Complications of Pregnancy: Bleeding During 1st Trimester

Bleeding during Pregnancy

• 1st Trimester Bleeding
  • Types of spontaneous miscarriages:
    • Threatened spontaneous miscarriage (early: under 16 weeks; late: 16 to 20 weeks)
    • Imminent (inevitable) miscarriage
    • Missed miscarriage
    • Incomplete spontaneous miscarriage
    • Complete spontaneous miscarriage
  • Causes: unknown, possibly chromosomal or uterine abnormalities
  • Signs and symptoms: vaginal spotting, cramping, cervical dilation

Ectopic Pregnancy

• Definition: implantation of zygote at a site other than in the uterus, associated with tubal constrictures
• Signs and Symptoms:
  • Sudden unilateral lower abdominal quadrant pain
  • Minimal vaginal bleeding, possible signs of hypovolemic shock or hemorrhage
  • Cullin's Sign: bluish umbilicus
• Most common site: tubal

Abruptio Placentae

• Definition: premature separation of the placenta
• Types of Separation:
  • Marginal: attached at the edge, painless vaginal bleeding
  • Central: most frequent, sharp stabbing pain at the fundus
• Signs and Symptoms:
  • Concealed bleeding: uterus becomes rigid, loses its ability to contract
  • Couvelaire uterus: hard, board-like, and copper in color
• Predisposing Factors:
  • Maternal hypertension
  • Increased maternal age
• Management:
  • Lateral position or side lying
  • Immediate CS
  • Oxygen administration by mask
  • Take FHT and VS

Preterm Labor

• Definition: many possible etiologic factors, increased chance in multiple gestation, mental illness
• Signs and Symptoms:
  • Show (pink-stained vaginal discharge) accompanied by uterine contractions becoming regular and effective
• Cautions:
  • Preterm labor may be halted if the cervix is less than 4cm dilated and the membranes are intact
  • Corticosteroids are administered to aid fetal lung maturity
• Management:
  • Surgical operations (cervical cerclage)
  • No coitus

3rd Trimester Bleeding

• Placenta Previa
  • Definition: abnormal implantation of the placenta in the lower part of the uterus, most common cause of painless bleeding in the third trimester
  • Four degrees of Placenta Previa:
    • Low-lying placenta
    • Marginal placenta
    • Partial placenta previa
    • Total placenta previa
  • Causes:
    • Rapid succession of pregnancy
    • Advanced maternal age
  • Signs and Symptoms:
    • Painless bright red vaginal bleeding due to tearing of placental attachment
  • Nursing Management:
    • Avoid coitus
    • Adequate rest
    • Monitor VS and FHR
    • Prepare oxygen and blood
    • In case of vaginal bleeding, prepare a double set up
  • Complications:
    • Infections
    • Hemorrhage
    • Prematurity
  • Nursing Diagnosis:
    • Fear related to outcome of pregnancy secondary to episode of placenta previa bleeding