Midwife Licensure Exam High-Risk Pregnancy & Complications (Recognize & Refer) — High-Risk Pregnancy & Bleeding DisordersConcept Map

Concept

First-Trimester Bleeding (Weeks 0–20)

Sub Concepts

• Abortion (Miscarriage)
• Ectopic Pregnancy
• Gestational Trophoblastic Disease (Hydatidiform Mole)

Relationship To Central

Comprises spontaneous abortion and ectopic pregnancy; requires rapid differentiation of viability

Concept

Third-Trimester Bleeding (Weeks 20+)

Sub Concepts

• Placenta Previa
• Abruptio Placentae
• Complications: Hypovolemic Shock and DIC

Relationship To Central

Life-threatening bleeding patterns requiring emergency assessment and immediate intervention

Concept

Diagnostic and Imaging Modalities

Sub Concepts

• Transvaginal Ultrasound
• Serial Beta-hCG Monitoring
• Transabdominal Ultrasound
• Coagulation Studies (PT, aPTT, D-dimer, Fibrinogen, Platelets)

Relationship To Central

Confirm diagnosis and guide management decisions

Concept

Pharmacological Interventions

Sub Concepts

• Methotrexate (Ectopic/Molar Malignancy)
• Rho(D) Immune Globulin (Isoimmunization Prevention)
• Betamethasone (Fetal Lung Maturity)
• Oxytocin/Methylergonovine (Hemorrhage Control)

Relationship To Central

Direct treatment of specific bleeding disorders and prevention of complications

Concept

Nursing Process Application

Sub Concepts

• NANDA-I Nursing Diagnoses
• Priority Nursing Interventions
• Patient and Family Teaching
• Emotional Support and Grief Care

Relationship To Central

Systematic assessment, diagnosis, planning, intervention, and evaluation across all bleeding disorders

Concept

Legal and Professional Framework

Sub Concepts

• RA 9173: Philippine Nursing Act
• Scope of Practice and Accountability
• Informed Consent and Patient Autonomy
• Reporting and Documentation Requirements

Relationship To Central

Standards guiding safe, ethical nursing practice in Philippine healthcare settings

To

Rho(D) Immune Globulin

From

Abortion (Miscarriage)

Strength

strong

Relationship

Rh-negative, unsensitized mothers require RhoGAM within 72 hours to prevent isoimmunization from fetal-maternal hemorrhage during abortion

To

Methotrexate

From

Ectopic Pregnancy

Strength

strong

Relationship

Unruptured ectopic pregnancies can be managed medically with methotrexate IM to dissolve trophoblastic tissue and preserve fallopian tube

To

Hypovolemic Shock

From

Ectopic Pregnancy

Strength

strong

Relationship

Rupture of ectopic pregnancy is a surgical emergency causing rapid hemorrhage and profound shock with Kehr sign (referred shoulder pain)

To

Preeclampsia

From

Gestational Trophoblastic Disease

Strength

strong

Relationship

Molar pregnancy characteristically triggers preeclampsia before 20 weeks gestation, a red flag that normally appears only after 20 weeks

To

Serial Beta-hCG Monitoring

From

Gestational Trophoblastic Disease

Strength

strong

Relationship

Critical follow-up for 6-12 months post-evacuation to detect rising hCG indicating malignant transformation to choriocarcinoma

To

Cesarean Delivery

From

Placenta Previa

Strength

strong

Relationship

Total placenta previa requires elective cesarean section because vaginal delivery is impossible when placenta covers the cervical opening

To

Disseminated Intravascular Coagulation

From

Abruptio Placentae

Strength

strong

Relationship

Placental abruption releases thromboplastin into maternal circulation, triggering DIC with consumptive coagulopathy and bleeding from multiple sites

To

Maternal Hypertension

From

Abruptio Placentae

Strength

strong

Relationship

Chronic hypertension is the strongest known risk factor for abruptio placentae due to placental vascular changes and abruption

To

Compensated Shock Stage

From

Hypovolemic Shock

Strength

strong

Relationship

Early recognition of compensatory mechanisms (tachycardia, cool skin, restlessness) allows nursing intervention before progression to decompensation

To

Aggressive IV Resuscitation

From

Hypovolemic Shock

Strength

strong

Relationship

Large-bore IV access and rapid fluid/blood product replacement are life-saving interventions to restore perfusion and prevent multi-organ failure

To

Fetal Lung Maturity

From

Betamethasone

Strength

strong

Relationship

Glucocorticoid given IM every 24 hours for 2 doses accelerates fetal lung development, reducing respiratory distress when preterm delivery is anticipated

To

Betamethasone

From

Placenta Previa

Strength

moderate

Relationship

In hemodynamically stable previa patients with preterm bleeding, betamethasone allows fetal maturation while expectant management is pursued

To

Pad Counting and Weighing

From

Bleeding Assessment

Strength

strong

Relationship

Quantifying blood loss (1 g = 1 mL) provides objective baseline to track ongoing bleeding and guide transfusion decisions

To

Transvaginal Ultrasound

From

First-Trimester Bleeding

Strength

strong

Relationship

Transvaginal imaging provides superior resolution to confirm intrauterine pregnancy location, fetal heart tones, and differentiate abortion from ectopic

To

Serial Beta-hCG

From

Ectopic Pregnancy

Strength

strong

Relationship

Abnormally slow rise in hCG that fails to double every 48-72 hours is diagnostic indicator of ectopic pregnancy

To

Concealed Bleeding

From

Abruptio Placentae

Strength

strong

Relationship

Hidden bleeding behind the placenta means visible blood loss can significantly underestimate true intravascular volume loss and shock severity

To

No Vaginal Examination

From

Placenta Previa

Strength

strong

Relationship

Vaginal or rectal exam can perforate a low-lying placenta and cause catastrophic hemorrhage, a critical safety rule

To

Fibrinogen Monitoring

From

Disseminated Intravascular Coagulation

Strength

strong

Relationship

Progressive consumption of fibrinogen in DIC results in hypofibrinogenemia; levels below 100 mg/dL signal severe coagulopathy requiring cryoprecipitate

To

Warning Signs Recognition

From

Patient Teaching

Strength

moderate

Relationship

Educating pregnant women to immediately report vaginal bleeding, severe abdominal pain, shoulder-tip pain, and dizziness enables early diagnosis and treatment

To

Emotional Support After Loss

From

Grief Care

Strength

moderate

Relationship

Acknowledging the loss, allowing parents to see/hold the fetus, and referring to support services are essential nursing interventions for healing

To

Folic Acid Antagonism

From

Methotrexate

Strength

strong

Relationship

Methotrexate blocks dihydrofolate reductase; patients must avoid folic acid supplements and alcohol, and monitor beta-hCG for tissue dissolution

To

Indirect Coombs Test

From

Rho(D) Immune Globulin

Strength

strong

Relationship

RhoGAM is only effective if mother is Rh-negative and indirect Coombs is negative (not already sensitized); positive Coombs means mother already has anti-D antibodies

To

Uterine Tone Assessment

From

Third-Trimester Bleeding Discrimination

Strength

strong

Relationship

Uterine tone is the bedside discriminator: soft non-tender uterus suggests previa; rigid board-like tender uterus suggests abruption

To

Avoid Pregnancy One Year

From

Hydatidiform Mole

Strength

strong

Relationship

Conception during follow-up after molar evacuation would cause rising hCG from the new pregnancy, masking malignant transformation signal

To

Maslow Hierarchy Priority

From

Nursing Process

Strength

strong

Relationship

Physiological needs (breathing, circulation, shock prevention) and safety (fetal monitoring, preventing hemorrhage) are prioritized before psychosocial needs

To

Scope of Nursing Practice

From

RA 9173 Philippine Nursing Act

Strength

moderate

Relationship

Under RA 9173, Filipino nurses are accountable for assessment, independent nursing diagnoses, and safe delegation of care in high-risk obstetrics

To

DIC Monitoring

From

Coagulation Studies

Strength

strong

Relationship

PT, aPTT, platelets, fibrinogen, and D-dimer together assess the degree of DIC; serial testing tracks progression and treatment response

To

Fetal Distress Recognition

From

Continuous Fetal Monitoring

Strength

strong

Relationship

Heart rate patterns (late decelerations, bradycardia) and decreased variability signal fetal hypoxia from blood loss or placental insufficiency