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Bleeding During Pregnancy

Course #93253 - $60 -

Participation Instructions
- Review the course material online or in print.
- Complete the course evaluation.
- Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.

Overview

Identifying the potential causes, as well as the appropriate assessments and any treatment required, is critical to intervening or consulting in a timely and meaningful way. This course provides a discussion of the differential diagnosis of a few of the many hemorrhagic conditions that may present during pregnancy, including the incidence and potential causes of early pregnancy loss and second and third trimester bleeding. Furthermore, nonobstetric causes of genital bleeding in pregnancy should be part of any differential diagnosis. Knowledge of appropriate history, physical, laboratory, and diagnostic data required to reach an accurate diagnosis and management plan is vital in providing optimal care to obstetric patients. The patient and her family's needs for education and support should also be addressed.

Education Category: Women's Health - Maternal / Child

Release Date: 04/01/2022

Expiration Date: 03/31/2025

Audience

This course is designed for all nurses, physicians, and physician assistants, especially those working in clinics, private practice, obstetric/gynecologic practice, or emergency room settings.

Accreditations & Approvals

In support of improving patient care, TRC Healthcare/NetCE is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. NetCE is accredited by the International Accreditors for Continuing Education and Training (IACET). NetCE complies with the ANSI/IACET Standard, which is recognized internationally as a standard of excellence in instructional practices. As a result of this accreditation, NetCE is authorized to issue the IACET CEU.

Designations of Credit

This activity was planned by and for the healthcare team, and learners will receive 10 Interprofessional Continuing Education (IPCE) credit(s) for learning and change. NetCE designates this enduring material for a maximum of 10 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. NetCE designates this continuing education activity for 10 ANCC contact hour(s). NetCE designates this continuing education activity for 1 pharmacotherapeutic/pharmacology contact hour(s). NetCE designates this continuing education activity for 12 hours for Alabama nurses. Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 10 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. Completion of this course constitutes permission to share the completion data with ACCME. Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn credit toward the CME and/or Self-Assessment requirements of the American Board of Surgery's Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit. Through an agreement between the Accreditation Council for Continuing Medical Education and the Royal College of Physicians and Surgeons of Canada, medical practitioners participating in the Royal College MOC Program may record completion of accredited activities registered under the ACCME's "CME in Support of MOC" program in Section 3 of the Royal College's MOC Program. AACN Synergy CERP Category A. NetCE is authorized by IACET to offer 1 CEU(s) for this program.

Individual State Nursing Approvals

In addition to states that accept ANCC, NetCE is approved as a provider of continuing education in nursing by: Alabama, Provider #ABNP0353, (valid through July 29, 2025); Arkansas, Provider #50-2405; California, BRN Provider #CEP9784; California, LVN Provider #V10662; California, PT Provider #V10842; District of Columbia, Provider #50-2405; Florida, Provider #50-2405; Georgia, Provider #50-2405; Kentucky, Provider #7-0054 through 12/31/2025; South Carolina, Provider #50-2405; West Virginia RN and APRN, Provider #50-2405.

Special Approvals

This activity is designed to comply with the requirements of California Assembly Bill 1195, Cultural and Linguistic Competency.

Course Objective

Bleeding during pregnancy is a frightening and potentially life-threatening event occurring in one out of every five pregnancies. The purpose of this course is to assist nurses, nurse practitioners, physicians, and physician assistants working in a variety of settings to understand, triage, and manage bleeding in pregnancy in order to facilitate more efficient diagnoses and treatment, resulting in better patient outcomes.

Learning Objectives

Upon completion of this course, you should be able to:

Discuss the epidemiology of hemorrhagic conditions in pregnancy.
Identify potential causes of bleeding in pregnancy and pregnancy loss.
Compare the presentation and management of the different types of spontaneous abortion, including patient education and support needs.
Describe the risk factors and signs and symptoms associated with ectopic pregnancy.
Discuss the management and treatment of ectopic pregnancy, including the role of ultrasound.
Describe gestational trophoblastic disease (GTD) and hydatidiform molar pregnancy.
Review the differential diagnosis of and complications correlated with complete, partial, and marginal placenta previa.
Define abruptio placenta and identify the associated risk factors.
Review the appropriate management of abruptio placenta.
Describe the evaluation of additional causes of bleeding in pregnancy.
Outline the importance of an interpreter in caring for non-English-proficient patients.

Faculty

Denise Wheeler, MS, ARNP, is a certified nurse-midwife in Des Moines, Iowa. She earned an Associate degree in Nursing in 1975, a Bachelor’s degree in Nursing from St. Louis University in 1982 and a Master’s degree in Nursing Sciences from the University of Illinois at Chicago in 1983. She has worked in a variety of settings, from out-of-hospital birth centers to tertiary care centers, and has gained significant experience in caring for women experiencing bleeding in pregnancy. She has authored papers and book chapters for publication and has been a guest lecturer at conferences for undergraduate and graduate nursing education programs.

Faculty Disclosure

Contributing faculty, Denise Wheeler, MS, ARNP, has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.

Division Planners

John V. Jurica, MD, MPH

Jane C. Norman, RN, MSN, CNE, PhD

Division Planners Disclosure

The division planners have disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.

Director of Development and Academic Affairs

Sarah Campbell

Director Disclosure Statement

The Director of Development and Academic Affairs has disclosed no relevant financial relationship with any product manufacturer or service provider mentioned.

About the Sponsor

The purpose of NetCE is to provide challenging curricula to assist healthcare professionals to raise their levels of expertise while fulfilling their continuing education requirements, thereby improving the quality of healthcare.

Our contributing faculty members have taken care to ensure that the information and recommendations are accurate and compatible with the standards generally accepted at the time of publication. The publisher disclaims any liability, loss or damage incurred as a consequence, directly or indirectly, of the use and application of any of the contents. Participants are cautioned about the potential risk of using limited knowledge when integrating new techniques into practice.

Disclosure Statement

It is the policy of NetCE not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners.

Technical Requirements

Supported browsers for Windows include Microsoft Internet Explorer 9.0 and up, Mozilla Firefox 3.0 and up, Opera 9.0 and up, and Google Chrome. Supported browsers for Macintosh include Safari, Mozilla Firefox 3.0 and up, Opera 9.0 and up, and Google Chrome. Other operating systems and browsers that include complete implementations of ECMAScript edition 3 and CSS 2.0 may work, but are not supported. Supported browsers must utilize the TLS encryption protocol v1.1 or v1.2 in order to connect to pages that require a secured HTTPS connection. TLS v1.0 is not supported.

Implicit Bias in Health Care

The role of implicit biases on healthcare outcomes has become a concern, as there is some evidence that implicit biases contribute to health disparities, professionals' attitudes toward and interactions with patients, quality of care, diagnoses, and treatment decisions. This may produce differences in help-seeking, diagnoses, and ultimately treatments and interventions. Implicit biases may also unwittingly produce professional behaviors, attitudes, and interactions that reduce patients' trust and comfort with their provider, leading to earlier termination of visits and/or reduced adherence and follow-up. Disadvantaged groups are marginalized in the healthcare system and vulnerable on multiple levels; health professionals' implicit biases can further exacerbate these existing disadvantages.

Interventions or strategies designed to reduce implicit bias may be categorized as change-based or control-based. Change-based interventions focus on reducing or changing cognitive associations underlying implicit biases. These interventions might include challenging stereotypes. Conversely, control-based interventions involve reducing the effects of the implicit bias on the individual's behaviors. These strategies include increasing awareness of biased thoughts and responses. The two types of interventions are not mutually exclusive and may be used synergistically.