Term
| what characterizes bleeding during early pregnancy (1st trimester/12 wks)? diagnostic modalities? |
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Definition
| the cervix may bleed during sex if a capillary is broken at the squamocolumnar junction (columnar becomes more exposed w/pregnancy). the cervix may bleed w/infection. a bimanual exam, an exam w/speculum, a good hx (at least 4 qualifiers), hCG test (serial, r/o ectopic pregnancy), Rh test (may need to administer RhoGAM), and US (can ID subchorionic bleeding, which should resolve) are all important investigative modalities for diagnosing bleeding during early pregnancy. |
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Term
| what are signs and symptoms of a miscarriage (abortion)? |
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Definition
| vaginal bleeding (but 50% of pts w/vaginal bleeding do not miscarry), cramping pain felt low in the abdomen (often stronger than menstrual cramps), and tissue passing from the vagina (send to pathology) |
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Term
| when does miscarriage most often happen? what is the rate of incidence? |
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Definition
| any time in the first half of the pregnancy (usually the first 13 wks). miscarriage happens in about 15-20% of pregnancies, (usually in older pts). |
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Term
| what is an incomplete abortion/miscarriage? how is this treated? |
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Definition
| if some tissue stays in the uterus - causing continuous bleeding. if the pt is < 9 wks this can be treated w/ mifepristone (progesterone antagonist) or misoprostol (prostaglandin). > 9 wks, the pt may require dilatation + evacuation (or D+C), where a suction device is used to remove any remaining fetal tissue after a miscarriage (sharp objects are avoided b/c they can cause uterine scarring). |
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Term
| can most miscarriage be prevented? |
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Definition
| no - the majority of them are due to a chromosomal mishap, which the body responds to w/miscarriage. there is no proof that exercise, sex, stress, or work causes them. |
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Term
| does 1 miscarriage mean there is a health problem? |
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Definition
| no, but 2 in a row does raise suspicion and testing would then be advised. |
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Term
| what characterizes bleeding in late pregnancy (after 24 weeks)? |
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Definition
| this is more of an issue, b/c the pregnancy is then considered viable. heavy bleeding late in pregnancy is usually associated w/placental problems: placental abruptio/placenta previa. PTL may also cause late pregnancy bleeding. late bleeding may pose a threat to the health of both the pt and fetus and may require tx/delivery. |
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Term
| w/bleeding in pregnancy, what are the possible anatomical areas to assess? |
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Definition
| the pudendum, vagina, cervix (ectropion, polyp, CA, cervicitis), and uterus |
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Term
| what are uterine sources of bleeding in early pregnancy? |
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Definition
| implantation bleed/subchorionic bleed (can self-resolve), vanishing twin (3-5% pregnancies start out w/twins, then in 20% one will be spontaneously lost), endometrial polyps, uterine anomalies (PTL more likely), hydatiform mole (most common gestational trophoblastic neoplasm), and ectopic gestation |
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Term
| what are uterine sources of bleeding in late pregnancy? |
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Definition
| in late pregnancy, spotting is PTL until proven otherwise. *placenta previa (implantation in the lower segment of the uterus) or *placenta abruptio (premature separation of the normally implanted placenta) may also be responsible. |
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Term
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Definition
| a common discharge of blood and mucus (plug) from the cervix, which is not a problem if it occurs w/in 3 weeks of due date (~37 wks) |
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Term
| what are possible signs of PTL? |
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Definition
| vaginal discharge, change in discharge, increase in amount of discharge, pressure in the pelvis/lower abdomen, low/dull backache, stomach cramps (with/without diarrhea), and regular contractions/uterine tightening |
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Term
| where is the best place for implantation of the trophoblastic tissues (placenta)? |
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Definition
| the high on the posterior wall of the uterus |
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Term
| what characterizes late bleeding in pregnancy due to placenta previa? |
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Definition
| placenta previa: placental implantation involving the cervix of which there are 3 categories: total placenta previa (the placenta covers the entire internal cervical os), partial placenta previa (internal os partially covered), and marginal placenta previa (edge of the placenta is touching the internal cervical os). signs/symptoms: *painless hemorrhage typically > 28 wks. |
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Term
| what is a low-lying placenta? |
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Definition
| a placenta w/in 2.5 cm of the internal cervical os (can migrate farther away as the uterus grows - monitor) |
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Term
| how is placenta previa treated? |
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Definition
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Term
| what are risk factors for placenta previa? |
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Definition
| pts w/previous children, pts with a past *C-section, and a hx of uterine sx, twins/triplets |
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Term
| what is a placenta percreta? |
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Definition
| when the placenta perforates through the myometrium and invades structures outside such as bladder/bowel |
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Term
| what is a placenta abruptio? |
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Definition
| premature separation (> 20 wks) of the normally implanted placenta (prior to this, separation is considered abortion). this can cause internal/external bleeding and severity of the abruption determines the prognosis - can be fetal or maternal loss |
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Term
| what are the risk factors for placenta abruptio? |
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Definition
| older age, previous placenta abruptio, pts w/HTN or abdominal trauma, and nicotine/cocaine used |
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