Pregnancy Bleeding Complications Case Concept 2

What condition is suspected when a 28-year-old pregnant patient at 26 weeks presents with bright red vaginal bleeding but no pain or uterine tenderness?

• Possible diagnosis: Placenta previa or preterm labor

• Placenta previa presents as painless, bright red bleeding

• Preterm labor is possible due to early contractions or cervical changes before 37 weeks

What is preterm labor?

• Onset of regular uterine contractions with cervical effacement or dilation occurring before 37 weeks gestation

• May occur with or without bleeding

• Early identification and management are crucial to prevent preterm birth

What are common risk factors for preterm labor?

• Previous preterm birth

• Multiple gestation

• Uterine abnormalities

• Smoking (as in Ms. P’s case)

• Infection or inflammation

• Placental problems (previa, abruption)

• Stress, dehydration, or trauma

What are typical assessment findings in preterm labor?

• Regular uterine contractions

• Pelvic pressure or backache

• Change in vaginal discharge or bleeding

• Mild uterine tenderness

• Cervical dilation ≥2 cm or effacement ≥80%

What are expected laboratory findings in preterm labor?

• Positive fetal fibronectin (fFN): indicates risk for preterm delivery

• CBC: to rule out infection

• UA/Culture: to rule out UTI as trigger

• Ultrasound: assesses cervical length and fetal well-being

What are the primary nursing interventions for preterm labor?

• Monitor contractions and FHR

• IV fluids for hydration

• Position in left lateral position to promote perfusion

• Administer tocolytics (terbutaline, nifedipine, magnesium sulfate)

• Administer corticosteroids (betamethasone) to mature fetal lungs if <34 weeks

• Monitor for infection if membranes ruptured

What patient teaching is important for a patient with preterm labor?

• Recognize warning signs: cramps, back pain, increased discharge, bleeding

• Avoid sexual activity and strenuous exercise

• Stay hydrated and rest on side

• Report any contractions, leakage, or decreased fetal movement immediately

How is evaluation of preterm labor outcomes measured?

• No further cervical change

• Contractions stop

• FHR stable and reactive

• Patient verbalizes understanding of warning signs and prevention strategies

What condition is suspected if the patient develops dark vaginal bleeding, abdominal pain, uterine tenderness, and contractions?

• Potential diagnosis: Placental abruption (abruptio placentae)

What is placental abruption?

• Premature separation of the placenta from the uterine wall after 20 weeks gestation

• Causes bleeding, pain, and uterine tenderness

• Medical emergency that threatens maternal and fetal life

What are the types of placental abruption?

• Concealed: bleeding trapped behind placenta (no visible bleeding)

• Apparent: visible vaginal bleeding

• Complete: total separation leading to fetal demise

What are the classic symptoms of placental abruption?

• Dark red vaginal bleeding

• Abdominal or back pain

• Uterine tenderness or rigidity

• Frequent contractions

• Nonreassuring FHR or fetal distress

What are the risk factors for placental abruption?

• Hypertension or preeclampsia

• Smoking

• Abdominal trauma

• Cocaine use

• Multiple gestation

• History of abruption

What are expected laboratory findings in placental abruption?

• Decreased hemoglobin/hematocrit

• Positive Kleihauer-Betke test (fetal blood in maternal circulation)

• Prolonged PT/PTT if DIC present

• Decreased fibrinogen

What are the nursing interventions for placental abruption?

• Assess maternal VS and FHR continuously

• Monitor bleeding amount and characteristics

• Administer oxygen and IV fluids

• Prepare for emergency delivery (usually C-section)

• Type and crossmatch for blood

• Administer corticosteroids if fetus preterm

• Monitor for DIC and shock

What are nursing considerations and person-centered care for placental abruption?

• Stay with patient and provide reassurance

• Maintain calm environment

• Educate about emergency procedures

• Offer emotional and psychological support

• Ensure informed consent for possible emergency surgery

What patient teaching is essential for placental abruption?

• Avoid smoking, cocaine, or trauma

• Monitor fetal movement daily

• Report decreased fetal activity, pain, or bleeding immediately

• Emphasize importance of BP control in hypertensive patients

What complications can arise from placental abruption?

• Maternal: Hypovolemic shock, DIC, renal failure, hemorrhage

• Fetal: Hypoxia, stillbirth, preterm delivery

What are common nursing diagnoses for both preterm labor and placental abruption?

• Risk for deficient fluid volume

• Risk for fetal injury

• Anxiety

• Knowledge deficit

• Risk for ineffective tissue perfusion

What are common nursing interventions for both conditions?

• Continuous fetal monitoring

• Maintain IV access and fluids

• Monitor for bleeding and contractions

• Assess emotional coping and provide education

• Prepare for delivery if indicated

How is evaluation of outcomes determined for both conditions?

• Maternal VS stable

• Bleeding controlled

• FHR remains stable

• Patient verbalizes understanding of warning signs and when to seek help

• No progression to DIC, abruption, or fetal distress