Bleeding Disorders during Pregnancy: Maternal Health Nursing

Study Notes

Bleeding Disorders During Pregnancy

Bleeding at any time during pregnancy is potentially life-threatening
Obstetric hemorrhage is a major cause of maternal death
Management of obstetric hemorrhage involves early recognition, assessment, and resuscitation

Abortion

Complications of abortion include hemorrhage and infection
Fluid therapy and oxytocin infusion may be used to control bleeding

Abruptio Placenta

Abruptio placenta is the premature separation of a normally implanted placenta from the uterine wall after 20-24 weeks' gestation
Assessment findings include:
- Sharp abdominal pain
- Vaginal bleeding
- Fetal distress
- Signs of shock
Grading of abruptio placenta:
- Grade 0: no signs of difficulty
- Grade 1: minimal separation, vaginal bleeding, and altered maternal vital signs
- Grade 2: moderate separation, signs of fetal distress, and uterine tenderness
- Grade 3: extreme separation, maternal shock, and fetal death
Possible causes of abruptio placenta include:
- Abdominal trauma
- Decreased blood flow to the placenta
- Multifetal pregnancy
- Placental bleeding caused by needle puncture during amniocentesis
- Pressure on vena cava from enlarged uterus
- Other risk factors (e.g., low serum folic acid levels, vascular or renal disease, gestational hypertension, chronic hypertension)
- Short umbilical cord
- Smoking

Diagnostic Evaluation and Treatment of Abruptio Placenta

Hospitalization
Ultrasonography to locate the placenta and detect clot or hematoma
I.V. infusion of lactated Ringer's solution to combat hypovolemia
Transfusion of packed RBCs, platelets, and fresh frozen plasma, if necessary
Vaginal delivery if no signs of fetal distress, minimal bleeding, and stable vital signs

Vesicular Mole

Treatment involves therapeutic abortion (suction and curettage) if spontaneous abortion does not occur
Follow-up care includes:
- Pelvic examinations and chest X-rays at regular intervals
- Weekly monitoring of HCG levels until they remain normal for 3 consecutive weeks
- Periodic follow-up for 1-2 years due to increased risk of neoplasm
- Antimetabolite methotrexate (Rheumatrex) prophylactically for choriocarcinoma
- Chemotherapy and irradiation for metastatic choriocarcinoma

Cervical Insufficiency

Cervical insufficiency, also known as premature dilation of the cervix, is a weak, structurally defective cervix that spontaneously dilates in the absence of uterine contractions
Typically occurs in the fourth or fifth month of gestation, resulting in the loss of the pregnancy
Pathophysiology:
- Exact mechanism not known
- The cervix may have less elastin, less collagen, and greater amounts of smooth muscle than the normal cervix
- Damage to the cervix due to hormonal factors (e.g., increased relaxin)
Therapeutic management:
- Bed rest
- Pelvic rest
- Avoidance of heavy lifting
- Progesterone supplementation in women at risk for preterm birth
- Placement of a cervical pessary or surgically via a cervical cerclage procedure in the second trimester

Incompetent Cervix

Management:
- Cervical cerclage or suturing of the cervix between 14 and 16 weeks of gestation to prevent cervical dilatation
- Assessment prior to the procedure:
  - Cervix not dilated beyond 3 cm
  - Intact membrane
  - No vaginal bleeding and uterine cramping
Types of cervical cerclage:
- Shirodkar suture: permanent suture left in place for next pregnancies, fetus delivered via CS
- McDonald suture: temporary suture removed at 38-39 weeks of gestation, fetus delivered vaginally

Description

Test your knowledge on bleeding disorders during pregnancy, including causes, clinical manifestations, and nursing diagnoses. This quiz covers the essential concepts in maternal health nursing, perfect for NUR-313 students.