2022-08-25T03:29:55+03:00[Europe/Moscow] en true What is placenta abruptio, what is the role of the placenta, when should the placenta detach, what are the causes of abruptia placenta, what are the signs and symptoms of abruptia placenta, when a patient has abruptia placenta what do you have to monitor for, what do you have to check and monitor if a patient is going into DIC, a patient who is 33 weeks pregnant comes in complaining of dark red bleeding, tender uterus and abdominal pain. the patients bp is 180/120 p= 120 bpm. The day before the bleeding started the patient had fallen and injured herself. What is your nursing diagnosis for the patient and what is your nursing interventions. , what is placenta previa, where should the placenta attach,  how do you manage a patient with hypertension at an MOU , how do you manage hypertension at a district hospital, when does gestational hypertension occur, what do you check for in a women diagnosed with gestational hypertension at a clinic, what should you ask a patient about when they have been diagnosed with gestational hypertension at a clinic, who is at risk for pre clampsia , why should you not use diuretics in pre clampsia, what may help a women reduce her chance of getting pre eclampsia, what effect does pre eclampsia have on utero-placental circulation, what is antepartum bleeding, what is the 3rd most important cause of maternal death in south africa, what is the time frame for a highest risk of death for antepartum bleeding, what are the types of antepartum bleeding, how much blood would a women have to lose for the antepartum bleeding to be considered a minor haemorrhage , how much blood would a women have to lose in order for the antepartum bleeding to be considered major haemorrhage, how much blood would a women have to lose in order for her antepartum bleeding to be conidered a massive haemorrage, what are the causes of APH, what cayses bleeding in the first trimester of pregnancy , what are causes of bleeding in late pregnancy (after 20 weeks), what are some complications of antepartum haemorrhage, can occur as a complication of placenta previa , if a patients membranes ruptures and clear blood is visible what could be the diagnosis, vasa previa, placenta praevia, placenta abruption, when is the peak time for a miscarriage, interuption of pregnancy before the doetus becomes viable at 26 weeks of gestation, abortion, what are causes of miscarriage, what are two types of threatening miscarriages, threatening miscarriage, blood tests measures what hormones in a womens body if abnormal hormones is the cause of a threatening miscarriage, what are the symptoms for a threatening miscarriage, what are threatening miscarriages most likely due to , what are less common factors of a threatening miscarriage in pregnancies, inevitable miscarriage, if a women who has vaginal bleeding increases, her cervix dilates and has an increase of cramping and lower abdominal pain, what is she experiencing, if a women is experiencing an inevitable miscarriage at 18 weeks how will she be treated, if a women is 14 weeks pregnant and experiences an ineveitable miscarriage, what will be the plan t treat her, complete miscarriage, incomplete miscarriage, habitual or recurrent miscarriage, what are the causes of habitual miscarriage, hydatidiform mole, products of conception resemble a large bunch of grapes, what are the signs and symptoms of hydatidiform mole, embryo is absorbed and no fetus or placenta can be identified , not all products of conception are expelled, all products of conception are expelled, vaginal bleeding with closed cervix and no pain, vaginal bleeding and pain with cervical dilation, three or more consecutive miscarriages after 14 weeks, a patient who comes in complaining of LAP. she is 17 weeks GA. She has ROM and on speculum insertion she is internal os open. what would her diagnosis be and what is the management for her., induced abortion, elective abortion, therapeutic abortion, septic abortion, placental abruption, what are the two forms of placenta abruption, what is a concealed placenta abruption, what is a revealed placental abruption, risk factors of placental abruption, what is the cause of placental abruption, what are the degrees of abruptio placenta, what degree of abruption placenta is mary having. She has a small amount of vaginal bleeding nd uterine contractions. There is ni sign of fetal distress or low blood pressure, explain what would occur if a women is experiencing a grade 2 placental abruption, describe grade 3 placental abruption , what are the onset and symptoms for abruption placenta, what would you do for a patient if she shows signs of abruption placenta at an MOU, what would you do for a patient who presents with placental abruption with mild bleeding at a hospital setting., what other maternal illness is in collaboration with abruptio placenta, if a patient is experiencing abruptio placenta and the fetus is not viable, how would you manage her, how would you manage a patient who has placenta abruptio and the fetus is dead , diagnose the patient Mrs September who is 37 weeks pregnant. she has gestational hypertension for which she takes alpha methyldopa in order to help her BP. She comes into the clinic and her vitals are BP=150/90 P=111 T=37C FM= vary faint . she is experiencing pain which is always present. On in examination her abdomen is hard and tender and her SFH is large for her GA. she is also  complaining of bleeding which is dark red and has blots, placenta previa, what is the statistics for plcenta previa, what are the four types of placenta previa, explain total placenta previa, explain partial placenta plevia, explain a marginal placenta previa, explain a low lying placenta, what is th emanagement of placenta previa dependent on, how should the women be managed if placenta previa is diagnosed in the 2nd trimester, how can placenta previa be monitored during the 2nd and 3rd trimester, what are risk factors for placenta previa, what are the symptoms of placenta previa, if a patient is 34 weeks and she is bleeding due to placenta previa with and bleeding, how will you manage her, what effect does placenta previa have on the mother, what is the effect of placenta previa on the baby, why is the mother given pitocin after a c sections flashcards

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  • What is placenta abruptio
    when the placenta detachs before the birth pf the baby
  • what is the role of the placenta
    - maintains pregnancy- delivers oxygen and nutrients- removes waste
  • when should the placenta detach
    after the birth of the baby
  • what are the causes of abruptia placenta
    - chronic hpt- preclampsia- trauma to the abdomen- history of many pregnancies- cocaine or smoking- multiple babies- history of previous abruptia placenta
  • what are the signs and symptoms of abruptia placenta
    - dark red bleeding- extended fundal height- tender uterus- abdominal pain/contraction- concealed bleeding- hard abdomen - experience of disceminated intervascular coagulation- distressed baby 
  • when a patient has abruptia placenta what do you have to monitor for
    - monitor for DIC (disceminated intervascular coagulation)- monitor for bleeding 
  • what do you have to check and monitor if a patient is going into DIC
    - low platelet, fibronogen and prothombin levels- bleeding gums- oozing from iv sites- petecnia or echymosis- micro emboli
  • a patient who is 33 weeks pregnant comes in complaining of dark red bleeding, tender uterus and abdominal pain. the patients bp is 180/120 p= 120 bpm. The day before the bleeding started the patient had fallen and injured herself. What is your nursing diagnosis for the patient and what is your nursing interventions.
    nursing diagnosis - patient is experiencing abruptia placentanursing interventions - - monitor patient for DIC and concealed bleeding- pad checks - check vital signs every 15mins- check patients platelet count and clotting factors- check for cleeding gums- check for oozing from the iv site- observe any bruising ( echymosis) - observe if patient has shortness of breath, chest pain, mental status changes, urine output decreases - this could indicate a clot in any of these major organs - check fundel height- NO pv or abdominal exams - patient should lay on their left side and not in a supine position in order to prevent supine hypertension (lying on the left side helps increase perfusion to the uterus)- monitor babys hr - prep patient for delivery. if they are stable they ma be able to deliver vaginally but if the patient is unstable they shoudl deliver via c section.
  • what is placenta previa
    abdominal attachment of rhe placenta in the uterus near or over the cervical opening 
  • where should the placenta attach
    at the top or the side of the uterus
  •  how do you manage a patient with hypertension at an MOU 
    - If patients BP is stable discuss patient with doctor and change meds to alpha methyldopa 500mg 8hourly via oral- patient should then be transferred to high risk facility at 24 weeks in order to go for blood tests for early detection of pre eclampsia and placental functions- if patients BP remains stable they are an intermediate risk and all the tests performed at a high risk facility remains normal- patient should attend HR clinic at MOU until 36 weeks if BP remians stable
  • how do you manage hypertension at a district hospital
    - do ultrasound in order to determine the relation between GA and fetus weight - if no dating u/s available- use the umbilical artery doppler test in order to test for fetal well-being- for viable baby a CTG should be coordinated and a fetus kickchart started- test for proteinuria- in order to exclude pre clampsia with unsure dip stick protenuria the first time, do another one 24hrs later- control BP: anti HPT methyldopa 1g orally if BP is raised, after that 500mg 8 hourly via oral (if patient is on hpt meds then proceed with that)- delivery should commence at 37 weeks of gestation  
  • when does gestational hypertension occur
    after 20 weeks GA 
  • what do you check for in a women diagnosed with gestational hypertension at a clinic
    proteinuriaoedemaincreased weight gain
  • what should you ask a patient about when they have been diagnosed with gestational hypertension at a clinic
    - family history of hypertension- history of gestational hypertension- previous stillbirths- neonatal deaths- bleeding in previous or index pregnancy- any symptoms of persistent headaches
  • who is at risk for pre clampsia 
    - primigravs- multigravs with new partners- wmen aged 35 and above- chronic hpt, previous pre clampsia- multiple pregnancies- diabetics- previous abruptio placentae- obesity
  • why should you not use diuretics in pre clampsia
    patient is already hypovoleamic 
  • what may help a women reduce her chance of getting pre eclampsia
    - calcium supplementation: 1g elemental calcium daily ( 2 tab orally x 3 times a day) - low dose aspirin: 75mp daily from the 12 weeks ga to 34 weeks ga 
  • what effect does pre eclampsia have on utero-placental circulation
    IUGRFetal distressabruptio placenta  these could cause - fetal death - pre term birth
  • what is antepartum bleeding
    bleeding from the genital tract from 20 weeks of pregnancy up to delivery of the baby 
  • what is the 3rd most important cause of maternal death in south africa
    antepartum bleeding
  • what is the time frame for a highest risk of death for antepartum bleeding
    24 hours
  • what are the types of antepartum bleeding
    - spotting bleeding- minor haemorrhage- major haemorrhage- massive haemorrhage
  • how much blood would a women have to lose for the antepartum bleeding to be considered a minor haemorrhage 
    50ml or less
  • how much blood would a women have to lose in order for the antepartum bleeding to be considered major haemorrhage
    50-1000ml minus the shock
  • how much blood would a women have to lose in order for her antepartum bleeding to be conidered a massive haemorrage
    more than a 1000ml including shock 
  • what are the causes of APH
    > placental - abruptio placentae, placenta praevia, vasa praevia> non-placental - vaginal and cervical lesions including cancer, cervical infections, trauma and decidual bleeding> unknown - cause of APH unknown origin
  • what cayses bleeding in the first trimester of pregnancy 
    - abortion/miscarriage- ectopic pregnancy- implantation of the placenta in the uterus- infection- trauma
  • what are causes of bleeding in late pregnancy (after 20 weeks)
    - vasa previa- show major- placental previa- placental abruption
  • what are some complications of antepartum haemorrhage
    - hypovalaemic shock - couvelaire uterus- disseminated intravascular coagulation- high rist of premature delivery- fetal hypoxia- maternal death- perinatal mortality- pph
  • can occur as a complication of placenta previa 
    vasa previa
  • if a patients membranes ruptures and clear blood is visible what could be the diagnosis
    vasa previa
  • vasa previa
    the presentation of the umbilical or fetal blood vessels that run in the membranes and lie in front of the cervical os
  • placenta praevia
    the implantation of the placenta in the lower segment of the uterus
  • placenta abruption
    the accidental haemorrhage where the placenta has separated partially or completely from the uterine wall the placenta is usally implanted in the upper segment of the fundus
  • when is the peak time for a miscarriage
    from week 6 - 10 of pregnancy
  • interuption of pregnancy before the doetus becomes viable at 26 weeks of gestation
    miscarriage
  • abortion
    the termination of a pregnnacy before the fetus is viable 
  • what are causes of miscarriage
    - abnormal zygote development - foetal death - advanced maternal age- chronic disease- decreased progesterone - malnutriion- recreational drugs- abnormalities of the reproductive tract- specific infections such as syphilis, rubella ad toxoplasmosis
  • what are two types of threatening miscarriages
    retained and term pregnancy
  • threatening miscarriage
    indicated by mild bleeding in early pregnancy without cervical dilation
  • blood tests measures what hormones in a womens body if abnormal hormones is the cause of a threatening miscarriage
    - HCG - progesterone
  • what are the symptoms for a threatening miscarriage
    - pregnant women has slight bleeding or spotting through an undilated cervix and no abdominal pain- they may also pass tissue with clot like material from the vagina
  • what are threatening miscarriages most likely due to 
    chromosomal abnormalities in the embryo
  • what are less common factors of a threatening miscarriage in pregnancies
    - an incompetent cervix- uterine fibroids- intra uterine inflammation, viral infection- multiparity- obesity- uncontrolled diabetes
  • inevitable miscarriage
    when a threatening miscarriage progresses, the volume of vaginal bleeding increases and the cervix dilates
  • if a women who has vaginal bleeding increases, her cervix dilates and has an increase of cramping and lower abdominal pain, what is she experiencing
    inevitable miscarriage
  • if a women is experiencing an inevitable miscarriage at 18 weeks how will she be treated
    she will have an evacuation of uterine contents
  • if a women is 14 weeks pregnant and experiences an ineveitable miscarriage, what will be the plan t treat her
    we will wait for a spontaneous expulsion of the products of conception
  • complete miscarriage
    when all products of conception includes the embryo and placenta with intact membranes from the uterus are expelled from the uterusbleeding is usually mild and os is closed
  • incomplete miscarriage
    cervix will remain open. the products of coneption may be visible or felt, usually the fetus is passed while the placenta and membranes are retained. there may be profuse/light bleeding as the uterus cannot contract and retract effectively due to the products of conception being retained in utero
  • habitual or recurrent miscarriage
    three or more consecutive spontaneous miscarriages after 14 weeks 
  • what are the causes of habitual miscarriage
    - uterine abnormality- cervicaal incompetence
  • hydatidiform mole
    the abnormal development of the primitive chorion, where hydropic or cystic degeneration of the centre of the villi occurs
  • products of conception resemble a large bunch of grapes
    hydatidiform mole
  • what are the signs and symptoms of hydatidiform mole
    - vaginal bleeding - excessive nausea and vomiting- hypertension may develop before 20 weeks of pregnancy - uterus large for the period of gestation, soft and bulky
  • embryo is absorbed and no fetus or placenta can be identified 
    hydatidiform mole
  • not all products of conception are expelled
    incomplete miscarriage
  • all products of conception are expelled
    complete miscarriage
  • vaginal bleeding with closed cervix and no pain
    threatening miscarriage
  • vaginal bleeding and pain with cervical dilation
    inevitable miscarriage
  • three or more consecutive miscarriages after 14 weeks
    habitual miscarriages 
  • a patient who comes in complaining of LAP. she is 17 weeks GA. She has ROM and on speculum insertion she is internal os open. what would her diagnosis be and what is the management for her.
    she is having an inevitable miscarriage. Her management would be to perform an MVA 
  • induced abortion
    when a procedure is done or medication is taken to end a pregnancy or the intentional termination of a pregnancy before the fetus can live independently viable interruption of pregnancy on demand
  • elective abortion
    a women chooses to end her pregnancy and it is not for maternal or fetal health reasons
  • therapeutic abortion
    performed in order to preserve the ehalth or save the life of a pregnant women 
  • septic abortion
    infection of th uterus following a miscarriage
  • placental abruption
    is the premature seperation of a placenta from its implantation in the uterus
  • what are the two forms of placenta abruption
    - concealed (20%) - revealed (80%)
  • what is a concealed placenta abruption
    where the bleeding is confined within the uterine cavity. it is also more severe form because the amount of blood loss is easily underestimated
  • what is a revealed placental abruption
    this is where the blood drains through the cervix usually with incomplete or detachment
  • risk factors of placental abruption
    - uterine abnormalities- hypertension / pre-eclampsia- cigarette smoking- multiple pregnancies- short umbilical cord- decompression of uterus (polyhydramnios)- folic acid deficiency - anemia - poor nutrition and social conditions
  • what is the cause of placental abruption
    - the maternal vessels tearing away rom the decidua basalis. Seeperatoin results in bleeding into the decidua basalis h=behind the placenta causing a retroplacental clot- direct trauma to the uterus
  • what are the degrees of abruptio placenta
    - asymptomatic- grade 1 - grade 2- graade 3
  • what degree of abruption placenta is mary having. She has a small amount of vaginal bleeding nd uterine contractions. There is ni sign of fetal distress or low blood pressure
    grade 1 
  • explain what would occur if a women is experiencing a grade 2 placental abruption
    she would have mild to moderate bleeding, uterine contractions and there will be some sign of fetal distress
  • describe grade 3 placental abruption 
    there will be moderate to severe bleeding which could be concealed. there would be uterine ontractions that does not relax, abdominal pain, low blood pressure and fetal death
  • what are the onset and symptoms for abruption placenta
    - more common after 28 weeks- retroplacental clot may begin to develop overtime- pain with or without external and concealed vaginal bleeding - uterus is hard (woody) and tender- dark clots of blood (may be concealed but if not then clots)- large SFH for expected dates- difficult to feel baby or hear fetal heart- FM may be absent or reduced
  • what would you do for a patient if she shows signs of abruption placenta at an MOU
    - admit her to labour ward- start an iv of ringers lactate- if mother is in shock then resuscitate with 1-2L of ringers lactate- no vaginal exams should be done- monitor vital signs every 15min- give oxygen with a face mask at 60% 6-8L in order to help improve tissue perfusion- insert a catheter- monitor her blood loss- contact referral hospital- monitor fetal heart rate 
  • what would you do for a patient who presents with placental abruption with mild bleeding at a hospital setting.
    - continue obs in order to detect hypovolaemic shock- take blood for FBC and cross match- do an ultrasound scan in order to help with the diagnosis- mmonitor uterine contractions (if she is having frequent uterine contractions >5/10 minutes) this could suggest abruptio placenta- if baby is in fetal distress and fetus is viable then deliver the women by an emergency c sections- insert a speculum in order to exclude a local cause- further management depends on cause
  • what other maternal illness is in collaboration with abruptio placenta
     pre-eclampsia
  • if a patient is experiencing abruptio placenta and the fetus is not viable, how would you manage her
    - rupture membranes - augment labour with oxytocic- monitor blood loss carefully
  • how would you manage a patient who has placenta abruptio and the fetus is dead 
    - deliver urgently - take bloods for a cross match, FBC, INR, PTT (partial thromboplastin test) and serum urea and creatine - blood tranfusion (2-4 units) is usually necessary- insert CVP line- insert catheter and  monitor hourly urine outout- give fluids in order to maintain a systolic bp of 100mmhg or more- if there is no progress of labour with in 1-2 hours after AROM then augment- give analgesia - morphine 5mg IM 4 hourly
  • diagnose the patient Mrs September who is 37 weeks pregnant. she has gestational hypertension for which she takes alpha methyldopa in order to help her BP. She comes into the clinic and her vitals are BP=150/90 P=111 T=37C FM= vary faint . she is experiencing pain which is always present. On in examination her abdomen is hard and tender and her SFH is large for her GA. she is also  complaining of bleeding which is dark red and has blots
    the patient is experience abruption placenta and should be transferred to a tertiary instution. 
  • placenta previa
    a condition in which the placenta is implanted in the lower segmant of the uterus and is too close to covering the cervix
  • what is the statistics for plcenta previa
    1 in every 200 births
  • what are the four types of placenta previa
    - total placenta previa- partial placenta previa- marginal placenta previa- low lying placenta
  • explain total placenta previa
    this would be classified as a grade 4 completely ocvers the internal os 
  • explain partial placenta plevia
    classified as a grade 3when the edge of the placenta is partially over the nternal os when undilated and up to 4cm when dilated 
  • explain a marginal placenta previa
    classified as a grade 2 when the placenta reaches the edge of the internal os
  • explain a low lying placenta
    classified as a grade 1 placenta is implanted in the lower segment
  • what is th emanagement of placenta previa dependent on
    gestation of the pregnancy
  • how should the women be managed if placenta previa is diagnosed in the 2nd trimester
    follow up and recheck the location in the 3rd trimester
  • how can placenta previa be monitored during the 2nd and 3rd trimester
    - transvaginal ultrasound- trans abdominal ultrasound - mri scan
  • what are risk factors for placenta previa
    - advanced maternal age- multiple pregnancy - grand multipara- damage of the endometrium in the upper segment due to previous dilation and curettage to remove any tissue from the uterus- previous c section- previous placenta previa
  • what are the symptoms of placenta previa
    - sudden and painless vaginal bleeding - bright red blood with no clots- no abdominal pain or tenderness- baby in breach or transverse positiion 
  • if a patient is 34 weeks and she is bleeding due to placenta previa with and bleeding, how will you manage her
    admit to hopsital bed rest till bleeding stopsgive corticosteriods
  • what effect does placenta previa have on the mother
    - preterm labour- c section- placenta accreta- shock and death
  • what is the effect of placenta previa on the baby
    - preterm birth, foetal distress, high risk - perinatal death- IUGR
  • why is the mother given pitocin after a c sections
    in order to cause the uterus to contract which can help stop bleeding