Bleeding during pregnancy Flashcards
signs of hypovolemic shock occur when?
10% of blood volume (2 units of blood) have been lost
fetal distress occurs when?
25% of blood volume is lost
primary causes of bleeding during pregnancy
first trimester
- Threatened spontaneous miscarriage
- Imminent (inevitable miscarriage)
3.Missed miscarriage
4.Incomplete spontaneous miscarriage - Complete spontaneous miscarriage
6.Ectopic (tubal) pregnancy
primary causes of bleeding during pregnancy
second trimester
- Gestational trophoblastic disease (hydatidiform mole)
2.Incompetent cervix
primary causes of bleeding during pregnancy
third trimester
- Placenta previa
- Premature separation of placenta (abruptio placentae)
- Pre term labor
unknown reasons but possibly poor placental attachment
Imminent (inevitable miscarriage)
Threatened spontaneous miscarriage assessment
vaginal spotting, perhaps slight cramping.
cervix closed
Threatened spontaneous miscarriage cautions
do not use tampons (can lead to infection)
Imminent (inevitable miscarriage)
vaginal spotting, cramping.
cervical dilation
Missed miscarriage
vaginal spotting, slight cramping, no apparent loss of pregnancy. Fetus dies in utero but is not expelled brownish vaginal discharge.
cervix closed
Missed miscarriage cautions
Disseminated intravascular coagulation is associated that may lead to multiple organ disfunction
Incomplete spontaneous miscarriage assesment
vaginal spotting, cramping.
cervical dilation and passage of clots or pieces of tissue
Incomplete spontaneous miscarriage cautions
high risk for uterine infection
Complete spontaneous miscarriage assessment
vaginal spotting, cramping.
cervical dilation and complete expulsion of uterine contents
implantation of zygote at site other than in uterus associated with tubal constrictures
Ectopic (tubal) pregnancy
Ectopic (tubal) pregnancy assesment
sudden unilateral lower quadrant pain, minimal vaginal bleeding
Ectopic (tubal) pregnancy cautions
may have ectopic pregnancy in future if tubal scarring is bilateral
abnormal proliferation of trophoblast cells; fertilization or division defect
Gestational trophoblastic disease (hydatidiform mole)
Gestational trophoblastic disease (hydatidiform mole) assesment
overgrowth of uterus
highly + HCG test
no bleeding from vagina of old or fresh blood accompanied by cyst formation
Gestational trophoblastic disease (hydatidiform mole) cautions
retained trophoblast tissue may become malignant ( choriocarcinoma)
follow for 6mos to 1 yr with hcg testing
Cervix begins to dilate and pregnancy is lost at about 20 weeks; unknown cause, but cervical trauma from dilation and curettage (D&C) may be associated
incompetent cervix
incompetent cervix assesment
painless bleeding leading to expulsion of fetus
incompetent cervix cautions
can have cervical sutures placed to ensure a second pregnancy
low implantation of placenta possible because of uterine abnormality
Placenta previa
Placenta previa assesment
painless bleeding at beginning of cervical dilation
Placenta previa cautions
don’t allow vaginal examination to minimize placental trauma
Unknown cause; associated with hypertension; placenta separations from uterus before birth of fetus.
Premature separation of placenta (abruptio placentae)
Premature separation of placenta (abruptio placentae) assesment
Sharp abdominal pain followed by uterine tenderness,
vaginal bleeding; signs of maternal hypovolemic shock fetal distress.
Premature separation of placenta (abruptio placentae) cautions
Disseminated intravascular coagulation is associated with condition.
pre term labor cause
Many possible etiologic factors such as trauma,
substance abuse,
hypertension of pregnancy, or cervicitis; increased chance in multiple gestation, maternal illness.
pre term labor assesment
Show (pink - stained vaginal discharge)
accompanied by uterine contractions becoming regular and effective.
pre term labor cautions
if the cervix is less than 4 cm dilated and the membrane are intact,
corticosteroids are administered to aid fetal lung maturity.
pathophysiology of bleeding
1.Blood Loss
2. Decreased intravascular volume
3. Decreased venous return, decreased cardiac output, and lowered blood pressure
4. Body compensating by increasing heart rate to circulated the decreased volume faster; vasoconstriction of peripheral vessels (to save blood for vital organs). Increased respiratory rate and a feeling of apprehension at body changes also occur.
5.Cold, clammy skin; decreased uterine perfusion. In the face of continued blood loss, although the body shifts fluid from interstitial spaces into intravascular spaces, blood pressure will continue to fall.
6.Reduced renal, uterine and brain perfusion
7.Lethargy, coma, decreased renal output.
- Renal failure
- Maternal and fetal death
sign and symptoms of hypovolemic shock
- increased pulse rate
- decreased blood pressure
- increased respiratory rate
- cold,clammy skin
- decreased urine output
- dizziness or decreased level of consciousness
- decreased central venous pressure
emergency intervention for bleeding in pregnancy
- Alert health care team of emergency situation.
- Place woman flat in bed on her side.
- Begin intravenous fluid such as ringer’s lactate with a 16 or 18 gauge angiocath.
- Administer oxygen as necessary at 6 - 10 L/min by face mask.
- Monitor uterine contractions and fetal heart rate by external monitor.
- Omit vaginal examination.
- Withhold oral fluid.
- Order type and cross - match of 2 units of whole blood.
9.Measure intake and output. - Assess vital signs (pulse, respirations and blood pressure every 15 minutes; apply oximeter and automatic blood pressure cuff as necessary).
11.Assist with placement of central nervous pressure or pulmonary artery catheter and blood determinations
- Measure maternal blood loss by weighing perineal pads; save any tissue passed.
13.Assist with ultrasound examination.
- Maintain a positive attitude about fetal outcome.
- Support woman’s self - esteem; provide emotional support to woman and her support person.
