Term
| Name five possible causes of first trimester bleeding. |
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Definition
| miscarriage, ectopic bleeding, severe cervicitis, cervical lesions, cervical polyp, post-coital bleeding, implantation spotting, subchorionic bleed, hydatidiform mole (V 662) |
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Term
| List at least 6 important questions to ask when a mother reports first trimester bleeding. |
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Definition
| 1. What is LMP, any other confirmation of date of pregnancy? 2. Was pregnancy test urine or blood sample and when was it positive? 3. Any previous pregnancy history (SAB, ectopic, etc.)? 4. Contraceptive history (especially current use of IUD) 5. History of bleeding? When/how much/color? Pads needed? 6. Is there pain or cramping? When/where/mild or intense/sharp or dull? 7. Any fever or UTI symptoms? 8. Any STI or UTI in this pregnancy? 9. Any changes in pregnancy symptoms? 10. Any recent intercourse? (V 662) |
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Term
| Give instructions to a 1st trimester mom for mild bleeding. |
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Definition
| 1. Rest: no need to change activity level but let up if symptoms escalate. 2. Pelvic rest: no sex or tampons or anything else into the vagina until resolved 3. No orgasm. 4. Notify midwife if increase in bleeding, lower abdominal cramps, pelvic pain other than cramping, gush of fluid from vagina, fever of more than 100.4 F (V 663) |
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Term
| SAB stands for _______ and is usually defined as _________________ |
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Definition
| spontaneous abortion/expulsion of the products of conception prior to 20 weeks gestation or 500 g in weight. (V 664) |
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Term
| Genetic abnormality accounts for about ___ % of all early pregnancy losses. |
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Definition
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Term
| What two signs of threatened abortion together mean the prognosis for the pregnancy is poor? |
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Definition
| bleeding and pain (V 665) |
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Term
| Give instructions to a woman experiencing a first trimester miscarriage, who prefers to remain at home rather than undergo a D&C. |
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Definition
| Take temp q 4 hours or more frequently if she has chills, call if she soaks a pad in less than an hour, passes clots larger than a 50-cent piece, or has a fever of 100.4 F or above. Also to call when she aborts. If this isn't her first SAB, ask her to save products of conception in a jar for further inspection and genetic studying if desired. (V 665) |
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Term
| Define incomplete abortion and concerns regarding it. |
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Definition
| When the placenta is not expelled with the fetus. This can cause bleeding and infection, especially if occurred during the second trimester. Will need MD consultation. (V 665) |
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Term
| What are signs and symptoms of missed abortion? |
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Definition
| Normal early pregnancy without presumptive and probable signs of pregnancy 2. vaginal spotting or bleeding or low back/abdominal pain at time of death of fetus (maybe) 3. fundal height ceases to increase and becomes smaller after a while 4. regression of mammary glands 5. weight loss 6. persistent amenorrhea 7. no FHT when anticipated by dates (V 665) |
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Term
| What is the biggest risk of missed abortion? |
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Definition
| Abnormal clotting mechanisms and possible development of disseminated intravascular coagulopathy (DIC) (V 665) |
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Term
| Define habitual abortion. |
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Definition
| When SAB has terminated three more more consecutive pregnancies. Genetic counseling recommended and referral to MD too. (V 666) |
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Term
| Define ectopic pregnancy and predisposing factors. |
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Definition
| Ectopic pregnancy is any time the blastocyst implants other than inside the uterine cavity. Most common in the fallopian tubes. Predisposing factors: previous ectopic, pelvic infections, IUD history, and prior tubal surgery. (V 666) |
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Term
| What are the early signs and symptoms of ectopic pregnancy? |
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Definition
| vaginal bleeding and spotting, occasional pelvic pain, possibly fewer presumptive signs of pregnancy. ANY WOMAN WHO REPORTS bleeding and pelvic pain must have ectopic ruled out. |
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Term
| The most common site of an ectopic pregnancy is ____________. |
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Definition
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Term
| Describe classic tubal pregnancy. |
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Definition
| May not know she's pregnant because mistook earlier bleeding to have been light period. Sudden onset of sharp, stabbing, severe abdominal pain. May become hypotensive and other signs of shock may or may not develop quickly. Abdomen is tender and VE is painful. ***Movement of cervix causes extreme pain.*** Referred pain in neck or shoulder may be causes by diaphragmatic irritation from blood in peritoneal cavity. Soft, pliable pelvic mass may be palpated posterior or lateral to the uterus. Diarrhea and/or rectal pressure. (V 666) |
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Term
| Define hydatidiform mole. |
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Definition
| Ths is a genetically abnormal pregnancy that manifests as a developmental anamoly of the placenta. The placental villi become a ass of clear, cystlike visicles, resembling grapes. Has the potential for becoming malignant and often proceeds the extremely malignant but rare trophoblastic neoplasm called choriocarcinoma. (V 667) |
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Term
| List signs and symptoms of hydatidiform mole. |
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Definition
| 1. Persistent, often severe nausea and vomiting, 2. uterine bleeding by 12th week, can be spotting or profuse but is most often a browning discharge 3. large for dates uterus clearly our or proportion to presumed gestational age 4. shortness of breath 5. enlarged tender ovaries 6. no FHT 7. No fetal activity 8. No fetal parts evident on palpation 9. PIH, preeclampsia, or eclampsia before 24 weeks. Refer to physician if suspected. (V 668) |
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Term
| Name four places an ectopic pregnancy might implant. |
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Definition
| fallopian tubes (95%), ovary, abdomen, cervix. (V 666-667) |
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Term
| Describe incompetent cervix. |
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Definition
| The cervix dilates and effaces without pain in the 2nd or early 3rd trimester. Typically the woman presents to office or L&D with vaginal bleeding, pelvic pressure, or ruptured membranes. Cervical exam shows advanced dilation. (V 669) |
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Term
| What is the cardinal sign of placenta previa? |
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Definition
| Painless vaginal bleeding with a sudden onset in the third trimester. (V 703) |
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Term
| A woman who presents in the third trimester with painless vaginal bleeding must be suspected to have _________. |
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Definition
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Term
| What is the most critical thing to remember when examining a woman in the case of suspected placenta previa? |
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Definition
| DO NOT DO A VAGINAL EXAM until placenta previa is ruled out. (V 703) |
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Term
| T of F. All women with diagnosed placenta previa should be on bedrest. |
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Definition
| False. They should be counseled to continue normal activity, but with pelvic rest (nothing in the vagina, no orgasm) and to call immediately in the case of vaginal bleeding. (V 703) |
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Term
| After one bleeding event in a woman with placenta previa, if it has resolved, she may/may not be allowed to return home on bedrest providing she has access to 24/7 emergency transport to hospital. |
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Definition
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Term
| Define placental abruption. |
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Definition
| Premature separation of the normally implanted uterus. (V 703) |
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Term
| T or F. There is always visible bleeding in the case of placental abruption. |
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Definition
| False. The bleeding can be concealed behind the placenta. (V 704) |
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Term
| Name 6 risk/etiological factors for placental abruption. |
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Definition
| maternal hypertensive disorders, advanced maternal age or parity, maternal smoking, poor maternal nutrition, chorioamnionitics, maternal blunt abdominal trauma, history of placental abruption, sudden decrease in uterine volume or size, external cephalic version, cocaine usage |
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Term
| What are the signs and symptoms of placental abruption? |
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Definition
| They depend on degree of separation but... can be mild with generalized back pain and colicky, discoordinate uterin activity. Bleeding may be concealed or obvious. Common to mistake early signs of abruption with premature or false labor. Woman's perception of pain out of proportion to what examiner feels. Classic hypertonic, boardlike uterus usually only occurs with large abruption. FHT may be normal in smaller abruptions. Greater separation will show abnormal FHT with no variability or late decels or loss of beat-to-beat variability, or sinusoidal rhythm. (V 704) |
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Term
| T or F Shock is associated with significant placental abruption. |
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Definition
| True. Degree depends on the severity of the abruption. (V 704) |
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Term
| Give two presenting complaints that should make you think about placental abruption for a woman in her third trimester. |
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Definition
| Back pain and colicky uterine activity (with or without bleeding). Any woman who has been the victim of trauma (car accident, abuse) the midwife should be extra suspicious. (V 705) |
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Term
| T or F Ultrasonography is equally good at confirming placenta previa and placental abruption. |
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Definition
| False. While ultrasonography is useful in diagnosing placenta previa and it can yield information if the abruption is of significant size and in a position that can be easily identified, a negative finding on ultrasound does NOT preclude a diagnosis of an abruption. Per Varney's "It is usually not of value in identifying a placental abruption." (V 705) |
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