Bleeding in Early Pregnancy

Bleeding in Early Pregnancy

• Bleeding in early pregnancy can be caused by abortion, ectopic pregnancy, or vesicular mole.
• Local gynecological lesions such as cervical ectopy, polyp, dysplasia, carcinoma, or rupture of varicose veins can also cause bleeding.

Abortion

• Definition: Termination of pregnancy before fetal viability, which occurs before 28 weeks gestation.
• Types:
  • Threatened abortion: Vaginal bleeding, closed cervix, viable fetus.
  • Inevitable abortion: Excessive vaginal bleeding, dilated cervix, nonviable fetus.
  • Incomplete abortion: Retention of parts of the products of conception in the uterus, continuous vaginal bleeding, open cervix.
  • Complete abortion: All products of conception expelled from the uterus, minimal vaginal bleeding, closed cervix.
  • Missed abortion: Retention of dead products of conception for 4 weeks or more, regression of pregnancy symptoms, no fetal movement.
  • Septic abortion: Any type of abortion complicated by infection, high fever, tachycardia, abdominal pain, offensive vaginal discharge.
  • Recurrent abortion: Three or more successive spontaneous abortions.

Ectopic Pregnancy

• Definition: Implantation of the fertilized ovum outside the normal uterine cavity.
• Common site: Fallopian tubes (95%)
• Rare sites: Ovaries, broad ligaments, peritoneum, cervix.
• Clinical picture:
  • Short period of amenorrhea (usually not exceeding 8-10 weeks).
  • Pain: Aching, colicky, stabbing depending on the stage of the ectopic pregnancy.
  • Vaginal bleeding: Usually slight and follows the pain.
• Treatment: Surgical intervention depending on the stage and severity of the ectopic pregnancy.

Vesicular Mole

• Definition: Benign neoplasm of the chorionic villi.
• Clinical picture:
  • Short period of amenorrhea (2-3 months).
  • Exaggerated symptoms of pregnancy, especially vomiting.
  • Vaginal bleeding (usually dark brown) with passage of vesicles.
  • Abdominal pain: Dull-aching, colicky.
• Diagnosis:
  • Positive urine pregnancy test in high dilution.
  • Highly elevated serum β-hCG levels.
  • Ultrasound reveals a characteristic "snow storm" appearance.
• Treatment:
  • Suction evacuation: Safest and most effective method.
  • Abdominal hysterectomy: Preferred if the patient is over 40 years old.

Bleeding in Late Pregnancy

• Definition: Bleeding from the genital tract after the 28th week of pregnancy and before the end of the second stage of labor.
• Classification:
  • Placenta previa: Bleeding from separation of a placenta wholly or partially implanted in the lower uterine segment.
  • Abruptio placenta: Premature separation of a normally implanted placenta.
  • Marginal separation: Bleeding from the edge of a normally implanted placenta.

Placenta Previa

• Definition: Bleeding from a placenta that is partially or totally attached to the lower uterine segment.
• Types:
  • First degree (Type I = P.P. lateralis = low-lying placenta): The lower edge of the placenta reaches the lower uterine segment but not the internal os.
  • Second degree (Type II = P.P. marginalis): The lower edge of the placenta reaches the margin of the internal os but does not cover it.
  • Third degree (Type III = P.P. incomplete centralis): The placenta covers the internal os when it is closed or partially dilated but not when it is fully dilated.
  • Fourth degree (Type IV = P.P. complete centralis): The placenta covers the internal os completely whether the cervix is partially or fully dilated.
• Diagnosis:
  • Causeless, painless, and recurrent bright-red vaginal bleeding.
  • Ultrasonography.
• Treatment:
  • Immediate caesarean section if bleeding is severe.
  • Induction of labor or caesarean section if gestational age is at or beyond 37 weeks.
  • Conservative treatment if gestational age is less than 37 weeks until the end of 37 weeks.

Abruptio Placenta (Accidental Hemorrhage)

• Definition: Premature separation of a normally situated placenta after the 28th week of pregnancy and before delivery of the fetus.
• Types:
  • Revealed hemorrhage: Blood appears externally.
  • Concealed hemorrhage: All blood is retained inside the uterus.
  • Combined or mixed type: The blood is partially concealed and partially revealed.
• Diagnosis:
  • Acute, constant, severe abdominal pain.
  • Dark vaginal bleeding.
  • Cessation of fetal movement.
• Treatment:
  • Immediate delivery: Amniotomy + oxytocin if bleeding is not severe and vertex presentation is present.
  • Caesarean section for severe cases.

Nursing Care in Case of Bleeding During Pregnancy

• Monitoring amount of blood loss, pain level, and uterine contractions.
• Assessing maternal vital signs frequently.
• Uterine massage.
• Observing color, odor, and amount of blood.
• Providing emotional support and listening to the patient's fears.
• Obtaining laboratory investigations: CBC, blood type, coagulation studies.
• Assisting the patient to remain on bed rest.
• Following strict aseptic technique to avoid infection.
• Continuously observing for signs of shock and fetal heart rate.
• Maintaining accurate recording of intake and output.

This quiz explores the various causes of bleeding in early pregnancy, such as abortion, ectopic pregnancy, and local gynecological lesions. It provides insights into the definitions and types of abortion, including threatened, inevitable, incomplete, complete, and missed abortion. Test your knowledge on the complexities of early pregnancy complications.