Bleeding During Pregnancy

Spontaneous Abortion

• Spontaneous abortion is the natural loss of a pregnancy before 20 weeks
• Possible causes of bleeding in the first trimester include ectopic pregnancy, gestational trophoblastic disease
• Possible causes of bleeding in the second trimester include placenta previa, abruptio placentae, and vasa previa
• Expected findings include abdominal cramping or pain, rupture of membranes, dilation of the cervix, and fever
• Manifestations of hemorrhage can be seen as low hemoglobin/hematocrit levels (Hgb and Hct), clotting factor deficiencies and/or elevated white blood cell count (WBC)
• hCG (serum human chorionic gonadotropin) levels can be used in testing
• Types of spontaneous abortion include threatened (possible mild cramping, slight spotting), inevitable (moderate cramping, moderate bleeding, cervical opening usually dilated (3cm)), incomplete (severe cramping, heavy bleeding, tissue passed), and complete (mild cramping, minimal bleeding, tissue passed, no dilation), missed (no cramping)

Spontaneous Abortion Procedures

• Determine if the fetus is viable or non-viable
• Examine the cervix
• Assess whether the cervix is open or closed
• Dilation and Currettage (D&C) to dilate and scrape the uterine walls to remove uterine contents
• Dilation and Evacuation (D&E) to dilate and evacuate uterine contents
• Prostaglandins and oxytocin to induce contractions and expel products

Spontaneous Abortion Care

• Emotional support
• Medications (analgesics and sedatives, prostaglandins, oxytocin, broad-spectrum antibiotics, Rho(D) immune globulin)
• Client education (no tub baths, notify provider of heavy bleeding, take antibiotics, small amount of discharge is normal, no sex or placing anything in the vagina for 1-2 weeks)

Ectopic Pregnancy

• Abnormal implantation of the fertilized ovum outside the uterine cavity
• Risk factors include tubal patency (STI), tubal surgery, contraceptive intrauterine device (IUD)
• Findings include unilateral sharp pain in lower abdomen, delayed or irregular menses, lighter than normal bleeding, and scant dark brown/red vaginal spotting (sometimes red if rupture occurs). Symptoms may include referred shoulder pain, hemorrhage and shock, and dizziness
• Diagnostic tests may include Transvaginal UA, medical management (if rupture hasn't occurred, methotrexate to dissolve the pregnancy, or salpingectomy if the tube is ruptured), surgical management (laparoscopic salpingectomy)
• Nursing care includes replacing fluids and maintaining electrolytes, providing psychological support, and preparing the client for surgery

Gestational Trophoblastic Disease

• Gestational trophoblastic disease
• Complete mole
• Characteristics of complete mole: genetic material from father, no fetus, no placenta, fluid is absent, genetic material is absent in the ovum, genetic material is present in paternal portion

Placenta Previa

• Placenta completely covers the cervical os (total)
• Partially covers the cervical os (incomplete)
• Marginally covers the cervical os, but not the os
• Risk factors are previous placenta previa and uterine scarring
• Client education should include saving any clots, bed rest
• Signs/symptoms include painless, bright red vaginal bleeding during the 2nd or 3rd trimester, soft uterus, relaxed, and nontender, fundal height is greater than would be expected for that time of pregnancy, fetus in a breech, oblique, or transverse position

Abruptio Placentae

• Premature separation of the placenta from the uterus
• Risk factors include maternal hypertension, blunt external abdominal trauma, cocaine use, a history of previous abruptio placentae, smoking
• Sudden onset of severe pain, dark red vaginal bleeding
• Nursing care includes monitoring, assessment, assessment of vital signs

Vasa Previa

• Velamentous insertion of the umbilical cord
• Succenturiate insertion of the umbilical cord
• Battledore insertion of the umbilical cord

This quiz covers the important aspects of spontaneous abortion, including its definition, causes, expected findings, and types. Participants will explore the physiological and clinical parameters associated with first and second trimester bleeding, as well as relevant laboratory tests. Gain a deeper understanding of this significant health topic.