N303 - Ch 31 Ob

Front 1

What are the types of late pregnancy bleeding disorders?

Back 1

1. Placenta previa
2. Premature separation of placenta (abruptio placentae)
3. Variations in the cord insertion and the placenta

Front 2

What is placenta previa?

Back 2

The implantation of the placenta in the lower uterine segment near or over the internal cervical os (opening)

Front 3

What are the types of placenta previa?

Back 3

1. Total
2. Partial
3. Marginal
4. Low-lying

Front 4

What is a total previa?

Back 4

The internal os is entirely covered by the placenta

Front 5

What is a partial placenta previa?

Back 5

Incomplete coverage of the internal os by the placenta

Front 6

What is a marginal placenta previa?

Back 6

Only an edge of the placenta extends to the margin of the internal os

Front 7

What is low-lying placenta?

Back 7

The placenta is implanted in the lower uterine segment but does not reach the os

Front 8

What is vasa previa?

Back 8

When unprotected fetal vessels pass across the cervical os in front of the presenting part of the fetus

Front 9

What should immediately alert the nurse of the possibility of vasa previa?

Back 9

1. Sudden appearance of bright red blood at the time of ROM (spontaneous or artificial)

2. A sudden change in the fetal heart rate without other known risk factors

Front 10

When should placenta previa be suspected?

Back 10

Whenever vaginal bleeding occurs after 24 weeks of gestation

Front 11

What causes vaginal bleeding in placenta previa?

Back 11

The stretching and thinning of the lower uterine segment that occurs during the third trimester

Front 12

What color blood is seen in placenta previa?

Back 12

Bright red

Front 13

What are indications of acute blood loss?

Back 13

Clinical presentation and decreasing urinary output

Front 14

What complications are associated with placenta previa?

Back 14

1. PROM
2. Preterm labor and birth
3. Surgery-related trauma to structures adjacent to the uterus
4. Anesthesia complications
5. Blood transfusion reactions
6. Overinfusion of fluids
7. Abnormal placental attachments
8. Postpartum hemorrhage
9. Anemia
10. Thrombophlebitis
11. Infection

Front 15

What are women with total previa at higher risk for?

Back 15

1. Giving birth prematurely
2. Requiring a hysterectomy at the time of cesarean birth

Front 16

What are the data of abdominal assessment?

Back 16

Soft, relaxed, nontender uterus with normal tone

Front 17

When do women require a C-section at term?

Back 17

When the placental edge is located within 2 cm of the internal cervical os

Front 18

What assessments are essential during a C-section?

Back 18

1. Maternal vital signs: especially BP, pulse rate, LOC, and oliguria

2. Fetal signs of hypoxia

Front 19

What is the expectant management for bleeding associated with placenta previa?

Back 19

Bed rest

Front 20

How is bleeding assessed?

Back 20

1. Checking the amount of bleeding on perineal pads, bed pads, and linens

2. Weighing pads: 1 g represents 1 mL of blood

Front 21

Why are women with placenta previa considered potential emergencies?

Back 21

Because massive blood loss can result in hypovolemic shock

Front 22

What is apruptio placentae?

Back 22

Premature separation of the placenta, in which part or all of the placenta detaches from its implantation site

Front 23

Where does separation of the placenta occur at?

Back 23

The area of the decidua basalis after 20 weeks of pregnancy and before the birth of the baby

Front 24

What is the most consistent cause for abruption of the placenta?

Back 24

Maternal hypertension

Front 25

What are the risk factors of abruptio placentae?

Back 25

1. Maternal HTN
2. Cocaine use
3. Blunt external abdominal trauma (motor vehicle accidents or maternal battering)
4. Maternal age older than 35 years and parity
5. Short umbilical cord
6. Folic acid deficiency

Front 26

What are the classic symptoms of abruptio placentae?

Back 26

1. Vaginal bleeding
2. Abdominal pain
3. Uterine tenderness and contractions
4. Mild to severe uterine hypertonicity
5. Mild to severe pain localized over one region of the uterus or diffuse over the uterus with a boardlike abdomen

Front 27

What is a boardlike abdomen a clinical symptom of?

Back 27

Abruptio placentae

Front 28

What is a Couvelaire uterus?

Back 28

A uterus that appears purplish and copper colored, is ecchymotic, and has lost its contractility

Front 29

What are the laboratory findings of Couvelaire uterus?

Back 29

1. A positive Apt test (blood in amniotic fluid)
2. A decrease in Hgb and Hct levels
3. A decrease in coagulation factor levels

Front 30

What is a positive Apt test?

Back 30

Blood in amniotic fluid

Front 31

What is a Kleihauer-Beke test?

Back 31

A test to determine the presence of fetal-to-maternal bleeding that predicts increased risk of preterm labor after maternal trauma

Front 32

What maternal complications are associated with severe abruption?

Back 32

1. Hemorrhage
2. Hypovolemic shock
3. Hypofibrinogenemia
4. Thrombocytopenia
5. Couvelaire uterus
6. Infection

Front 33

What is used to rule out plcenta previa?

Back 33

Sonographic examination

Front 34

What is the treatment for abruptio placentae?

Back 34

1. Depends on the severity of blood loss and fetal maturity and status

2. If abruption is mild and the fetus is less than 36 weeks of gestation and not in distress, expectant management may be implemented

Front 35

What is the treatment of choice for abruptio previa if the fetus is at term gestation?

Back 35

Delivery

Front 36

What is the treatment of choice for abruptio previa if the bleeding is moderate to severe and the mother or fetus is in jeopardy?

Back 36

Delivery

Front 37

What is an excellent indirect measure of maternal organ perfusion?

Back 37

Foley catheter insertion for continuous assessment of urinary output

Front 38

When should cesarean birth be avoided?

Back 38

When the woman has severe and uncorrected coagulopathy, since it may result in surgically uncontrollable bleeding

Front 39

What is velamentous insertion of the cord?

Back 39

A rare placental anomaly associated with placenta previa and multiple gestation. The vessels begin to branch at the membranes and then begin to course onto the placenta

Front 40

What is disseminated intravascular coagulation (DIC)?

Back 40

A pathologic form of clotting that diffuse and consumes large amounts of clotting factors, causing widespread external bleeding, internal bleeding, or both, and clotting

Front 41

What can trigger DIC?

Back 41

1. Severe preeclampsia
2. HELLP syndrome
3. Gram-negative sepsis