Maternity Nursing: Intrapartum Q 15
A maternity nurse is preparing for the admission of a client in the 3rd trimester of pregnancy that is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the physician’s orders and would question which order?
A. Prepare the client for an ultrasound.
B. Obtain equipment for external electronic fetal heart monitoring.
C. Obtain equipment for a manual pelvic examination.
D. Prepare to draw a Hgb and Hct blood sample.
Correct Answer: C. Obtain equipment for a manual pelvic examination.
Manual pelvic examinations are contraindicated when vaginal bleeding is apparent in the 3rd trimester until a diagnosis is made and placenta previa is ruled out. Digital examination of the cervix can lead to maternal and fetal hemorrhage.
Option A: A diagnosis of placenta previa is made by ultrasound. A patient presenting with vaginal bleeding in the second or third trimester should receive a transabdominal sonogram before a digital examination. If there is a concern for placenta previa, then a transvaginal sonogram should be performed to confirm the location of the placenta. Transvaginal sonogram has been shown to be superior to a transabdominal sonogram and is safe.
Option B: External fetal monitoring is crucial in evaluating the fetus that is at risk for severe hypoxia. Placental abruption presents with severe abdominal pain, vaginal bleeding, and electronic fetal monitoring may show tachysystole and a nonreassuring fetal heart tracing; this too can lead to high morbidity in mortality to the fetus and mother secondary to hemorrhage.
Option D: The H/H levels are monitored, and external electronic fetal heart rate monitoring is initiated. A leading cause of third-trimester hemorrhage, placenta previa presents classically as painless bleeding. Bleeding is thought to occur in association with the development of the lower uterine segment in the third trimester. Placental attachment is disrupted as this area gradually thins in preparation for the onset of labor; this leads to bleeding at the implantation site, because the uterus is unable to contract adequately and stop the flow of blood from the open vessels.