PPH clotting

Hemorrhage in Pregnancy

Abortions, ectopic pregnancy, placental abruption, placenta previa, postpartum hemorrhage (PPH), clotting disorders

Spontaneous abortion definition

Loss of pregnancy before 20 weeks gestation (miscarriage)

Main cause of spontaneous abortion

Chromosomal abnormalities (~50%)

Threatened abortion

Bleeding/cramping, viable embryo, cervix closed

Inevitable abortion

Cervix dilated, products not yet passed, cannot prevent loss

Incomplete abortion

Some products of conception expelled, some retained

Complete abortion

All products of conception expelled

Missed abortion

No fetal cardiac activity, cervix closed

Septic abortion

Retained products become infected

Spontaneous abortion S/S

Vaginal bleeding, cramping, passage of tissue

Septic abortion S/S

Fever, foul discharge, tachycardia

Diagnostics for abortion

Ultrasound + serial hCG levels

Expectant management (abortion)

80% resolve naturally within ~8 weeks

Medical management (abortion)

Misoprostol ± mifepristone

Urgent intervention needed when

Hemorrhage, instability, infection

Rh-negative abortion care

Give Rho(D) immune globulin (Rhogam)

Ectopic pregnancy definition

Implantation outside the uterus

Most common ectopic site

Fallopian tube

Ectopic risk factors

PID, smoking, IUD, infertility, age >35, endometriosis

Ectopic classic S/S

Abdominal pain + vaginal bleeding

Additional ectopic symptoms

N/V, diarrhea, urinary symptoms

Definitive ectopic diagnosis

Fetal heartbeat outside uterus on ultrasound

Ectopic labs

Serial hCG, CBC

Ectopic emergency sign

Tachycardia + hypotension (rupture → hypovolemia)

Ectopic treatment

Methotrexate or surgery

Placenta previa definition

Placenta covers or is near cervical os

Placenta previa hallmark

Painless vaginal bleeding after 20 weeks

Placenta previa types

Marginal, partial, complete

Placenta previa risk factors

Prior C-section, smoking, age >35, multiple pregnancies

Placenta previa key rule

NO digital vaginal exam

Placenta previa treatment

Monitor, corticosteroids, likely C-section at 36-37 weeks

Placental abruption definition

Premature separation of placenta from uterus

Abruption hallmark

Painful vaginal bleeding + uterine tenderness

Abruption risk factors

HTN, trauma, smoking, cocaine, prior abruption

Abruption severe signs

Rigid uterus, shock, fetal distress/death

Abruption can be

Visible bleeding OR concealed hemorrhage

Abruption labs

CBC, coagulation studies

PPH definition

Excessive bleeding after delivery

Leading cause of maternal death

Postpartum hemorrhage

Primary cause of PPH

Uterine atony

Uterine atony

Failure of uterus to contract → bleeding

5 Ts of PPH

Tone, Tissue, Trauma, Thrombin, Traction

Tone

Uterine atony

Tissue

Retained placenta/clots

Trauma

Lacerations of vagina/cervix/uterus

Thrombin

Clotting disorders (coagulopathy)

Traction

Uterine inversion

PPH early nursing actions

Fundal massage, oxytocin, monitor VS

PPH severe management

IV fluids, blood transfusion, surgery

PPH advanced treatments

Balloon tamponade, uterine artery ligation, hysterectomy

PPH Trauma signs

Firm uterus + continuous trickling blood

Hematoma S/S

Severe pain, swelling, possible shock

Hematoma treatment

Ice if small, surgery if large

Uterine inversion definition

Uterus turns inside out after delivery

Uterine inversion S/S

Severe pain, shock, visible inversion

Uterine inversion treatment

Immediate manual replacement + surgery if needed