Exam 3
Exam 3
Things need to know for exam 3
BLEEDING DURING PREGNANCY- EARLY bleeding is b4 20 weeks gestation,
LATE bleeding is after 20 weeks
Bleeding at any time during pregnancy is potentially life threatening.
Bleeding is a common concern during the first trimester of pregnancy
o Diagnosis/Evaluating: Use a transvaginal ultrasound to
evaluate bleeding in early pregnancy
o Causes of early Bleeding: spontaneous abortion, uterine fibroids,
ectopic pregnancy, GTD, and cervical insufficiency
Factors associated with LATE Bleeding:
o placenta previa, placental abruption, and placenta accreta
ASSESSMENT OF VAGINAL BLEEDING
o Ask the patient about:
the color of the vaginal bleeding (bright red is significant)
Ask if they have saturated a peripad in less than an hour,
and if they have passed clots
Tell them to save and bring clots to the healthcare facility
observe the amount, color, and characteristics of the
bleeding
evaluate the amount and intensity of the patient’s
abdominal cramping or contractions
Spontaneous Abortion
An abortion is the loss of an early pregnancy, usually before week 20 of gestation.
Spontaneous abortion refers to the loss of a fetus resulting from natural causes,
that is, not elective or therapeutically induced by a procedure
Abortion can be spontaneous or induced.
most common complication of early pregnancy
usually result from an abnormality not their actions
medications such as misoprostol or prostaglandin E2 (PGE2). May be
used’
,MEDICATIONS RELATED TO ABORTION
1. Misoprostol (Cytotec)
a. Action/Indications: Stimulates uterine contractions to terminate a
pregnancy and to evacuate the uterus after abortion to ensure
passage of all the products of conception; taken 24–48 hours
after mifepristone
b. Sides Effects: dyspepsia. Report any increased bleeding, pain,
symptoms of shock
2. Mifepristone (Korlym)
a. Action/Indications: Causes endometrium to slough and
contractions
b. Side effects/ monitor for: NVD/ heavy bleeding., administration of
antiemetic with it, / acetaminophen for pain
3. PGE2, dinoprostone (Prostin E2 suppository)
a. Action/Indications: causing expulsion of uterine contents from
fetal death , effaces and dilates the cervix in pregnancy at term
b. More information: needs to be room temp, vaginal suppository,
do not touch skin, encourage patient to lie still 10 min
Etopic pregnancy
1. CAUSES: result from conditions that obstruct or slow the passage of
the fertilized ovum through the fallopian tube to the uterus or failure of
the tubal epithelium to move the zygote
2. Symptoms/signs: begin at about the seventh or eighth week, missed
period, adnexal fullness, and tenderness
3. Treatment for Non ruptured ectopic pregnancies: methotrexate
administration or laparoscopic surgery, linear salpingostomy to
preserve the tube
4. Treatment for ruptured ectopic pregnancy: surgery is necessary as a
result of possible uncontrolled hemorrhage. laparotomy with the
removal of the tube (salpingectomy), RH immunoglobulin is given to
RH neg pts
5. ASSESSMENT OF ECTOPIC PREGANANCY
a. risk factors
i. History of ectopic pregnancy, PID, endometriosis, Infertility
and assisted reproduction use, advanced maternal age
,6. HEALING/recovery: Use of contraceptives is needed for at least three
menstrual cycles to allow the reproductive tract to heal and the tissue
to be repaired.
7. POSTOPERATIVE CARE: closely assess and monitor the patient’s vital
signs and bleeding (peritoneal or vaginal) to identify hypovolemic
shock. Instruct the patient to return on Days 4 and 7 for follow-up beta-
hCG titers.
Gestational Trophoblastic Disease
1. is a spectrum of benign and malignant disorders that are created from
abnormal trophoblastic tissue includes:
a. (hydatidiform mole—complete and partial) and neoplasms of the
trophoblast (choriocarcinoma, invasive mole, epithelioid
trophoblastic tumor, and placental site trophoblastic tumor
2. FEATURES: produce HCG, serves as a clinical marker for the presence of
persistent or progressive trophoblastic disease, abnormal
hyperproliferation of trophoblastic cells, Gestational tissue is present BUT
pregnancy is not viable.
3. SIGNS/SYMPTOMS: include vaginal bleeding, pelvic pressure or pain,
enlarged uterus, preeclampsia, and hyperemesis gravidarum.
4. PATHO: comes from gestational instead of maternal tissue
5. TREATMENT: can be removed via surgical uterine evacuation (dilatation
and curettage [D&C]) or a hysterectomy, 15-20 % OF DEVELOPING
gestational trophoblastic neoplasm, Choriocarcinoma is treated with
chemotherapy.
6. Recovery: serial measurements of beta hCG are taken until they
become nondetectable. Use contraceptives for 6 months. Follow up
with close surveillance after surgery for one year
7. RISK FACTORS: maternal age, prior molar pregnancy, infertility,
prior spontaneous abortion, and vitamin A deficiency.
choriocarcinoma is the history of complete hydatidiform mole
Cervical Insufficiency
1. refers to painless cervical dilatation in the second trimester.
Ultimately, an immature fetus will be expelled.
, 2. AFTER CERVICAL DILATION: rupture of the membranes, release
of amniotic fluid, and uterine contractions occur, subsequently
resulting in delivery of the fetus, often before it is viable.
3. CAUSES: cervical trauma or abnormal cervical development
(possibly from in-utero DES exposure) preterm labor, fetal loss,
previous surgeries
4. history of a pregnancy loss during the second or early third
trimester associated with painless cervical dilation without
evidence of uterine activity.
5. SIGNS/SYMPTOMS: pink-tinged vaginal discharge or an increase
in low pelvic pressure, cramping with vaginal bleeding, and loss
of amniotic fluid. Cervical dilation also occurs
6. TREATMENT: A cervical cerclage may be placed during the second
trimester, transvaginal or transabdominally.
Placenta Previa- INSIDIOUS
Exist when the placenta covers the internal cervical opening
1) RISK of : prenatal and postpartum hemorrhage, mortality, be
careful to not do vaginal examination, check for signs of
Uteroplacental Perfusion ( due to detached placenta)
2) DX/MONITORING: transvaginal ultrasound and color Doppler are
utilized to determine whether the placenta is migrating upward.
To reduce the risk of bleeding, cervical examination is
avoided.
3) PRECAUTIONS: After 20 weeks’ gestation, the patient should
avoid strenuous activity and sexual activity leading to orgasm.
May be put on bed rest
4) EMERGENCY: A patient with placenta previa who demonstrates
active vaginal bleeding should be considered a potential
obstetric emergency.
5) RISK FACTORS: Previous cesarean birth, Multiple gestation,
Increasing parity, Increasing maternal age, Previous uterine
surgical procedure, Infertility treatment, Prior uterine artery
embolization
Exam 3
Things need to know for exam 3
BLEEDING DURING PREGNANCY- EARLY bleeding is b4 20 weeks gestation,
LATE bleeding is after 20 weeks
Bleeding at any time during pregnancy is potentially life threatening.
Bleeding is a common concern during the first trimester of pregnancy
o Diagnosis/Evaluating: Use a transvaginal ultrasound to
evaluate bleeding in early pregnancy
o Causes of early Bleeding: spontaneous abortion, uterine fibroids,
ectopic pregnancy, GTD, and cervical insufficiency
Factors associated with LATE Bleeding:
o placenta previa, placental abruption, and placenta accreta
ASSESSMENT OF VAGINAL BLEEDING
o Ask the patient about:
the color of the vaginal bleeding (bright red is significant)
Ask if they have saturated a peripad in less than an hour,
and if they have passed clots
Tell them to save and bring clots to the healthcare facility
observe the amount, color, and characteristics of the
bleeding
evaluate the amount and intensity of the patient’s
abdominal cramping or contractions
Spontaneous Abortion
An abortion is the loss of an early pregnancy, usually before week 20 of gestation.
Spontaneous abortion refers to the loss of a fetus resulting from natural causes,
that is, not elective or therapeutically induced by a procedure
Abortion can be spontaneous or induced.
most common complication of early pregnancy
usually result from an abnormality not their actions
medications such as misoprostol or prostaglandin E2 (PGE2). May be
used’
,MEDICATIONS RELATED TO ABORTION
1. Misoprostol (Cytotec)
a. Action/Indications: Stimulates uterine contractions to terminate a
pregnancy and to evacuate the uterus after abortion to ensure
passage of all the products of conception; taken 24–48 hours
after mifepristone
b. Sides Effects: dyspepsia. Report any increased bleeding, pain,
symptoms of shock
2. Mifepristone (Korlym)
a. Action/Indications: Causes endometrium to slough and
contractions
b. Side effects/ monitor for: NVD/ heavy bleeding., administration of
antiemetic with it, / acetaminophen for pain
3. PGE2, dinoprostone (Prostin E2 suppository)
a. Action/Indications: causing expulsion of uterine contents from
fetal death , effaces and dilates the cervix in pregnancy at term
b. More information: needs to be room temp, vaginal suppository,
do not touch skin, encourage patient to lie still 10 min
Etopic pregnancy
1. CAUSES: result from conditions that obstruct or slow the passage of
the fertilized ovum through the fallopian tube to the uterus or failure of
the tubal epithelium to move the zygote
2. Symptoms/signs: begin at about the seventh or eighth week, missed
period, adnexal fullness, and tenderness
3. Treatment for Non ruptured ectopic pregnancies: methotrexate
administration or laparoscopic surgery, linear salpingostomy to
preserve the tube
4. Treatment for ruptured ectopic pregnancy: surgery is necessary as a
result of possible uncontrolled hemorrhage. laparotomy with the
removal of the tube (salpingectomy), RH immunoglobulin is given to
RH neg pts
5. ASSESSMENT OF ECTOPIC PREGANANCY
a. risk factors
i. History of ectopic pregnancy, PID, endometriosis, Infertility
and assisted reproduction use, advanced maternal age
,6. HEALING/recovery: Use of contraceptives is needed for at least three
menstrual cycles to allow the reproductive tract to heal and the tissue
to be repaired.
7. POSTOPERATIVE CARE: closely assess and monitor the patient’s vital
signs and bleeding (peritoneal or vaginal) to identify hypovolemic
shock. Instruct the patient to return on Days 4 and 7 for follow-up beta-
hCG titers.
Gestational Trophoblastic Disease
1. is a spectrum of benign and malignant disorders that are created from
abnormal trophoblastic tissue includes:
a. (hydatidiform mole—complete and partial) and neoplasms of the
trophoblast (choriocarcinoma, invasive mole, epithelioid
trophoblastic tumor, and placental site trophoblastic tumor
2. FEATURES: produce HCG, serves as a clinical marker for the presence of
persistent or progressive trophoblastic disease, abnormal
hyperproliferation of trophoblastic cells, Gestational tissue is present BUT
pregnancy is not viable.
3. SIGNS/SYMPTOMS: include vaginal bleeding, pelvic pressure or pain,
enlarged uterus, preeclampsia, and hyperemesis gravidarum.
4. PATHO: comes from gestational instead of maternal tissue
5. TREATMENT: can be removed via surgical uterine evacuation (dilatation
and curettage [D&C]) or a hysterectomy, 15-20 % OF DEVELOPING
gestational trophoblastic neoplasm, Choriocarcinoma is treated with
chemotherapy.
6. Recovery: serial measurements of beta hCG are taken until they
become nondetectable. Use contraceptives for 6 months. Follow up
with close surveillance after surgery for one year
7. RISK FACTORS: maternal age, prior molar pregnancy, infertility,
prior spontaneous abortion, and vitamin A deficiency.
choriocarcinoma is the history of complete hydatidiform mole
Cervical Insufficiency
1. refers to painless cervical dilatation in the second trimester.
Ultimately, an immature fetus will be expelled.
, 2. AFTER CERVICAL DILATION: rupture of the membranes, release
of amniotic fluid, and uterine contractions occur, subsequently
resulting in delivery of the fetus, often before it is viable.
3. CAUSES: cervical trauma or abnormal cervical development
(possibly from in-utero DES exposure) preterm labor, fetal loss,
previous surgeries
4. history of a pregnancy loss during the second or early third
trimester associated with painless cervical dilation without
evidence of uterine activity.
5. SIGNS/SYMPTOMS: pink-tinged vaginal discharge or an increase
in low pelvic pressure, cramping with vaginal bleeding, and loss
of amniotic fluid. Cervical dilation also occurs
6. TREATMENT: A cervical cerclage may be placed during the second
trimester, transvaginal or transabdominally.
Placenta Previa- INSIDIOUS
Exist when the placenta covers the internal cervical opening
1) RISK of : prenatal and postpartum hemorrhage, mortality, be
careful to not do vaginal examination, check for signs of
Uteroplacental Perfusion ( due to detached placenta)
2) DX/MONITORING: transvaginal ultrasound and color Doppler are
utilized to determine whether the placenta is migrating upward.
To reduce the risk of bleeding, cervical examination is
avoided.
3) PRECAUTIONS: After 20 weeks’ gestation, the patient should
avoid strenuous activity and sexual activity leading to orgasm.
May be put on bed rest
4) EMERGENCY: A patient with placenta previa who demonstrates
active vaginal bleeding should be considered a potential
obstetric emergency.
5) RISK FACTORS: Previous cesarean birth, Multiple gestation,
Increasing parity, Increasing maternal age, Previous uterine
surgical procedure, Infertility treatment, Prior uterine artery
embolization
