Pregnancy Bleeding Complications Map

What are the common causes of vaginal bleeding during pregnancy?

• 1st trimester: Miscarriage (spontaneous abortion), ectopic pregnancy, molar pregnancy

• 2nd/3rd trimester: Placenta previa, placental abruption

• Other causes: Cervical irritation (sex, exam), infections, or cervical insufficiency

What is a spontaneous abortion (miscarriage)?

• Pregnancy loss before 20 weeks gestation

• Often caused by chromosomal abnormalities, maternal illness, or uterine abnormalities

• Classified as: threatened, inevitable, incomplete, complete, or missed

What are clinical manifestations of a threatened abortion?

• Slight vaginal bleeding or spotting

• No cervical dilation

• Closed cervix

• Mild cramping

• Fetus may still be viable if heartbeat is present

What are clinical signs of an incomplete abortion?

• Heavy bleeding with tissue expelled but some retained products

• Dilated cervix

• Severe abdominal cramping

• Risk for infection and hemorrhage

What are the main nursing interventions for a spontaneous abortion?

• Assess bleeding (amount, color, clots)

• Monitor vital signs and signs of shock

• Collect tissue for examination

• Prepare for dilation and curettage (D&C) if incomplete

• Provide Rh immunoglobulin (RhoGAM) if Rh-negative

• Provide emotional support and grief counseling

What lab findings are expected in a miscarriage?

• Low hCG levels

• Decreased hemoglobin/hematocrit with heavy bleeding

• Possible positive pregnancy test but declining hormone trend

What education should be given after miscarriage management?

• Avoid intercourse, tampons, or douching for 2 weeks

• Report fever, foul discharge, or heavy bleeding

• Wait 2–3 months before conceiving again

• Provide info on support groups and grief counseling

What is cervical insufficiency (incompetent cervix)?

• Painless cervical dilation in 2nd trimester

• Leads to recurrent pregnancy loss

• Often occurs without contractions or pain

What are causes and risk factors of cervical insufficiency?

• Congenital structural weakness or uterine anomalies

• Cervical trauma (D&C, laceration, cone biopsy)

• Multiple gestations

• Previous preterm birth

How is cervical insufficiency treated?

• Cervical cerclage (McDonald procedure) placed around 12–14 weeks

• Removed at 37 weeks or onset of labor

• Bed rest and pelvic rest post-procedure

What nursing care is provided for a client with a cerclage?

• Monitor for contractions or rupture of membranes

• Assess for vaginal bleeding or infection

• Administer tocolytics as ordered

• Teach to report uterine cramping, backache, or fluid leakage immediately

What patient teaching is essential after cerclage placement?

• Avoid sexual intercourse or heavy lifting

• Return for regular follow-up and ultrasound monitoring

• Go to hospital if cramping, pressure, or bleeding occurs

• Plan for cerclage removal at 37 weeks or earlier if labor starts

What is an ectopic pregnancy?

• Implantation of a fertilized ovum outside the uterus (usually in fallopian tube)

• Nonviable pregnancy—can cause tubal rupture and hemorrhage

What are the key risk factors for ectopic pregnancy?

• Pelvic inflammatory disease (PID)

• Previous ectopic pregnancy

• Tubal surgery or scarring

• Use of IUD

• Smoking

What are early signs and symptoms of ectopic pregnancy?

• Missed period

• Abdominal or unilateral pelvic pain

• Abnormal vaginal bleeding (spotting)

• Low hCG levels that rise slowly

What are late signs of a ruptured ectopic pregnancy?

• Severe unilateral pain, shoulder pain, rigid abdomen

• Dizziness or fainting

• Signs of hypovolemic shock (↓BP, ↑HR, pallor, clammy skin)

How is an ectopic pregnancy diagnosed?

• Transvaginal ultrasound (no intrauterine sac)

• Serial quantitative hCG (doesn’t double every 48 hrs)

• Low progesterone levels

• Culdocentesis may reveal blood in peritoneum

What is the medical management of ectopic pregnancy?

• Methotrexate IM (if unruptured and stable): inhibits fetal cell growth

• Monitor hCG until undetectable

• Surgical option: salpingostomy or salpingectomy if ruptured

What are important nursing considerations for methotrexate therapy?

• Verify no fetal cardiac activity before giving

• Teach: avoid alcohol, folic acid, and NSAIDs

• Monitor for abdominal pain, bleeding, or signs of rupture

• Use reliable contraception for 3 months post-treatment

What are the priorities in care for a ruptured ectopic pregnancy?

• Emergency surgery

• Stabilize vitals, start IV fluids

• Type and crossmatch blood

• Administer oxygen

• Emotional support and grief counseling

What are key nursing diagnoses for clients with pregnancy bleeding complications?

• Deficient fluid volume

• Risk for infection

• Acute pain

• Fear/anxiety

• Anticipatory grieving

What diagnostic tests are most important for bleeding complications?

• CBC (for anemia or blood loss)

• hCG (to confirm pregnancy/viability)

• Ultrasound (determine location and fetal activity)

• Blood type and Rh factor

• Coagulation profile if heavy bleeding

What are nursing priorities for all bleeding complications in pregnancy?

• Assess bleeding and vital signs frequently

• Assess FHR if viable pregnancy

• Initiate large-bore IV access

• Maintain NPO for possible procedure

• Prepare for blood transfusion if indicated

• Provide emotional and psychological support

What discharge teaching applies to all patients with pregnancy bleeding complications?

• Report heavy bleeding, abdominal pain, or dizziness immediately

• Avoid intercourse, tampons, and strenuous activity until cleared

• Keep follow-up appointments

• Encourage rest and hydration

• Provide support for emotional healing and grief