OB 4 28 ante hemorrhagic
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what might be happening to a mother with her cervix open but no tissue is passing?
what happens when a mother has perfuse bleeding and tissue has passed? (mom calls and says a big blood clot passed)
a mother has had a complete abortion. how much tissue has passed, what does the cervix look like, how much bleeding is she having and what do you have to do after?
all the tissue has passed. the cervix is closed. minimal bleeding. usually no additional tx is needed.
what is a missed abortion?
what do you do after?
- almost not bleeding
- no cramps
- cervix closed
- await passing of fetus
- monitor clotting factors.
what is the plan for a pt that has a short cervix?
bedrest. tocolytics. look out for PPROM, education on S/S
What can be surgically done to someone that has a short cervix?
McDonald cerclage. they stitch the cervix closed and cut the stitch when it's ready (term or c/s)
what are some early S/S of an ectopic pregnancy?
missed period + pain in the uterus area
what are some progressing signs of an ectopic pregs?
- the uterus pain that they felt before turns from tenderness to dull to clolicky.
- dark red or brown vag bleeding.
what are signs of a late ectopic pregs?
increased pain. acute deep pain. "cullens" sign.
what med is used to destroy cells that haven't ruptured yet in ectopic pregs?
we have an ectopic pregs that have ruptured. what is the plan now?
- stop the bleeding.
- remove all remains of the pregs (tuboplasty)
what is the pouch of douglas?
between the vagina and rectum. bleeding can pool into this area from ectopic rupture. feel rectal pressure.
what is a complete molar pregs?
the egg doesn't really have the 23 chromes. ultrasound looks like a bunch of white grapes. mother mimics a pregnancy, but there isn't any life growing. there is blood going to uterus but no placenta to receive it = hemorrhage.
what is a partial mole?
2 sperm fertilizing a single egg. there are too many anomalies so the fetus dies.
what will the person look like when she comes with a complete molar pregs?
anemia from bleeding.
what is placenta previa?
- where the placenta is planted on the bottom of the uterus, not the top.
- complete - closes the whole bottom. can't have vaginal birth.
- partial - if it implants early, it might pull up the placenta as the uterus grows.
the mom has placenta previa. when would the first signs of bleeding show?
about 28 weeks. the baby is big enough to put pressure on the placenta, causing it to bleed.
what is placental abruption? is it a medical emergency?
- there is bleeding coming from the placenta ripping off from the uterine wall.
- yes. the placenta is d/c so no oxygen going to baby.
how serious is it if a mother has a grade 1 placental abruption?
not that serious. just watch her. little to no uterine tenderness/tetany. they are not in distres.
what does it mean if the mother is in grade 2 placental abruption? how much % detached? what is the uterus like? what is the fetal heart rate/pattern look like?
- 20-50% detached.
- uterine tetany and tenderness
- non-reassuring FHR
what does it mean when a mother has a grade 3 placental abruption? how much % has detached? how is the uterus? what is the prognosis for the mother?
- >50% detached.
- severe pain, tetany
- fetus might be dead.
- mother might have DIC
what might cause placental abruption?
abuse (hit in stomach). car crash. drugs.
if the mother has painless bleeding, bright red bleeding, fetus is fine, is the mother previa or abruption?
previa. PAINLESS bleeding is the difference.
how do you manage an abruption?
hemodynamically stable. C/S right away.
what is a battledore insertion of cord?
where the cord is placed wrong on the placenta. risk of tearing = hemorrhage.
what is a succenturiate placenta?
where it separates into two lobes. both functioning. the vessels connecting them two might tear = hemorrhage.
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