening
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| Partial placenta previa | Partially covers the cervical opening
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| Complete placenta previa | Completely covers cervical opening.
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| Placenta previa cautions | No vaginal exams, may cause tearing. Bed rest, monitor blood loss-pad count, VS & signs of shock, monitor fetal status, lab values
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| Placenta previa management | Depends on type of previa, condition of mother & fetus, amount of bleeding, # of weeks gestation
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| Abruptio placenta | Emergency situation,usually painful. Premature separation of placenta, can cause hemorrhage
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| Complete abruptio | Almost total separation, massive vaginal bleeding, fetal mortality almost 100%.
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| Abruptio signs & symptoms | Painful, sudden bleeding. S/S of shock - increased BP, decreased pulse. Hard uterus, if bleeding is concealed.
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| Abruptio risks | Maternal - death, but uncommon, DIC, renal failure
Fetal death from lack of O2.
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| Abruptio treatment | C-section, hydration, transfusion may be necessary, hysterectomy may be needed.
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| Couvelaire uterus | Reduced circulation to uterus, uterus turns blue and will not contract after birth
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| Hydatidiform mole | Molar pregnancy - Chorionic villi of placenta become edematous & fluid-filled grape like clusters.
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| Ruptured uterus | Tearing of uterus, rupture of weakened area - old scar. Risk related to VBAC. Can occur during pregnancy or during labor
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| Complete rupture | Through the 3 muscular layers
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| Incomplete rupture | Tear through endometrium & myometrium
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| Rupture cause | Weakened c-section scar, obstetric trauma - manipulation of fetus, mismanagement of oxytocin, obstructed labor - CPD, congenital or acquired uterine defects, external trauma, VBAC
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| Signs & symptoms of rupture | HEMORRHAGE - resulting in shock
Infection - peritonitis - complication
PAIN
Change in fetal station - fetus rising up in the abdomen, change in abdominal contour, abrupt stop of contractions, fetal distress
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| Rupture & fetal distress | With complete rupture, fetus is forced into abdomen and can die quickly - depends on where the placenta location & where rupture occurs
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| Rupture treatment | C-section, repair if small rupture, hysterectomy if large rupture.
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| Rh Factor | Rh- mom with Rh+ fetus
If father is Rh-, children will be Rh-.
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| Rh screening & management | Indirect Coombs test - done on maternal blood, measures antibodies
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| Direct coombs | Done on infant after birth from cord blood
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| RhoGAM | Given 72 postpartum to prevent sensitization. Also given after amniocentesis, abortion and routinely during prenatal care at 28 & 34 weeks to Rh negative women - preventative measure.
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| Abortion | Termination of pregnancy prior to 20 weeks. Either spontaneous or elective.
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| Abortion patho | If embryo dies, this leads to drop in hcG and progesterone during 1st trimester.
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| Threatened abortion | Unexplained bleeding, cramping & backache. Cervix is closed, partial or complete expulsion may occur
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| Imminent abortion | Bleeding & cramping, cervical dilation, membranes may rupture, expulsion WILL occur.
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| Incomplete abortion | Part of conception retained, most often placenta. Cervix is dilated. May require d & c.
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| Missed abortion | Fetus dies but is not expelled. Uterine growth ceases, breast changes regress, brownish vaginal discharge.
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| Habitual abortion | 3 or more consecutive abortions
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| Treatment during impending loss | Monitor for hemorrhage - vitals, pallor, clammy skin, restlessness. If greater than 12 weeks,
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| Distinguish spotting from abortions | Cramping usually present if abortion
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| Ectopic pregnancy | Implantation of blastocyst in site other than uterus
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| Ectopic implantation sites | Fallopian tube, ovary, peritoneal cavity, cervix, uterine cornua
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| Ectopic symptoms | S&S of early pregnancy, hcG found in blood, may have spontaneous abortion. As embryo grows, pain begins.
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| Ectopic warning signs | Sharp, one sided pain, may radiate. Syncope, referred shoulder pain, internal hemorrhage from ruptured tube.
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| Ectopic treatment | Early identification is key. Symptoms can be similar to appendicitis, UTI or ovarian cyst.
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