Vaginal bleeding during pregnancy has many causes Some are serious and others are not Bleeding can occur early or later in pregnancy Bleeding in early pregnancy is common In many cases it does not signal a major problem Bleeding later in pregnancy can be more serious ID: 1042634
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1. Bleeding During Pregnancy
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4. Vaginal bleeding during pregnancy has many causes. Some are serious and others are not. Bleeding can occur early or later in pregnancy. Bleeding in early pregnancy is common. In many cases, it does not signal a major problem. Bleeding later in pregnancy can be more serious
5. A ) Some causes of bleeding in the first part of pregnancy are:Implantation bleeding: This is when the fertilized egg implants in the wall of your uterus and cause s light bleeding. It’s considered a normal part of early pregnancy.Molar pregnancy: A rare condition when a fertilized egg implants in your uterus, but a tumor forms instead of a fetus.Ectopic pregnancy: When a pregnancy forms outside of your uterus (like in your fallopian tubes). It can be life-threatening.Subchorionic hematoma: Bleeding from one of the membranes that surround the embryo inside your uterus. Subchorionic hematomas usually resolve on their own.Cervical polyps: A noncancerous growth on your cervix that bleeds in pregnancy due to increased estrogen levels.aMiscarriage: The loss of the pregnancy before 20 weeks. It usually starts as light bleeding and gets heavier. It can be accompanied by severe cramping.
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7. the most common causes of bleeding in the second or third trimesterBleeding in the second half of pregnancy is often associated with more serious conditions, so contact your healthcare provider immediately so they're aware of your symptoms.Some conditions that can cause bleeding in the second and third trimesters are:Placenta previa: When the placenta covers all or part of your cervix. It’s rare after 20 weeks of pregnancy.Placental abruption: A rare condition where the placenta detaches from the wall of your uterus. This can be dangerous for both you and your fetus.
8. Etiologies of maternal bleeding:Etiologies are broadly divided in to three:A) Bleeding in early pregnancy (conception up to gestational age of less than 20wks) 1) Ectopic pregnancy: - is one in which implantation occurs outside the uterinecavity. The most common site is fallopian tube (in greater than 90% of cases) 2) Abortion: - It is a uterine bleeding before fetal viability, i.e., before 28 weeksof pregnancy. 3) Molar Pregnancy is characterized by abnormal proliferations of chorionic villi, and vaginal bleeding with expulsion of conceptus tissue that have grape-like appearance.
9. What are 2 signs of a hydatidiform mole pregnancy?Symptoms of a molar pregnancy may include:Abnormal growth of the uterus, either bigger or smaller than usual.Severe nausea and vomiting.Vaginal bleeding during the first 3 months of pregnancy.
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11. Types of Abortion1. Inevitable: - abortion with cervical dilatation but with out expulsion of products ofconception (including amniotic fluid)2. Incomplete: - Abortion with partial expulsion of conceptus materials.3. Complete: - Abortion with complete expulsion of conceptus materials4. Threatened: - Abortion with out cervical dilatation.5. Missed: - when a dead fetus retained in the uterus at least for another one month.6. Habitual (recurrent): is diagnosed if there is three or more consecutive spontaneousexpulsion of conceptus.
12. Incidence of common causes of maternal bleeding♦ Ectopic pregnancy:- one in 50 to 200 pregnancies.♦ Spontaneous abortion:- 10-20% of all pregnancies.♦ Molar pregnancy:- Varies and overall ranges between 1 in 1000 to 1 in 5000pregnancies.♦ Ante partum hemorrhage (APH): 2-4% of all pregnancies♦ Postpartum hemorrhage (PPH): - 3.9% of vaginal deliveries. - 6.49% of C/S deliveries
13. B) Bleeding in late pregnancy and labour 1-Heavy show: - is Blood-stained mucus that herald onset of labor. 2-Antepartum Hemorrhage (APH):- is bleeding from the genital tract of pregnant motherafter the fetus reached the age of viability, i.e, 28 completed weeks and before deliveryIncidence: 2 –4% all pregnancies
14. Etiologies of Antepartum hemorrhage1. Placental 1- Abruption placenta 2- Placenta preavia , , 2. Non placental 1- Local causes: Cervicitis , Cervical polyp , eversion , varices , infection , trauma , malignancies 2-Heavy show 3-Ruptured uterus 4-. Unknown Causes:- In many of cases no causes is found clinically or by investigation
15. Clinical FeatureClinical manifestation of maternal bleeding depends on: 1- the etiologies: 2- Amount of blood loss (volume) 3- Rate of blood Loss 4- Intervention done
16. Clinical features of some commo causes of maternal bleedinga. Clinical features of APHPlacenta praevia: is due to abnormally lower uterine segment placenta attachment.Bleeding after 28 weeks of gestation that may be precipitated by intercourse, relaxed uterus,lower uterine pole feel empty, bleeding May be light or heavy but painless, shock, fetalcondition depends on the severity of maternal bleeding. n
17. Placenta abruption: is due to premature separation of normally implanted placenta.Bleeding occur after 28 weeks, and it is usually dark oozing vaginally or may be retained inthe uterus, Intermittent or constant abdominal pain, tense /tender uterus, fetal movementdecreased or absent, fetal distress or absent fetal heart sound.
18. Complications of maternal bleeding a) ImmediateI) Related to Bleeding - Hemorrhagic shock /sever anemia/ - Acute renal failure (ARF) - Adult respiratory distress syndrome (ARDS) - Infection - Intra –abdominal organ Injury - DeathII) Related to resuscitation & blood Transfusion• Infection (HBV, HIV)• Hemolytic anemia• Fluid over load - pulmonary edema• Acute lung Injuryb) Late: - Infertility secondary to amenorrhea (sheen syndrome)
19. Abortion: Definition: The death or expulsion of fetus before 20th weeks of gestation (Before it is viable or less than 500 gm wt)Causes: i. Chromosomal abnormalitiesii. Uterine - Cervical incompetence - Congenital abnormality - Fibroids:iii. Maternal - Febrile illness - Syphilis - Hypertension - Diabetes
20. Classifications of Abortion1. Spontaneous -Threatened ↓ - Missed abortion - Inevitable abortion (may be either complete or incomplete) - Recurrent /habitual abortion 2. Induced - Therapeutic - Non- therapeutic (safe/ usually unsafe, leading to septic abortion
21. Spontaneous abortionIs an abortion which has not been interfered /happens spontaneously. Many pregnanciesend in the 1st trimester because of spontaneous abortion.Causes:♦ About 50 % of early spontaneous abortions are related to chromosomal abnormalities.♦ Teratogenic drugs♦ Faulty implantation due to abnormalities of the female reproductive tract,♦ Weakened cervix, or placental abnormalities,♦ Chronic maternal diseases, endocrine imbalances and maternal infections from theTORCH group (Toxoplasmosis, rubella, cytomegally virus and herpes virus)
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23. Threatened abortionThreatened abortion is defined as bleeding of intrauterine origin occurring before 20 weeks ofgestation, with or without uterine contractions, without dilatation of the cervix, and with outexpulsion of the products of conception. threatened abortion include: - Slight vaginal bleeding -Slight backache - Cervix closed.
24. - Nursing Management of threatened abortion includes:• Provide quiet atmosphere.• Encourage rest.• Observation• Discharge her after 48 hrs if bleeding stopped and condition of mother and fetus isstable.• No sexual intercourse for 2-3 weeks.Despite the above management if bleeding persists it suggests inevitable abortion.Inevitable abortion is when it is impossible to continue pregnancy.S/S of inevitable abortion - Severe backache and bleeding - Cervix dilated. (Marker of inevitable abortion) - Membranes ruptured. ⇒ Outcome: either complete or incomplete abortion
25. Emergency Nursing Management inevitable abortion at H/C: Secure IV drip Monitor V/S Ergometrine 0.5 Mg. IM to control bleeding Digital evacuation if the tissue if noted at the cervix . Prepare oxytocin infusion Lie the patient flat Monitor V/S Provide psychological support Prepare the patient for curetag support pation (both physically and psychologically)
26. Missed When fetus is dead and retained in the uterus for about eight weeks.S/S - brownish vaginal discharge -Pregnancy test is decres - Uterus fails to enlarge. - Other S/S of pregnancy will be reduced or vanished Obstetric Management - oxytocin infusion - D & C .Complication - DIC -Sepsisabortion.
27. Habitual Abortion: when a woman has 3 or more consecutive abortion spontaneously.Cause - Cervical incompetence due to weakness or repeated D & C - It can also be caused by chromosomal abnormalities Obstetric Management- Shirodkar stitch. The stitch should be removed at term (at 38weeks of gestation)
28. Nursing Management of unclassified APH , the following nursing measures should be implemented for a mother beingtreated for bleeding disorders during pregnancy:• Lie pt flat; check FHB• IV infusion in case of severe bleeding.• Assess B/P, P, R every 2 hours, and more frequently with active bleeding• Observe level of consciousness and behaviors indicative of shock such as pallor,clammy skin, perspiration, dyspnea or restlessness.• Carryout gentle abdominal examination when bleeding is stopped.• Count pads to assess amount of bleeding over a given time period, save any tissueor clots expelled and provide fresh pads.• Collect and organize all data, including antenatal history, on set of bleeding episode,lab studies (hemoglobin, hematocrit, and hormonal assays).• Insert catheter and assess urine output hourly (It should not be less than 30 ml /hr)
29. Assess if there are contractions: frequency, duration & intensity• Assess uterine tenderness and DIC• • Assessing coping mechanisms of woman in crisis, give emotional support to enhanceher coping abilities by: ,♦ Clear explanation of procedures, and♦ Communicating her status to her family.♦ Most important, prepare the woman for possible fetal loss.♦ Assess her expressions of anger, , silence, guilt, depression, or selfblame.• • Arrange blood donor and refer the pt with pertinent history.• Caution: never do V/E or rectal examination.
30. Nursing Interventions and ActionsAssess the client's reproductive history. ...Assess maternal vital signs. ...Auscultate and report FHR; note bradycardia or tachycardia. ...Note expected date of birth (EDB) and fundal height. ...Monitor and record maternal blood loss and uterine contractions. ...Assess for signs of hypovolemia.
31. Common Nursing diagnosis:• Fear related to possible pregnancy loss• Anticipatory grieving related to expected loss of unborn child• Fluid volume deficit related to hypovolemia secondary to excessive blood lass• Altered tissue perfusion: high risk, related to blood loss secondary to uterine atonyfollowing birth.• Impaired fetal gas exchange: high risk, related to decreased blood volume andhypotension.
32. Nursing Care Plans and ManagementHemodynamic stabilization. ...Identifying the source of bleeding. ...Maternal and fetal monitoring. ...Prompt obstetric consultation. ...Blood transfusion and coagulation management. ...Preterm labor prevention. ...Maternal resuscitation. ...Emotional support.Assessment and management of vaginal bleeding in early pregnancy