NCM 109 - Bleeding in Pregnancy

Abortion, Ectopic pregnancy

Enumerate bleding causes/complications during first-trimester

Hydatidiform mole, Incompetent cervical os

Enumerate bleding causes/complications during second-trimester

Placenta previa, Abruptio placenta

Enumerate bleding causes/complications during third-trimester

Abortion

Abortion refers to the termination or interruption of pregnancy before the fetus reaches viability

20 weeks gestation or fetal weight of 500g

viability is defined as reaching

Therapeutic , Elective, Spontaneous

Enumerate 3 General Classification of Abortion

Therapeutic Abortion

is also referred to as induced, medical, intentional, or criminal abortion. It involves the deliberate termination of pregnancy. It may be recommended by healthcare providers to protect the mother's physical or mental health.

Elective Abortion

is initiated based on personal choice. Examples include an unintended pregnancy, teenage pregnancy, and pregnancy occurring among women engaged in prostitution

Spontaneous Abortion

also known as miscarriage, refers to pregnancy loss caused by natural factors

Ab fetal dev, immune fcators, implantation ab, alcohol, infection

Causes of Abortion

early miscarriage

miscarriage that occurs before the 16th week of pregnancy

late miscarriage

miscarriage that occurs between the 16th and 20th weeks of pregnancy

Missed, Incomplete, Septic, Inevitable, Threatened, Complete, Habitual

Enumerate Types of Abortion

Missed Abortion

abortion occurs when the entire product of conception remains inside the uterus after fetal death

Vaginal spotting, Mild cramping, Disappearance of the signs of pregnancy

S/S of missed abortion

Fetal maceration

refers to the softening of fetal tissue after death

Dilatation and curettage, Dilatation and evacuation

The retained products of conception may be removed through:

misoprostol, then oxytocin or mifepristone

For pregnancies beyond 14 weeks, labor may be induced using (missed abortion management)

Incomplete Abortion

abortion occurs when some products of conception are expelled, usually the fetus, while portions of the placenta or membranes remain inside the uterus

Heavy vaginal bleeding, Severe uterine cramping, Cervical dilatation, Incomplete passage of tissue

S/S of inconplete abortion

Dilatation and curettage, oxytocin, Emotional support

management of incomplete abortion

Septic Abortion

abortion complicated by infection

Foul-smelling discharge, Uterine cramping, Fever

Antibiotic

management of septic abortion

Inevitable or Imminent Abortion

abortion occurs when the loss of the products of conception can no longer be prevented

Mod to profuse bleeding, Mod to severe uterine cramping, Cervical dilatation, Rupture of membranes

S/S of imminent/inevitable abortion

Dilatation and curettage, oxytocin, Emotional support

management of inevitable abortion

Threatened Abortion

abortion refers to a possible loss of the products of conception

Bright-red bleeding, Mild cramping, Backache, Absence of cervical dilatation

Bed rest, Saving used pads , Avoiding intercourse for two weeks after the bleeding

Management of threatened abortion

Complete Abortion

abortion occurs when the entire product of conception is expelled from the uterus

Min or light vaginal bleeding, Cramping, Cervical dilatation, Complete passage of tissue

S/S of complete abortion

Habitual Abortion

refers to pregnancy loss occurring during three or more successive pregnancies. It is also referred to as recurrent pregnancy loss

Fetal and Maternal

Causes of Spontaneous Abortion

Hemorrhage, Infection, Isoimmunization, Powerlessness or anxiety

enumerate Complications of Spontaneous Abortion

fundus massage, observe signs of shock, methergine/oxytocin

Hemorrhage management due to spontaneous abortion

Isoimmunization

occurs when an Rh-negative mother carries an Rh-positive fetus

Powerlessness or Anxiety

The woman's emotional adjustment following pregnancy

Ectopic Pregnancy

occurs when the fertilized ovum implants outside the uterine cavity

80%

Tubal locations rate of implantation in ampulla

12%

Tubal locations rate of implantation in isthmus

8%

Tubal locations rate of implantation in interstitial portion

UTZ, HCG, MRI

Diagnostics for ectopic pregnancy

Culdoscopy, Culdocentesis

Procedures for unruptured EP

Culdoscopy

Insertion of an instrument through the vaginal fornix to visualize blood

Culdocentesis

Aspiration of blood from the cul-de-sac

Methotrexate

a folic acid antagonist and chemotherapeutic agent that destroys rapidly growing cells'

Mifepristone

used to promote sloughing of the tubal implantation site

Hydatidiform Mole

a form of gestational trophoblastic disease commonly described as resembling a bunch of grapes because the chorionic villi develop into a mass of clear, fluid-filled vesicles and involves abnormal placental development and progressive degeneration and swelling of the chorionic villi

Complete Hydatidiform Mole

Type of H-Mole wherein all trophoblastic villi become swollen and cystic and when an embryo develops, it dies at a very early stage, usually when it measures only 1 to 2 millimeters. Fetal blood is absent from the villi.

Choriocarcinoma

malignant trophoblastic tumor that can spread rapidly and extensively. It may occur after approximately 15% to 20% of hydatidiform mole cases

Partial Hydatidiform Mole

Type of H-Mole wherein some chorionic villi develop normally, while others become swollen and abnormal

Suction curettage, Dilatation and curettage, Hysterectomy

surgical management of h-mole

Methotrexate

medical management for H-Mole

Incompetent Cervical OS

also known as premature cervical dilatation and is characterized by painless opening of the cervix without uterine contractions

modified Shirodkar procedure

described as more complicated and involves an anterior incision, placement of special Mersilene tape, and suturing of the cervical mucosa

Abruptio Placenta

premature separation of a normally implanted placenta and commonly occurs after the 20th week of pregnancy and may be accompanied by a rigid, tender, and irritable uterus.

Couvelaire uterus

may develop when blood infiltrates the uterine musculature. This produces a hard, boardlike uterus and may occur with or without visible vaginal bleeding

Placenta Previa

occurs when the placenta implants in the lower uterine segment instead of the upper portion of the uterus.

Low-Lying Placenta Previa

The placenta implants in the lower portion of the uterus but does not reach the cervical opening.'

Marginal Placenta Previa

The placental edge approaches or lies close to the internal cervical os

Partial Placenta Previa

A portion of the placenta covers part of the internal cervical os.

Complete Placenta Previa

The placenta completely covers and obstructs the internal cervical os

Bethamethasone

may be administered to accelerate fetal lung maturity when preterm birth is anticipated. It may be given 12 to 24 hours before birth when delivery is expected at approximately 34 weeks