1. A 39-year-old at 37 weeks gestation is admitted to the hospital with complaints of vaginal bleeding following the use of cocaine 1 hour earlier. Which complication is most likely causing the client’s complaint of vaginal bleeding?
- Placenta previa
- Abruptio placentae
- Ectopic pregnancy
- Spontaneous abortion
2. A pregnant woman arrives at the emergency department (ED) with abruptio placentae at 34 weeks’ gestation. She’s at risk for which of the following blood dyscrasias?
- Thrombocytopenia.
- Idiopathic thrombocytopenic purpura (ITP).
- Disseminated intravascular coagulation (DIC).
- Heparin-associated thrombosis and thrombocytopenia (HATT).
3. A maternity nurse is caring for a client with abruptio placentae and is monitoring the client for disseminated intravascular coagulopathy. Which assessment finding is least likely to be associated with disseminated intravascular coagulation?
- Swelling of the calf in one leg
- Prolonged clotting times
- Decreased platelet count
- Petechiae, oozing from injection sites, and hematuria
4. A nurse is assessing a pregnant client in the 2nd trimester of pregnancy who was admitted to the maternity unit with a suspected diagnosis of abruptio placentae. Which of the following assessment findings would the nurse expect to note if this condition is present?
- Absence of abdominal pain
- A soft abdomen
- Uterine tenderness/pain
- Painless, bright red vaginal bleeding
5. An ultrasound is performed on a client at term gestation that is experiencing moderate vaginal bleeding. The results of the ultrasound indicate that an abruptio placentae is present. Based on these findings, the nurse would prepare the client for:
- Complete bed rest for the remainder of the pregnancy
- Delivery of the fetus
- Strict monitoring of intake and output
- The need for weekly monitoring of coagulation studies until the time of delivery
6. Which of the following is described as premature separation of a normally implanted placenta during the second half of pregnancy, usually with severe hemorrhage?
- Placenta previa
- Ectopic pregnancy
- Incompetent cervix
- Abruptio placentae
7. Which of the following would the nurse assess in a client experiencing abruptio placenta?
- Bright red, painless vaginal bleeding
- Concealed or external dark red bleeding
- Palpable fetal outline
- Soft and nontender abdomen
8.Which of the following increases the risk of placental abruption?
- Age < 35 years
- Gestational diabetes
- Previous placental abruption
- Strenuous exercise
Answers & Rationale
- Answer: B. Abruptio placentae. The major maternal adverse reactions from cocaine use in pregnancy include spontaneous abortion first, not third, trimester abortion and abruptio placentae.
- Answer: C. Disseminated intravascular coagulation (DIC). Abruptio placentae is a cause of DIC because it activates the clotting cascade after hemorrhage.
- Option A: Thrombocytopenia results from decreased production of platelets.
- Option B: ITP doesn’t have a definitive cause.
- Option D: A patient with abruptio placentae wouldn’t get heparin and, as a result, wouldn’t be at risk for HATT.
- Answer: A. Swelling of the calf in one leg. DIC is a state of diffuse clotting in which clotting factors are consumed, leading to widespread bleeding. Platelets are decreased because they are consumed by the process; coagulation studies show no clot formation (and are thus normal to prolonged); and fibrin plugs may clog the microvasculature diffusely, rather than in an isolated area. The presence of petechiae, oozing from injection sites, and hematuria are signs associated with DIC. Swelling and pain in the calf of one leg are more likely to be associated with thrombophlebitis.
- Answer: C. Uterine tenderness/pain. In abruptio placentae, acute abdominal pain is present. Uterine tenderness and pain accompany placental abruption, especially with a central abruption and trapped blood behind the placenta. The abdomen will feel hard and board-like on palpation as the blood penetrates the myometrium and causes uterine irritability. Observation of the fetal monitoring often reveals increased uterine resting tone, caused by the failure of the uterus to relax in an attempt to constrict blood vessels and control bleeding.
- Answer: B. Delivery of the fetus.The goal of management in abruptio placentae is to control the hemorrhage and deliver the fetus as soon as possible. Delivery is the treatment of choice if the fetus is at term gestation or if the bleeding is moderate to severe and the mother or fetus is in jeopardy.
- Answer D. Abruptio placentae. Abruptio placentae is described as premature separation of a normally implanted placenta during the second half of pregnancy, usually with severe hemorrhage. Placenta previa refers to implantation of the placenta in the lower uterine segment, causing painless bleeding in the third trimester of pregnancy. Ectopic pregnancy refers to the implantation of the products of conception in a site other than the endometrium. Incompetent cervix is a conduction characterized by painful dilation of the cervical os without uterine contractions.
- Answer B. Concealed or external dark red bleeding. A client with abruptio placentae may exhibit concealed or dark red bleeding, possibly reporting sudden intense localized uterine pain. The uterus is typically firm to boardlike, and the fetal presenting part may be engaged. Bright red, painless vaginal bleeding, a palpable fetal outline and a soft nontender abdomen are manifestations of placenta previa.
- Answer C. Previous placental abruption. The risk of placental abruption is increased 15- to 20-fold if an earlier pregnancy had been complicated by placental abruption.6 Other risk factors include chronic hypertension, cocaine use, preeclampsia, age over 35 years, trauma, thrombophilia, cigarette smoking, preterm premature rupture of membranes, chorioamnionitis, and multiparity.