High Risk Pregnancy - Bleeding

High Risk Pregnancy - Bleeding

• Restoring Blood Volume: IV fluid replacement using a large-gauge angiocath is used for rapid expansion. Obtain hemoglobin and hematocrit levels and secure a blood sample for typing or cross-matching.
• Assess Hypovolemic Shock: Monitor signs of hypovolemic shock, including decreased blood pressure, increased pulse rate and respiratory rate, decreased urine output, and restlessness.
• O2 Administration: Administer supplemental O2 via face mask if respiration is rapid
• Complete Bed Rest: Lateral position to restrict movement and sexual activity
• Ultrasound: Assess the integrity of the sac.
• First-Trimester Bleeding: Includes miscarriage, threatened miscarriage, imminent miscarriage, and incomplete miscarriage.

Spontaneous Abortion

• Causes: Abnormal fetal formation (due to teratogens or chromosomal aberrations), implantation abnormalities (inadequate endometrial formation or inappropriate implantation site), inadequate progesterone production by the corpus luteum, infection (rubella, syphilis, poliomyelitis, cytomegalovirus, toxoplasmosis, UTI), ingestion of teratogenic drugs, or severe maternal malnutrition.
• Presenting Symptoms: Painless vaginal bleeding

Types of Abortion/Miscarriage

• Threatened Miscarriage: Bright red vaginal bleeding (initially scanty), slight cramping, no cervical dilation. Diagnostic procedures are used to assess the situation
• Imminent (Inevitable) Miscarriage: Uterine contractions and cervical dilation. The loss of the products of conception cannot be halted. Diagnostic procedures are ultrasound to determine if the fetus is viable and if the uterus is empty.
• Complete Miscarriage: All products of conception expelled spontaneously without assistance. Bleeding slows within two hours and stops after a few days.
• Incomplete Miscarriage: Part of the conceptus is expelled, but membranes or placenta remain. There is danger of hemorrhage. Management often includes D&C to remove retained products of conception.
• Missed Miscarriage: Fetus dies in utero but is not expelled.

Septic Abortion

• Definition: Abortion complicated by infection. It can happen after spontaneous abortion. It is more common in self-induced abortions.
• Manifestations: Fever, crampy abdominal pain, tender uterus.

Isoimmunization

• Definition: A condition in which a woman's immune system develops antibodies against the fetus's red blood cells. It occurs when a Rh-negative mother carries a Rh-positive fetus.
• Diagnostic Procedure: Rh-negative women have anti-D titers monitored approximately every two weeks.
• Management: Rh immune globulin (RhoGAM) is administered to prevent the buildup of antibodies in case the fetus is Rh positive. This is given in different stages of pregnancy and after birth.
• Ectopic Pregnancy: Implantation outside the uterine cavity; may occur on the surface of the ovary, cervix, or fallopian tube. Possible causes include congenital defects of the reproductive tract or diverticular disease.

Second Trimester Bleeding

• Gestational Trophoblastic Disease: A proliferation and degeneration of trophoblastic villi. May show dense growth with no fetal outline
• Hydatidiform Mole (molar pregnancy): Abnormal pregnancy resulting from abnormal growth of cells surrounding the embryo and placenta. Usually no embryo inside, characterized by a grape-like appearance on ultrasound.
• Diagnosis: Ultrasound and hCG detection (hCG is abnormally high) are used.
• Treatment: Suction curettage to evacuate the molar pregnancy. Monitor hCG levels after removal.

Premature Cervical Dilation

• Definition: Cervical dilation prematurely.
• Risk Factors: Increased maternal age, congenital cervical defects, cervical trauma.
• Management: Cervical cerclage (suturing of the cervix) to prevent premature dilation .

Third Trimester Bleeding

• Placenta Previa: Placenta implants abnormally low within the uterine cavity, potentially covering the internal os of the cervix. Management depends on severity.
• Accreta/increta/percreta: Placenta abnormality where it implants too deeply within the uterine wall. Can have more adverse outcomes
• Risk Factors: Advanced maternal age, past C-sections, past uterine curettage, and multiple gestations.
• Diagnosis: Ultrasound

Preterm Rupture of Membranes

• Causes: Unknown, but associated with infection
• Manifestations: Sudden gush of clear fluid from vagina
• Diagnostics: Nitrazine paper test, ferning, ultrasound.
• Management: Labor does not begin: place patient on bed rest, antibiotic use to avoid infection. If fetus is too young to survive outside womb, administer IV oxytocin.

Pregnancy-Induced Hypertension

• Risk Factors: Primipara <20, primipara >40, low socioeconomic background, multiple pregnancy, hydramnios, underlying disease (heart disease, diabetes, essential hypertension)
• Pathophysiology: Vasospasm, altered vascular tone, reduced placental perfusion, kidney damage. Classic signs: hypertension, proteinuria, edema.

HELLP Syndrome

• Signs/Symptoms: Hemolysis, elevated liver enzymes, low platelets.
• Management: Blood transfusions, delivery

Multiple Pregnancy

• Types: Identical (monozygotic) and fraternal (dizygotic).
• Diagnostic procedures: Ultrasound

Hydramnios

• Definition: Excessive accumulation of amniotic fluid.
• Causes: Fetus's inability to swallow, increased urine production by fetus (if diabetic mother), congenital anomalies.

Hyperemesis Gravidarum

• Definition: Persistent and uncontrolled vomiting during pregnancy.
• Manifestations: Continuous severe nausea and vomiting, dehydration, electrolyte imbalances, jaundice, dry skin, coated tongue, non-elastic skin turgor, and hypokalemia.

Gestational Diabetes

• Definition: Diabetes that develops during pregnancy.
• Risk Factors: Obesity, history of delivering large neonates, age > 35, family history, and previous pregnancies with gestational diabetes/obesity and weight
• Diagnostic: Glucose tolerance test, glycosylated hemoglobin assessment.
• Monitoring: Diet, exercise, blood glucose control measures.

Cardiac Disease

• Classification: Divided by degree of limitation of activity; usually monitored by cardiac specialist
• Management: Medications, and adjustments made as needed by cardiologist

Toxoplasmosis

• Cause: Protozoan infection
• Manifestations: Asymptomatic, myalgia, malaise, rash, and splenomegaly
• Treatment: Antiparasitic drugs (sulfadiazine, pyrimethamine) to prevent complications for fetus. Prevention: avoiding raw or undercooked meat.

This quiz covers critical aspects of managing high-risk pregnancies, particularly focusing on bleeding incidents. It addresses the importance of assessing hypovolemic shock, appropriate interventions, and understanding the implications of spontaneous abortion. This knowledge is vital for healthcare professionals in maternal health.