Causes of Bleeding in Early Pregnancy

Causes of Bleeding in Early Pregnancy

• Abortion: Termination of pregnancy before fetal viability (before 28 weeks gestation). Causes include endocrine issues, infections, environmental toxins (like alcohol and smoking), trauma, maternal anoxia, malnutrition, psychological stress, uterine abnormalities, fetal chromosomal abnormalities, and idiopathic factors.
• Ectopic Pregnancy: Fertilized ovum implants outside the uterus. Common site is the fallopian tubes (95%). Other less common sites include ovaries, broad ligaments, peritoneum, and cervix. Potential outcomes are tubal mole, tubal abortion, or tubal rupture.
• Hydatidiform Mole: A benign neoplasm of the chorionic villi. Characterized by abnormal growth in the uterine cavity, absence of a fetus, and possible exaggeration of pregnancy symptoms, along with vaginal bleeding. Can lead to complications like preeclampsia or hyperthyroidism.
• Local Gynaecological Lesions: Cervical ectopy, polyps, dysplasia, carcinoma, and ruptured varicose veins can also cause bleeding.

Types of Abortion

• Threatened Abortion: Mild vaginal bleeding and cramping, closed cervix; fetus is viable. Management focuses on bed rest and supportive care.
• Inevitable Abortion: Excessive vaginal bleeding and cramping, dilated cervix; fetus is non-viable. Uterine evacuation (medically or surgically) is necessary.
• Incomplete Abortion: Retained products of conception inside the uterus (part of placenta, or entire fetus). Heavy vaginal bleeding and cramping, an open cervix. Management: similar to inevitable abortion.
• Complete Abortion: All products of conception expelled; minimal bleeding, closed cervix, uterus reduced in size. No further treatment needed.
• Missed Abortion: Retained dead products of conception for 4 or more weeks. Regression of pregnancy symptoms, no growth in abdomen, no fetal movement, possibly "prune-juice" discharge. Cervix and uterus are closed initially. Pregnancy tests will become negative. Ultrasound confirms fetal death.
• Septic Abortion: Any type of abortion complicated by infection. Common causes include bacteria (E. coli, bacteroids, anaerobic streptococci, clostridia, streptococci, staphylococci). Typically presents with fever, tachycardia, rigors, malaise, and suprapubic pain with vaginal discharge. Management: Isolation, IV antibiotics, fluid therapy, and surgical evacuation.
• Recurrent Abortion: Three or more successive spontaneous abortions

Ectopic Pregnancy

• Definition: Implantation of a fertilized ovum outside the uterus.
• Clinical Picture: Amenorrhea (usually short), pain (aching, colicky, stabbing depending on the stage), light vaginal bleeding (dark brown color possible), and lower abdominal tenderness. Uterus enlarged, soft, and tender.
• Diagnosis: Differentiate it from other causes of bleeding in early pregnancy using physical exam, symptom analysis, and diagnostic tests.

Hydatidiform Mole

• Definition: Benign neoplasm of the chorionic villi. No fetus or normal embryo.
• Clinical Picture: Short amenorrhea, exaggerated pregnancy symptoms, vaginal bleeding (brown, possible vesicles), potential abdominal pain (dull or colicky), enlarged uterus with a 'doughy' consistency; absence of fetal heartbeat.
• Diagnosis: Confirmed using urine pregnancy tests (highly positive), serum beta-hCG levels (extremely high), and ultrasound ("snow storm" appearance).

Bleeding in Late Pregnancy

• Placenta Previa: Placenta implants in the lower uterine segment; painless vaginal bleeding after 28 weeks. May or may not be recurrent.
• Abruptio Placenta: Premature separation of a normally implanted placenta; severe abdominal pain, vaginal bleeding (dark or concealed), potentially high risk of fetal death, uterine tenderness, hardness or rigidity.
• Vasa Praevia: Exceptionally rare; blood vessels of the umbilical cord traverse the membranes just above the cervix. Bleeding risk and possible fetal death.

Nursing Care for Bleeding with Pregnancy

• Monitoring: Blood loss assessment, pain levels, uterine contractions, and maternal vital signs.
• Emotional support: Addressing client anxieties and fears.
• Laboratory investigations: CBC, blood typing, coagulation studies.
• Aseptic technique: Infection prevention measures.
• Fetal monitoring: Auscultation of fetal heart rate.
• Fluid balance: Recording intake and output.
• Bed rest: Following medical advice for proper rest and recovery.