📚 Reading: Exam 3 — confirmed by the recording; week split inferred
Painless and bright = previa. Painful with a board-like uterus = abruption.
Never do a vaginal exam with suspected previa.
💡 The one idea
Bleeding in early pregnancy is sorted by where the pregnancy is and whether the cervix is
open. Those two facts separate almost all of them.
Condition
Signature
Priority
Ectopic
Unilateral stabbing pain, missed period, shoulder pain if ruptured
Surgical emergency — shock risk
Threatened miscarriage
Bleeding, cervix CLOSED
Rest, monitor — may continue
Inevitable
Bleeding, cervix OPEN
Will not continue
Hydatidiform mole
Very high hCG, uterus large for dates, grape-like vesicles, no fetal heart
Evacuate; hCG follow-up 1 year
🖼️ Ectopic and molar pregnancy.Swipe it sideways if it is cut off, or tap to open it full size.
🚨 Two details that decide questions
Shoulder pain in early pregnancy means a ruptured ectopic until proven otherwise —
blood in the abdomen irritates the diaphragm and refers to the shoulder.
After a molar pregnancy she must avoid pregnancy for a year, because a rising hCG is the marker for choriocarcinoma. A new pregnancy would hide it.
Placenta previa
Abruptio placentae
Bleeding
Bright red, PAINLESS
Dark red, PAINFUL (may be concealed)
Uterus
Soft, relaxed
Rigid, board-like, tender
Vaginal exam
ABSOLUTELY NOT
Not typically
Risk factors
Prior C-section, multiparity
Hypertension, trauma, cocaine, smoking
Never perform a vaginal exam with suspected placenta previa. It can tear the placenta and cause catastrophic hemorrhage.
Painless bright bleeding = previa. Painful board-like uterus = abruption. That pair
appears on nearly every maternity exam.
⭐ High-yield — what the exam actually asks
First-trimester vaginal bleeding with cramping is the priority finding — threatened miscarriage or ectopic → ultrasound and hCG. Morning nausea, urinary frequency and no fetal movement yet at 10 weeks are all expected.
Ectopic pregnancy: unilateral sharp stabbing lower abdominal pain, adnexal tenderness, spotting, positive pregnancy test, referred shoulder pain from peritoneal blood, sometimes Cullen sign.
Suspected UNRUPTURED ectopic in the ED: large-bore IV access, continuous vital signs, methotrexate as prescribed. Not Trendelenburg and not straight to laparoscopy.
Methotrexate discharge teaching: no folic acid supplements · return for serial hCG until undetectable · reliable contraception for at least 3 months · no intercourse until the ectopic has fully resolved.
Placenta previa is PAINLESS bright red bleeding with a soft uterus — no vaginal exams.Abruption is dark red bleeding with a rigid, painful, board-like uterus.
RhoGAM at 28 weeks and again within 72 hours of birth if the newborn is Rh-positive.
📕 From your ATI review book
Covered by ch. 7 · ch. 2 (ectopic recurrence).
Show 5 moreHide these 5
Type an early loss by cervix and tissue: threatened = cervix closed, no tissue · inevitable = dilated, no tissue passed · incomplete = dilated with tissue in the canal, heavy bleeding · complete = tissue passed, cervix closed · missed = closed cervix, no bleeding, retained tissue.
For any early bleed: avoid vaginal exams, count or weigh pads, save all passed tissue. Retained products can trigger DIC. Use the word "miscarriage" with her.
Referred shoulder pain after ectopic rupture is blood irritating the diaphragm. Transvaginal ultrasound shows an empty uterus.
Methotrexate: no folic-acid-containing vitamins (they blunt the drug), avoid sun, avoid pregnancy at least 3 months.
Molar pregnancy: uterus larger than dates, hCG persistently high past 10–12 weeks, hyperemesis, dark brown "prune juice" bleeding with vesicles, and preeclampsia features BEFORE 24 weeks — that early timing is the giveaway.
Show 5 moreHide these 5
Complete mole = all paternal DNA, no fetus, ~20% progress to choriocarcinoma. Partial mole has fetal parts, under 5%.
After mole evacuation: serial hCG weekly ×3, then monthly for 6–12 months, with reliable contraception the entire time so a new pregnancy cannot mask a rising hCG.
Abruption is the most common obstetric cause of DIC, and immediate birth is the treatment. Leading risks: hypertension, blunt trauma, cocaine.
In previa, decreasing urine output may reveal blood loss before the vital signs do.
Give Rho(D) after any loss, ectopic, or molar evacuation in an Rh-negative client.
📚 From your Maternal & Child textbook
Pillitteri, Maternal and Child Health Nursing — ch. 21 (sudden pregnancy complications).
Any vaginal bleeding in pregnancy is serious until proven otherwise, and the visible amount can badly understate the real loss because bleeding may be concealed internally.
Miscarriage is loss before 20 weeks, most often from a chromosomal abnormality — worth saying to a parent who assumes she caused it.
Ectopic caught before rupture can be treated with methotrexate rather than surgery.
Premature cervical dilatation is painless dilation before viability, treated with a cervical cerclage.
Preterm labor is after 20 weeks and before the end of week 37. Corticosteroids are given because they accelerate fetal lung surfactant formation.
⚠️ Exam traps
Previa is painless; abruption is painful and rigid. That one word decides the question.
Folic acid rescues the cells methotrexate is trying to kill — that is why it is withheld here, even though you push it everywhere else in this course.
🧠 Mind maps 2
One per disorder, built from the structure of your ATI chapter.
Fertility
🧪 What confirms it
Pelvic exam checks for uterine or vaginal structural anomalies.
Hormone panel: prolactin, FSH, LH, estradiol, progesterone, and thyroid levels assess the hypothalamic-pituitary-ovarian axis.
Postcoital test evaluates coital technique and how sperm interact with cervical mucus.
Ultrasound (transvaginal or abdominal) visualizes the reproductive organs.
🩺 What you do
Recognize infertility as a major life stressor; encourage clients to voice their feelings.
Explain the roles of the genetic counselor, reproductive specialist, geneticist, and pharmacist.
Monitor for adverse effects of fertility medications.
Warn that ART significantly raises the odds of a high-risk multiple gestation pregnancy.
⚠️ What goes wrong
Ectopic pregnancy: ovum implants outside the uterus, often from endometrial tissue or adhesions in the tube.
As an ectopic pregnancy grows, tube rupture can cause severe bleeding requiring surgical removal.
Unruptured ectopic pregnancy is treated with surgical removal or methotrexate to dissolve it.
Losing the tube from ectopic pregnancy raises risk of recurrence and future infertility.
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
Bleeding During Pregnancy
🎯 Who gets it
Chromosomal abnormalities are a leading cause of spontaneous abortion
Advanced maternal age raises the risk of miscarriage
Antiphospholipid syndrome is linked to recurrent pregnancy loss
Substance use during pregnancy raises spontaneous abortion risk
👀 What you see
Spontaneous abortion: vaginal bleeding, cramping, dilating cervix, possible fever or hemorrhage signs
Ectopic pregnancy: sudden unilateral stabbing lower-quadrant pain, usually first trimester
Ectopic pregnancy: scant dark spotting; bright red bleeding and shoulder pain if the tube ruptures
GTD: hyperemesis from very high hCG; uterus grows faster than expected for dates
🧪 What confirms it
Hgb and Hct can drop with significant blood loss from miscarriage, previa, or abruption
Clotting factors are checked because retained tissue or abruption can trigger DIC
Serum hCG confirms pregnancy or flags a value abnormal for gestational age
WBC is drawn if infection is suspected with pregnancy loss
🩺 What you do
Avoid vaginal exams with suspected previa or a miscarriage in progress—can worsen bleeding
Save any passed tissue or clots for pathology exam
Use the term "miscarriage" instead of "abortion" when talking with clients
Count or weigh pads to track color and amount of bleeding
💊 Drugs
NSAIDs or opioids may be given for pain after miscarriage
ATI Active Learning Template — System DisorderFertility
Filled from ATI chapter 2, row by row from that chapter’s own sections — 12 of 12 rows have content.
7 rows came from outside your ATI chapter — 5 cite a source, 2 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Covers infertility evaluation and care for people unable to conceive after 6 to 12 months, including causes, diagnostic workup, assisted reproductive technologies, genetic counseling, and psychosocial support for fertility-related grief and treatment decisions.
Health Promotion & Disease Prevention
Not in your ATI chapter — filled from NICHD.
Losing just 5% of body weight can meaningfully raise the odds of ovulation in women who have PCOS.
Avoiding tobacco, heavy alcohol use, and illegal drugs protects fertility in both female and male partners.
Limiting exposure to known reproductive toxins, such as certain pesticides and industrial chemicals, is advised to protect fertility.
Eunice Kennedy Shriver National Institute of Child Health and Human Development · What lifestyle and environmental factors may be involved with infertility in females and males? · open the source →
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Not in your ATI chapter — filled from NICHD.
Both obesity and being underweight impair ovulation and reduce the chance of conception in women.
In men, obesity is linked to lower sperm count, and high blood pressure can alter sperm shape.
Radiation therapy and chemotherapy can cause infertility in either partner, depending on dose and treatment site.
NICHD · What lifestyle and environmental factors may be involved with infertility in females and males? · open the source →
Assessment — Expected Findings
From this module — built from the notes above on this page, not a section of the ATI chapter.
Infertility is a diagnosis of time: no conception after 12 months of unprotected sex, or 6 months if she is over 35.
Expected on examination: often entirely normal findings in both partners — which is itself distressing and needs naming.
Irregular or absent periods point toward an ovulation problem; PCOS commonly adds acne, hirsutism and weight gain.
Painful periods and pain with intercourse suggest endometriosis.
Expect grief, guilt, and strain on the relationship. Ask about mood at every visit — it is part of the assessment, not an aside.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Not in your ATI chapter — filled from NICHD.
A progesterone blood level drawn around day 23 of the cycle helps confirm that ovulation occurred.
FSH and AMH blood tests estimate how many eggs remain in a woman's ovarian reserve.
Semen analysis requires the male partner to avoid ejaculation for about 48 hours before the sample.
ATI Active Learning Template — System DisorderBleeding During Pregnancy
Filled from ATI chapter 7, row by row from that chapter’s own sections — 12 of 12 rows have content.
3 rows came from outside your ATI chapter — 3 cite a source, 0 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
This chapter explains why any vaginal bleeding in pregnancy needs urgent evaluation. It covers early causes—miscarriage, ectopic pregnancy, and molar pregnancy—and later causes—placenta previa, abruption, and vasa previa—along with their distinguishing signs, testing, and nursing priorities.
Health Promotion & Disease Prevention
Not in your ATI chapter — filled from StatPearls, 2024.
Encouraging smoking cessation and cocaine avoidance is advised because both are modifiable risk factors for placental abruption.
Getting a pregnant patient's blood pressure under control is linked to fewer cases of abruption overall.
StatPearls (NCBI Bookshelf) · Placental Abruption · open the source →
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Chromosomal abnormalities are a leading cause of spontaneous abortion
Advanced maternal age raises the risk of miscarriage
Antiphospholipid syndrome is linked to recurrent pregnancy loss
Substance use during pregnancy raises spontaneous abortion risk
Tubal damage from STIs, prior tubal surgery, an IUD, or ART raises ectopic pregnancy risk
A prior molar pregnancy raises the risk of another one
Age under 15 or over 35 raises gestational trophoblastic disease risk
Oxytocin augments contractions to expel products of conception
Broad-spectrum antibiotics are given for septic abortion
Rho(D) immune globulin is given to Rh-negative clients
Betamethasone matures fetal lungs if early birth is expected with previa
Therapeutic Procedures
D&C dilates the cervix and scrapes the uterus to remove retained tissue
D&E dilates and evacuates uterine contents for inevitable or incomplete abortion
Suction curettage removes a molar pregnancy
Hysterectomy may be considered if fertility isn't desired or GTN risk is high
Salpingostomy tries to save the fallopian tube if it hasn't ruptured
Laparoscopic salpingectomy removes the tube after rupture
💬 Around the patientClient Education · Interprofessional Care
Client Education
Report heavy bright red bleeding, fever, or foul-smelling discharge to the provider
A small amount of discharge is expected for 1 to 2 weeks after miscarriage
Finish the entire course of prescribed antibiotics
Avoid tub baths, sex, or vaginal insertion for 2 weeks after miscarriage
Talk through feelings of grief with the provider before conceiving again
Avoid folic-acid vitamins while on methotrexate to prevent toxicity
Avoid pregnancy for at least 3 months after methotrexate treatment
Interprofessional Care
Not in your ATI chapter — filled from StatPearls, 2024.
Managing significant antepartum hemorrhage calls for an interprofessional team including obstetrics, maternal-fetal medicine, anesthesiology, and hematology.
Laboratory and blood bank personnel are essential team members for rapid type-and-cross and transfusion support during hemorrhage.
Resuscitation for severe hemorrhage ideally occurs in a setting with anesthesia support available for complex interventions.
StatPearls (NCBI Bookshelf) · Postpartum Hemorrhage · open the source →
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from StatPearls, 2024.
Placental abruption accounts for an estimated 10% to 20% of maternal deaths, with fetal mortality ranging from 1% to 40%.
Severe placental abruption can trigger disseminated intravascular coagulation, a life-threatening bleeding disorder.
Cesarean hysterectomy is required in about 0.2% of placenta previa cases when hemorrhage cannot be controlled conservatively.
Placenta accreta spectrum risk climbs sharply with prior cesareans, from about 3% after one to roughly 67% after five or more.
StatPearls (NCBI Bookshelf) · Placental Abruption; Placenta Previa · open the source →
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
First-trimester vaginal bleeding with cramping is the priority finding — threatened miscarriage or ectopic → ultrasound and hCG. Morning nausea, urinary frequency and no fetal movement yet at 10 weeks are all expected.
Methotrexate discharge teaching: no folic acid supplements · return for serial hCG until undetectable · reliable contraception for at least 3 months · no intercourse until the ectopic has fully resolved.
RhoGAM at 28 weeks and again within 72 hours of birth if the newborn is Rh-positive.
Methotrexate: no folic-acid-containing vitamins (they blunt the drug), avoid sun, avoid pregnancy at least 3 months.
Molar pregnancy: uterus larger than dates, hCG persistently high past 10–12 weeks, hyperemesis, dark brown "prune juice" bleeding with vesicles, and preeclampsia features BEFORE 24 weeks — that early timing is the giveaway.
Complete mole = all paternal DNA, no fetus, ~20% progress to choriocarcinoma. Partial mole has fetal parts, under 5%.
After mole evacuation: serial hCG weekly ×3, then monthly for 6–12 months, with reliable contraception the entire time so a new pregnancy cannot mask a rising hCG.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
