MATERNITY NEWBORN AND WOMEN’S HEALTH
NURSING A CASE-BASED APPROACH 2ND EDITION
O’MEARA’S TEST BANK
Chapter: 1 Immediate Postpartum Hemorrhage
a a a a
MULTIPLE CHOICE a
1. An expectant woman is being discharged from the health center after the placemento
a a a a a a a a a a a a a
f a cervical cerclage because of a history of recurrent gestation/pregnancy loss, secondary to
a a a a a a a a a a a a a
aan incompetent cervix. Which information regarding post procedural care should the nursin
a a a a a a a a a a a
g attendantemphasize in the discharge teaching?
a a a a a a
, MATERNITY NEWBORN AND WOMEN’S HEALTH
NURSING A CASE-BASED APPROACH 2ND EDITION
O’MEARA’S TEST BANK
a. Any vaginal discharge should be immediately reported to her health care provider.
a a a a a a a a a a a
b. The presence of any contractions, rupture of membranes (ROM), or severe perineal pre
a a a a a a a a a a a a
ssure should be reported a a a
c. The client will need to make arrangements for care at home, because her activitylevel
a a a a a a a a a a a a a a
awill be restricted a a
d. The client will be scheduled for a cesarean birth.A a a a a a a a a a
CCURATE CHOICE:-B a
Reasoning:-
>>>>Nursing care should stress the importance of monitoring for the signs and symptoms of p
a a a a a a a a a a a a a a
reterm labor. Vaginal bleeding needs to be reported to her primary health care provider. Bed rest
a a a a a a a a a a a a a a a a
is an element of care. However, the woman may stand for periods of up to 90 minutes, which al
a a a a a a a a a a a a a a a a a a
lows her the freedom to see her physician. Home uterine activity monitoring may be used to li
a a a a a a a a a a a a a a a a
mit the womans need for visits and to monitor her status safely at home. The cerclage can be rem
a a a a a a a a a a a a a a a a a a
oved at 37 weeks of gestation (to prepare for a vaginal birth), or a cesarean birth can be planne
a a a a a a a a a a a a a a a a a a
d.
DIF: Cognitive Level: Apply REF: dm. 675
a a a a a a
TOPIC Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs:HealthPromo
a a a a a a a a a a a
tion and Maintenancea a
2. A perinatal nursing attendant is giving discharge instructions to a woman, status post
a a a a a a a a a a a a
suction,and curettage secondary to a hydatidiform mole. The woman asks why she must take or
a a a a a a a a a a a a a a a
al contraceptives for the next 12 months. What is the best response by the nursing attendant?
a a a a a a a a a a a a a a a
a. If you get expectant within 1 year, the chance of a successful gestation/pregnancy is v
a a a a a a a a a a a a a a
ery small. Therefore, if gestation/pregnancy, it would be better for you to use the most reli
a a a a a a a a a a a a a a a
able methodof contraception available.
a a a a
b. The major risk to you after a molar gestation/pregnancy is a type of cancer that can be diagno
a a a a a a a a a a a a a a a a a
sed only by me hormone that your body produces during gestation/pregnancy. If you were to g
a a a a a a a a a a a a a a a
et expectant, then itwould make this cancer more difficult.
a a a a a a a a
c. If you can avoid a gestation/pregnancy for the next year, the chance of developing a secon
a a a a a a a a a a a a a a a
d molar gestation/pregnancy improve your chance of a successful gestation/pregnancy, not gett
a a a a a a a a a a a
ing expectant at this timeisbest.
a a a a a
d. Oral contraceptives are the only form of birth control that will prevent a recurrence of amo
a a a a a a a a a a a a a a a a
lar gestation/pregnancy
a
ACCURATE CHOICE:-B a
Reasoning:->>>>Betahuman chorionic gonadotropin (beta- a a a
hCG) hormone levels are drawn for1 year to ensure that the mole is completely gone. The chanc
a a a a a a a a a a a a a a a a a
e of developing choriocarcinomaafter the development of a hydatidiform mole is increased. Th
a a a a a a a a a a a a a
erefore, the goal is to achieve azero a a a a a a a
, MATERNITY NEWBORN AND WOMEN’S HEALTH
NURSING A CASE-BASED APPROACH 2ND EDITION
O’MEARA’S TEST BANK
human chorionic gonadotropin (hCG) level. If the woman were to become expectant, then it may
a a a a a a a a a a a a a a a
obscure the presence of the potentially carcinogenic cells. Women should be instructed to use bi
a a a a a a a a a a a a a a
rth control for 1 year after treatment for a hydatidiform mole. The rationale for avoiding gestation
a a a a a a a a a a a a a a a
/pregnancy for 1 year is to ensure that carcinogenic cells are not present. Any contraceptive met
a a a a a a a a a a a a a a a
hod except an intrauterine device (IUD) is acceptable.
a a a a a a a
DIF: Cognitive Level: Apply REF: dm. 679
a a a a a a
TOPIC Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs:Physi
a a a a a a a a a a a
ologic Integrity a
3. The nursing attendant is preparing to administer methotrexate to the client. This haza
a a a a a a a a a a a a
rdousdrug is most often used for which obstetric complication?
a a a a a a a a a
a. Complete hydatidiform mole a a
b. Missed abortion a
c. Unruptured ectopic gestation/pregnancy a a
d. Abruptio placentae a a
ACCURATE CHOICE:-C a
Reasoning:-
>>>>Methotrexate is an effective nonsurgical treatment option for a hemodynamically stable wo a a a a a a a a a a a
man whose ectopic gestation/pregnancy is unruptured and measures less than 4 cm in diameter.
a a a a a a a a a a a a a a
Methotrexate is not indicated or recommended as a treatment option for a complete hydatidiform
a a a a a a a a a a a a a a
mole, for amissed abortion, or for abruptio placentae.
a a a a a a a
DIF: Cognitive Level: Apply REF: dm. 677 TOPIC Nursing Process: Planning MSC: Client Needs:
a a a a a a a a a a a a a a
Physiologic Integrity a
4. A 26-year-old expectant woman, gravida 2, para 1-0-0-
a a a a a a a
1, is 28 weeks expectant whenshe experiences bright red, painless vaginal bleeding. On her
a a a a a a a a a a a a a a a
arrival at the health center, which diagnostic procedure will the client most likely have perf
a a a a a a a a a a a a a a
ormed?
a. Amniocentesis for fetal lung maturity a a a a
b. Transvaginal ultrasound for placental location a a a a
c. Contraction stress test (CST) a a a
d. Internal fetal monitoring a a a
ACCURATE CHOICE:-B a
Reasoning:-
>>>>The presence of painless bleeding should always alert the health care teamto the possibi
a a a a a a a a a a a a a a
lity ofplacenta previa, which can be confirmed through ultrasonography.
a a a a a a a a
Amniocentesis is not performed on a woman who is experiencing bleeding. In the event of anim
a a a a a a a a a a a a a a a a
minent delivery, the fetus is presumed to have immature lungs at this gestational age, andthe
a a a a a a a a a a a a a a a a
mother is given corticosteroids to aid in fetal lung maturity. A CST is not performed at a preter
a a a a a a a a a a a a a a a a a
m gestational age. Furthermore, bleeding is a contraindication to a CST. Internal fetal monitori
a a a a a a a a a a a a a
ng is also contraindicated in the presence of bleeding.
a a a a a a a a
DIF: Cognitive Level: Apply REF: dm. 680
a a a a a a
TOPIC Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
a a a a a a a a a a
5. A laboring woman with no known risk factors suddenly experiences spontaneous ROM. T
a a a a a a a a a a a a
he fluid consists of bright red blood. Her contractions are consistent with her current stage oflab
a a a a a a a a a a a a a a a a
or. No change in uterine resting tone has occurred. The fetal heart rate (FHR) begins to decline r
a a a a a a a a a a a a a a a a a
apidly after the ROM. The nursing attendant should suspect the possibility of what condition?
a a a a a a a a a a a a a
a. Placenta previa a
, MATERNITY NEWBORN AND WOMEN’S HEALTH
NURSING A CASE-BASED APPROACH 2ND EDITION
O’MEARA’S TEST BANK
b. Vasa previa a
c. Severe abruptio placentae a a
d. Disseminated intravascular coagulation (DIC) a a a a
ACCURATE CHOICE:-B a
Reasoning:-
>>>>Vasa previa is the result of a velamentous insertion of the umbilical cord. Theumbilical ves
a a a a a a a a a a a a a a a
sels are not surrounded by Wharton jelly and have no supportive tissue. The umbilical blood ve
a a a a a a a a a a a a a a a
ssels thus are at risk for laceration at any time, but laceration occurs most frequently during RO
a a a a a a a a a a a a a a a a
M. The sudden appearance of bright red blood at the time of ROM and a sudden change in the F
a a a a a a a a a a a a a a a a a a a
HR without other known risk factors should immediately alert the nursing attendant to the poss
a a a a a a a a a a a a a a
ibility of vasa previa. The presence of placenta previa most likely would be ascertained before la
a a a a a a a a a a a a a a a
bor andis considered a risk factor for this gestation/pregnancy. In addition, if thewoman had a p
a a a a a a a a a a a a a a a a
lacenta previa, itis unlikely that she would be allowed to pursue labor and a vaginal birth. With t
a a a a a a a a a a a a a a a a a
he presence of severe abruptio placentae, the uterine tonicity typically is tetanus (i.e., a boardlik
a a a a a a a a a a a a a a
e uterus). DIC is a pathologic form of diffuse clotting that consumes large amounts of clotting fac
a a a a a a a a a a a a a a a a
tors, causing widespread external bleeding, internal bleeding, or both. DIC is always a secondar
a a a a a a a a a a a a a
y diagnosis, often associated with obstetric risk factors such as the hemolysis, elevated liver enz
a a a a a a a a a a a a a a
yme levels, and low platelet levels (HELLP) syndrome. This woman did not have any prior risk f
a a a a a a a a a a a a a a a a
actors.
DIF: Cognitive Level: Analyze REF: dm. 684 TOPIC Nursing Process: Diagnosis MSC: ClientNee
a a a a a a a a a a a a a
ds: Physiologic Integrity
a a
6. A woman arrives for evaluation of signs and symptoms that include a missed period,a
a a a a a a a a a a a a a a
dnexal fullness, tenderness, and dark red vaginal bleeding. On examination, the nursing attendan
a a a a a a a a a a a a
t noticesan ecchymotic blueness around the womans umbilicus. What does this finding indic
a a a a a a a a a a a a
ate?
a. Normal integumentary changes associated with gestation/pregnancy a a a a a
b. Turner sign associated with appendicitis a a a a
c. Cullen sign associated with a ruptured ectopic gestation/pregnancy a a a a a a a
d. Chadwick sign associated with early gestation/ a a a a a
pregnancyACCURATE CHOICE:-C a a
Cullen sign, the blue ecchymosis observed in the umbilical area, indicates hematoperitoneum
a a a a a a a a a a a a
Reasoning:-
>>>>associated with an undiagnosed ruptured intraabdominal ectopic gestation/pregnancy.Linea a a a a a a a a a
nigra on theabdomen is the normal integumentary change associated with gestation/pregnancy
a a a a a a a a a a
aand exhibits a brown pigmented, vertical line on the lower abdomen. Turner sign is ecchymosi
a a a a a a a a a a a a a a
s in the flank area, often associated with pancreatitis. A Chadwick sign is a blue-
a a a a a a a a a a a a a a
apurple cervix that may be seen during or around the eighth week of gestation/pregnancy.
a a a a a a a a a a a a a
DIF: Cognitive Level: Analyze REF: dm. 676
a a a a a a
TOPIC Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
a a a a a a a a
7. The nursing attendant who elects to practice in the area of womens health must have
a a a a a a a a a a a a a a a
a thorough understanding of miscarriage. Which statement regarding this condition is mos
a a a a a a a a a a a
taccurate?
a
a. A miscarriage is a natural gestation/pregnancy loss before labor begins.
a a a a a a a a a
b. It occurs in fewer than 5% of all clinically recognized pregnancies.
a a a a a a a a a a
c. Careless maternal behavior, such as poor nutrition or excessive exercise, can be a factori a a a a a a a a a a a a a a
n causing miscarriage
a a
d. If a miscarriage occurs before the 12th week of gestation/pregnancy, then it may be observe
a a a a a a a a a a a a a a
d only asmoderate blood loss
a a a a a
ACCURATE CHOICE:-D a
NURSING A CASE-BASED APPROACH 2ND EDITION
O’MEARA’S TEST BANK
Chapter: 1 Immediate Postpartum Hemorrhage
a a a a
MULTIPLE CHOICE a
1. An expectant woman is being discharged from the health center after the placemento
a a a a a a a a a a a a a
f a cervical cerclage because of a history of recurrent gestation/pregnancy loss, secondary to
a a a a a a a a a a a a a
aan incompetent cervix. Which information regarding post procedural care should the nursin
a a a a a a a a a a a
g attendantemphasize in the discharge teaching?
a a a a a a
, MATERNITY NEWBORN AND WOMEN’S HEALTH
NURSING A CASE-BASED APPROACH 2ND EDITION
O’MEARA’S TEST BANK
a. Any vaginal discharge should be immediately reported to her health care provider.
a a a a a a a a a a a
b. The presence of any contractions, rupture of membranes (ROM), or severe perineal pre
a a a a a a a a a a a a
ssure should be reported a a a
c. The client will need to make arrangements for care at home, because her activitylevel
a a a a a a a a a a a a a a
awill be restricted a a
d. The client will be scheduled for a cesarean birth.A a a a a a a a a a
CCURATE CHOICE:-B a
Reasoning:-
>>>>Nursing care should stress the importance of monitoring for the signs and symptoms of p
a a a a a a a a a a a a a a
reterm labor. Vaginal bleeding needs to be reported to her primary health care provider. Bed rest
a a a a a a a a a a a a a a a a
is an element of care. However, the woman may stand for periods of up to 90 minutes, which al
a a a a a a a a a a a a a a a a a a
lows her the freedom to see her physician. Home uterine activity monitoring may be used to li
a a a a a a a a a a a a a a a a
mit the womans need for visits and to monitor her status safely at home. The cerclage can be rem
a a a a a a a a a a a a a a a a a a
oved at 37 weeks of gestation (to prepare for a vaginal birth), or a cesarean birth can be planne
a a a a a a a a a a a a a a a a a a
d.
DIF: Cognitive Level: Apply REF: dm. 675
a a a a a a
TOPIC Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs:HealthPromo
a a a a a a a a a a a
tion and Maintenancea a
2. A perinatal nursing attendant is giving discharge instructions to a woman, status post
a a a a a a a a a a a a
suction,and curettage secondary to a hydatidiform mole. The woman asks why she must take or
a a a a a a a a a a a a a a a
al contraceptives for the next 12 months. What is the best response by the nursing attendant?
a a a a a a a a a a a a a a a
a. If you get expectant within 1 year, the chance of a successful gestation/pregnancy is v
a a a a a a a a a a a a a a
ery small. Therefore, if gestation/pregnancy, it would be better for you to use the most reli
a a a a a a a a a a a a a a a
able methodof contraception available.
a a a a
b. The major risk to you after a molar gestation/pregnancy is a type of cancer that can be diagno
a a a a a a a a a a a a a a a a a
sed only by me hormone that your body produces during gestation/pregnancy. If you were to g
a a a a a a a a a a a a a a a
et expectant, then itwould make this cancer more difficult.
a a a a a a a a
c. If you can avoid a gestation/pregnancy for the next year, the chance of developing a secon
a a a a a a a a a a a a a a a
d molar gestation/pregnancy improve your chance of a successful gestation/pregnancy, not gett
a a a a a a a a a a a
ing expectant at this timeisbest.
a a a a a
d. Oral contraceptives are the only form of birth control that will prevent a recurrence of amo
a a a a a a a a a a a a a a a a
lar gestation/pregnancy
a
ACCURATE CHOICE:-B a
Reasoning:->>>>Betahuman chorionic gonadotropin (beta- a a a
hCG) hormone levels are drawn for1 year to ensure that the mole is completely gone. The chanc
a a a a a a a a a a a a a a a a a
e of developing choriocarcinomaafter the development of a hydatidiform mole is increased. Th
a a a a a a a a a a a a a
erefore, the goal is to achieve azero a a a a a a a
, MATERNITY NEWBORN AND WOMEN’S HEALTH
NURSING A CASE-BASED APPROACH 2ND EDITION
O’MEARA’S TEST BANK
human chorionic gonadotropin (hCG) level. If the woman were to become expectant, then it may
a a a a a a a a a a a a a a a
obscure the presence of the potentially carcinogenic cells. Women should be instructed to use bi
a a a a a a a a a a a a a a
rth control for 1 year after treatment for a hydatidiform mole. The rationale for avoiding gestation
a a a a a a a a a a a a a a a
/pregnancy for 1 year is to ensure that carcinogenic cells are not present. Any contraceptive met
a a a a a a a a a a a a a a a
hod except an intrauterine device (IUD) is acceptable.
a a a a a a a
DIF: Cognitive Level: Apply REF: dm. 679
a a a a a a
TOPIC Nursing Process: Planning | Nursing Process: Implementation MSC: Client Needs:Physi
a a a a a a a a a a a
ologic Integrity a
3. The nursing attendant is preparing to administer methotrexate to the client. This haza
a a a a a a a a a a a a
rdousdrug is most often used for which obstetric complication?
a a a a a a a a a
a. Complete hydatidiform mole a a
b. Missed abortion a
c. Unruptured ectopic gestation/pregnancy a a
d. Abruptio placentae a a
ACCURATE CHOICE:-C a
Reasoning:-
>>>>Methotrexate is an effective nonsurgical treatment option for a hemodynamically stable wo a a a a a a a a a a a
man whose ectopic gestation/pregnancy is unruptured and measures less than 4 cm in diameter.
a a a a a a a a a a a a a a
Methotrexate is not indicated or recommended as a treatment option for a complete hydatidiform
a a a a a a a a a a a a a a
mole, for amissed abortion, or for abruptio placentae.
a a a a a a a
DIF: Cognitive Level: Apply REF: dm. 677 TOPIC Nursing Process: Planning MSC: Client Needs:
a a a a a a a a a a a a a a
Physiologic Integrity a
4. A 26-year-old expectant woman, gravida 2, para 1-0-0-
a a a a a a a
1, is 28 weeks expectant whenshe experiences bright red, painless vaginal bleeding. On her
a a a a a a a a a a a a a a a
arrival at the health center, which diagnostic procedure will the client most likely have perf
a a a a a a a a a a a a a a
ormed?
a. Amniocentesis for fetal lung maturity a a a a
b. Transvaginal ultrasound for placental location a a a a
c. Contraction stress test (CST) a a a
d. Internal fetal monitoring a a a
ACCURATE CHOICE:-B a
Reasoning:-
>>>>The presence of painless bleeding should always alert the health care teamto the possibi
a a a a a a a a a a a a a a
lity ofplacenta previa, which can be confirmed through ultrasonography.
a a a a a a a a
Amniocentesis is not performed on a woman who is experiencing bleeding. In the event of anim
a a a a a a a a a a a a a a a a
minent delivery, the fetus is presumed to have immature lungs at this gestational age, andthe
a a a a a a a a a a a a a a a a
mother is given corticosteroids to aid in fetal lung maturity. A CST is not performed at a preter
a a a a a a a a a a a a a a a a a
m gestational age. Furthermore, bleeding is a contraindication to a CST. Internal fetal monitori
a a a a a a a a a a a a a
ng is also contraindicated in the presence of bleeding.
a a a a a a a a
DIF: Cognitive Level: Apply REF: dm. 680
a a a a a a
TOPIC Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
a a a a a a a a a a
5. A laboring woman with no known risk factors suddenly experiences spontaneous ROM. T
a a a a a a a a a a a a
he fluid consists of bright red blood. Her contractions are consistent with her current stage oflab
a a a a a a a a a a a a a a a a
or. No change in uterine resting tone has occurred. The fetal heart rate (FHR) begins to decline r
a a a a a a a a a a a a a a a a a
apidly after the ROM. The nursing attendant should suspect the possibility of what condition?
a a a a a a a a a a a a a
a. Placenta previa a
, MATERNITY NEWBORN AND WOMEN’S HEALTH
NURSING A CASE-BASED APPROACH 2ND EDITION
O’MEARA’S TEST BANK
b. Vasa previa a
c. Severe abruptio placentae a a
d. Disseminated intravascular coagulation (DIC) a a a a
ACCURATE CHOICE:-B a
Reasoning:-
>>>>Vasa previa is the result of a velamentous insertion of the umbilical cord. Theumbilical ves
a a a a a a a a a a a a a a a
sels are not surrounded by Wharton jelly and have no supportive tissue. The umbilical blood ve
a a a a a a a a a a a a a a a
ssels thus are at risk for laceration at any time, but laceration occurs most frequently during RO
a a a a a a a a a a a a a a a a
M. The sudden appearance of bright red blood at the time of ROM and a sudden change in the F
a a a a a a a a a a a a a a a a a a a
HR without other known risk factors should immediately alert the nursing attendant to the poss
a a a a a a a a a a a a a a
ibility of vasa previa. The presence of placenta previa most likely would be ascertained before la
a a a a a a a a a a a a a a a
bor andis considered a risk factor for this gestation/pregnancy. In addition, if thewoman had a p
a a a a a a a a a a a a a a a a
lacenta previa, itis unlikely that she would be allowed to pursue labor and a vaginal birth. With t
a a a a a a a a a a a a a a a a a
he presence of severe abruptio placentae, the uterine tonicity typically is tetanus (i.e., a boardlik
a a a a a a a a a a a a a a
e uterus). DIC is a pathologic form of diffuse clotting that consumes large amounts of clotting fac
a a a a a a a a a a a a a a a a
tors, causing widespread external bleeding, internal bleeding, or both. DIC is always a secondar
a a a a a a a a a a a a a
y diagnosis, often associated with obstetric risk factors such as the hemolysis, elevated liver enz
a a a a a a a a a a a a a a
yme levels, and low platelet levels (HELLP) syndrome. This woman did not have any prior risk f
a a a a a a a a a a a a a a a a
actors.
DIF: Cognitive Level: Analyze REF: dm. 684 TOPIC Nursing Process: Diagnosis MSC: ClientNee
a a a a a a a a a a a a a
ds: Physiologic Integrity
a a
6. A woman arrives for evaluation of signs and symptoms that include a missed period,a
a a a a a a a a a a a a a a
dnexal fullness, tenderness, and dark red vaginal bleeding. On examination, the nursing attendan
a a a a a a a a a a a a
t noticesan ecchymotic blueness around the womans umbilicus. What does this finding indic
a a a a a a a a a a a a
ate?
a. Normal integumentary changes associated with gestation/pregnancy a a a a a
b. Turner sign associated with appendicitis a a a a
c. Cullen sign associated with a ruptured ectopic gestation/pregnancy a a a a a a a
d. Chadwick sign associated with early gestation/ a a a a a
pregnancyACCURATE CHOICE:-C a a
Cullen sign, the blue ecchymosis observed in the umbilical area, indicates hematoperitoneum
a a a a a a a a a a a a
Reasoning:-
>>>>associated with an undiagnosed ruptured intraabdominal ectopic gestation/pregnancy.Linea a a a a a a a a a
nigra on theabdomen is the normal integumentary change associated with gestation/pregnancy
a a a a a a a a a a
aand exhibits a brown pigmented, vertical line on the lower abdomen. Turner sign is ecchymosi
a a a a a a a a a a a a a a
s in the flank area, often associated with pancreatitis. A Chadwick sign is a blue-
a a a a a a a a a a a a a a
apurple cervix that may be seen during or around the eighth week of gestation/pregnancy.
a a a a a a a a a a a a a
DIF: Cognitive Level: Analyze REF: dm. 676
a a a a a a
TOPIC Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity
a a a a a a a a
7. The nursing attendant who elects to practice in the area of womens health must have
a a a a a a a a a a a a a a a
a thorough understanding of miscarriage. Which statement regarding this condition is mos
a a a a a a a a a a a
taccurate?
a
a. A miscarriage is a natural gestation/pregnancy loss before labor begins.
a a a a a a a a a
b. It occurs in fewer than 5% of all clinically recognized pregnancies.
a a a a a a a a a a
c. Careless maternal behavior, such as poor nutrition or excessive exercise, can be a factori a a a a a a a a a a a a a a
n causing miscarriage
a a
d. If a miscarriage occurs before the 12th week of gestation/pregnancy, then it may be observe
a a a a a a a a a a a a a a
d only asmoderate blood loss
a a a a a
ACCURATE CHOICE:-D a
