Unit 6 - Childbearing Risks (exam 3)

Early Bleeding Problems

Miscarriage

What is the other term for miscarriage?

  • Spontaneous abortion

What are the causes of miscarriage in the first trimester?

  • Genetic abnormalities

  • **while still upsetting to the mom, can provide a sense of relief because if the pregnancy had been carried to term them could have been serious problems with the baby

What are the causes of miscarriage in the second trimester?

  • Maternal conditions

What should you as the nurse assess?

  • How many weeks pregnant is the patient?

  • Does she have any other medical conditions that could have contributed?

  • Is she having any vaginal bleeding (**Can indicate hemorrhage and would need to be watched more closely)

Miscarriage (before 20 weeks) Stillbirth (after 20 weeks)

Ectopic Pregnancy

What is ectopic pregnancy?

  • Ovum (Fertilized egg) implants anywhere THAT IS NOT THE UTERUS

  • THIS IS AN EMERGANCY AND CAN END IN DEATH

Where is the most common place for ectopic pregnancies to occur?

  • In the fallopian tubes

Other places ovum can implant?

  • Cervix

  • Abdominal cavity

  • Ovaries

What is the most common cause of ectopic pregnancy?

  • Pelvic inflammatory disease (due to the scaring in fallopian tubes)

Other causes?

  • IUD

  • Previous Tubal

  • Smoking

  • Douching

What would you give if the mother has not ruptured/to prevent rupture?

  • Methotrexate

What intervention would be best for a mother who has ruptured?

  • Surgical Intervention (medical emergency)

  • Will bleed a lot

What medication would you give in the event mom is Rh-negative?

  • Rhogam (Rh immunoglobin)

What are the signs and symptoms of ectopic pregnancy. (Ex: A women comes into a clinic experiencing these S/S, what could she be experiencing or at risk for?)

  • Abdominal pain

  • Spotting within 6 TO 8 WEEKS AFTER MISSED MENSES (period)

What is the main way to confirm ectopic pregnancy? ( Ex: A woman comes into a clinic with abdominal pain, spotting, and absence of menses for 7 weeks what order do you expect to see?)

  • Transvaginal ultrasound

What is the PRIORITY nursing intervention for a woman experiencing an ectopic pregnancy?

  • Preparing a woman for treatment

What would administer to a woman experiencing pain with an ectopic pregnancy?

  • Opioid analgesics

A woman is not a surgical candidate for her ectopic pregnancy, what treatment would be best? What is the priority nursing intervention?

  • Medical treatment

  • EXPLAIN THE MEDS AND WHAT THEY DO

What medication would be given to block the fetus from developing and stop the tubes from rupturing?

  • Methotrexate (the fetus absorbs into the body, stops rupture)

What should you provide to a mother who is going through an ectopic pregnancy?

  • Emotional support **allow her to express herself to you

  • Refer to support groups.

  • Education ( NO SMOKING DURING CHILD BEARING YEARS, limit sexual partners, wear protection, PROMT TREATMENT in the event an STI is contracted)

EX: A women is at the clinic for an appointment following an ectopic pregnancy, what would you expect to be ordered (what is the primary intervention) (what would you need to collect)

  • Do a Sereal HCG test (this will be routine at every follow up)

Gestational Trophoblastic Disease

Trophoblastic cells proliferate and produce HCG.

What is the clinical marker for this disease?

  • Positive HCG test

S/S

  • Vaginal bleeding

  • Anemia

  • Hyperemesis

  • Preeclampsia

What should be watched for a decrease overtime?

  • HGC Levels

What should be done to manage this disease?

  • Uterine content evacuation **as soon as diagnosis is made.

What clinical manifestations are you likely to see for gestational trophoblastic disease?

  • Will mimic a spontaneous abortion at 12 weeks (Amenorrhea, Breast tenderness, fatigue, nausea vomiting, High HCG)

  • ****ABSCENSE OF FETAL HEARTBEAT

On an ultrasound what pattern are you likely to see?

  • Molar Pattern

As the nurse what is important to do preoperatively?

  • Prepare the women for the evacuation of uterine contents.

  • Provide emotional support, Allow the women to grieve the loss of her pregnancy and acknowledge her feelings of sadness.

What other disease is this associated with?

  • Cancer (choriocarcinoma)

Following diagnosis what is important to explain to the patient?

  • The need for regular follow ups to ensure there is no trophoblastic tissue remaining **For ONE YEAR

  • Prophylactic Chemotherapy (giving methotrexate)

Late Bleeding Problems

Placenta Previa

Placenta implants over the cervical os (opening)

S/S

***PAINLESS, bright red bleeding

  • Can bleed more during labor.

  • Bleeding can be continuous or intermittent.

What should be monitored?

  • Vaginal Bleeding ***No more than one pad an hour

  • ****NO VAGINAL EXAMS

When do you usually begin to see bleeding begin?

  • Around 20 weeks gestation

Complete / Partial / Marginal

  • Complete- Completely covering.

  • Partial- Partially covering.

  • Marginal- Within 2 cm of the os

If the patient is having severe bleeding, what might be indicated?

  • The need for immediate Cesarean birth (For minor bleeding bedrest, For major bleeding blood products and IV fluids)

Placental Abruption

Early Separation of the placenta, Prior to birth

What does placental abruption cause?

  • Hemorrhage

  • Decrease in fetal blood supply.

  • ***EMERGENCY, can end in death

!!!What should be started in a patient with placental abruption?!!!

  • ****Fluid resuscitation via IV fluids

What is the most common cause of placental abruption?

  • COCAINE USE

Other causes?

  • Fetal growth restrictions

  • Maternal age

  • Preeclampsia

S/S

  • Blood loss (dark red)

  • PAIN

  • Abdomen becomes very hard (feels solid)

What will decrease during placental abruption?

  • Fetal blood supply

  • Fetal movement