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41 Cards in this Set

  • Front
  • Back
What are the types of late pregnancy bleeding disorders?
1. Placenta previa
2. Premature separation of placenta (abruptio placentae)
3. Variations in the cord insertion and the placenta
What is placenta previa?
The implantation of the placenta in the lower uterine segment near or over the internal cervical os (opening)
What are the types of placenta previa?
1. Total
2. Partial
3. Marginal
4. Low-lying
What is a total previa?
The internal os is entirely covered by the placenta
What is a partial placenta previa?
Incomplete coverage of the internal os by the placenta
What is a marginal placenta previa?
Only an edge of the placenta extends to the margin of the internal os
What is low-lying placenta?
The placenta is implanted in the lower uterine segment but does not reach the os
What is vasa previa?
When unprotected fetal vessels pass across the cervical os in front of the presenting part of the fetus
What should immediately alert the nurse of the possibility of vasa previa?
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
When should placenta previa be suspected?
Whenever vaginal bleeding occurs after 24 weeks of gestation
What causes vaginal bleeding in placenta previa?
The stretching and thinning of the lower uterine segment that occurs during the third trimester
What color blood is seen in placenta previa?
Bright red
What are indications of acute blood loss?
Clinical presentation and decreasing urinary output
What complications are associated with placenta previa?
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
What are women with total previa at higher risk for?
1. Giving birth prematurely
2. Requiring a hysterectomy at the time of cesarean birth
What are the data of abdominal assessment?
Soft, relaxed, nontender uterus with normal tone
When do women require a C-section at term?
When the placental edge is located within 2 cm of the internal cervical os
What assessments are essential during a C-section?
1. Maternal vital signs: especially BP, pulse rate, LOC, and oliguria

2. Fetal signs of hypoxia
What is the expectant management for bleeding associated with placenta previa?
Bed rest
How is bleeding assessed?
1. Checking the amount of bleeding on perineal pads, bed pads, and linens

2. Weighing pads: 1 g represents 1 mL of blood
Why are women with placenta previa considered potential emergencies?
Because massive blood loss can result in hypovolemic shock
What is apruptio placentae?
Premature separation of the placenta, in which part or all of the placenta detaches from its implantation site
Where does separation of the placenta occur at?
The area of the decidua basalis after 20 weeks of pregnancy and before the birth of the baby
What is the most consistent cause for abruption of the placenta?
Maternal hypertension
What are the risk factors of abruptio placentae?
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
What are the classic symptoms of abruptio placentae?
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
What is a boardlike abdomen a clinical symptom of?
Abruptio placentae
What is a Couvelaire uterus?
A uterus that appears purplish and copper colored, is ecchymotic, and has lost its contractility
What are the laboratory findings of Couvelaire uterus?
1. A positive Apt test (blood in amniotic fluid)
2. A decrease in Hgb and Hct levels
3. A decrease in coagulation factor levels
What is a positive Apt test?
Blood in amniotic fluid
What is a Kleihauer-Beke test?
A test to determine the presence of fetal-to-maternal bleeding that predicts increased risk of preterm labor after maternal trauma
What maternal complications are associated with severe abruption?
1. Hemorrhage
2. Hypovolemic shock
3. Hypofibrinogenemia
4. Thrombocytopenia
5. Couvelaire uterus
6. Infection
What is used to rule out plcenta previa?
Sonographic examination
What is the treatment for abruptio placentae?
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
What is the treatment of choice for abruptio previa if the fetus is at term gestation?
What is the treatment of choice for abruptio previa if the bleeding is moderate to severe and the mother or fetus is in jeopardy?
What is an excellent indirect measure of maternal organ perfusion?
Foley catheter insertion for continuous assessment of urinary output
When should cesarean birth be avoided?
When the woman has severe and uncorrected coagulopathy, since it may result in surgically uncontrollable bleeding
What is velamentous insertion of the cord?
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
What is disseminated intravascular coagulation (DIC)?
A pathologic form of clotting that diffuse and consumes large amounts of clotting factors, causing widespread external bleeding, internal bleeding, or both, and clotting
What can trigger DIC?
1. Severe preeclampsia
2. HELLP syndrome
3. Gram-negative sepsis