REPUBLIC OF THE PHILIPPINES

University of Northern Philippines

College of Nursing

CARE OF THE MOTHER AND CHILD WITH OR AT RISK FOR PROBLEM

-Lewis Paul Sablay, RN, USRN-

BLEEDING DURING PREGNANCY

Spontaneous Abortion
Abortion- is the expulsion of the products of conception or embryonic demise before the age of viability (usually 20 weeks AOG)
Spontaneous abortion- also known as miscarriage
 It is a natural death of the embryo.
 Risk factors:
o Infections
o Lifestyle
o Genetics
o Occupational/chemical factors
o Autoimmune disorder
o Endocrine
o Structural
 Signs and symptoms:
o Abdominal cramp
o Passing of clot or fetal tissues
o Sonographic confirmation
Types of Miscarriage
TYPES S/SX NURSING MANAGEMENT
DIAGNOSES
THREATENED ABORTION Vaginal bleeding with no passage 1. Grieving  Bed rest
or loss of the embryo or fetus 2. Risk for altered family  Tocolytics
and the cervical os is closed. processes/role  Nutritional support
performance  Prenatal
3. Situational low self- supplementation
esteem  Risk reduction (eg.
4. Risk for spiritual distress Smoking cessation,
5. Deficient knowledge lifestyle changes)
6. Risk for infection (for  Emotional support
 IMMINENT/INEVITABLE Presence of an open internal os missed abortion)  Bed rest
ABORTION in the presence of bleeding in the 7. Risk for decreased  Tocolytics
first trimester of pregnancy. cardiac output (for  Emotional support
Most often the conception missed abortion)
products are not expelled and 8. Impaired tissue perfusion
intracervical contents are present (missed abortion)
at the time of examination.
COMPLETE ABORTION A history of vaginal bleeding,  No surgical
abdominal pain, and passage of interventions needed
tissue exists. After the tissue  Emotional support
passes, the patient notes that the and counselling.
pain subsides and the vaginal
bleeding significantly diminishes.
The examination reveals some
blood in the vaginal vault; a
closed cervical os; and no
tenderness of the cervix, uterus,
adnexa, or abdomen. The
ultrasound demonstrates an
empty uterus.
MISSED ABORTION A missed abortion is a nonviable  Completion
intrauterine pregnancy that has curettage
been retained within the uterus  Antibiotics
without spontaneous abortion.  Oxytocic or uterine
There is no signs or symptoms tonic
other than amenorrhea, no  Emotional support
noticeable progress of pregnancy
and on UTZ, no heart tone is
appreciable.

RECURRENT PREGNANCY LOSS  Counselling

(RPL)
Defined as the loss of 3
consecutive pregnancies prior to
20 weeks AOG.
Also known as the habitual
abortion
 COMPLICATIONS OF MISCCARIAGE

COMPLICATION SIGNS AND SYMPTOMS MANAGEMENT

Hemorrhage 1. Profuse bleeding 1. Monitor vital signs
 Usually happens when a piece or 2. Uterine non-involution 2. Initiate IV line
pieces of tissue are retained in 3. Decreasing hematocrit/hemoglobin 3. Coordinate for curettage
the uterus count 4. Monitor H & H
 Uterine contraction is not 4. Decreasing blood pressure 5. Request for blood typing
initiated, is necessary in 5. Cold, clammy skin 6. Blood transfusion (PRBC; FFP)
controlling bleeding by 6. Pallor and pale conjunctivae 7. Antibiotics
constricting blood vessels 7. Signs of shock 8. Blood volume expanders
9. Vasopressors
10. Oxytocics
11. “E” D & C or hysterectomy

Infection 1. Fever 1. Monitor vital signs

 Usually caused by retained conceptus 2. Bleeding 2. Assess CBC count
or maybe an insertion of foreign 3. Increasing WBC count 3. Culture and sensitivity
object (for intentional abortion) 4. Foul-smelling vaginal discharge 4. Initiate IV line
5. Antibiotics
6. Completion curettage
Septic abortion 1. High-grade fever 1. Monitor vital signs
 Usually caused by the bacterial 2. Chills 2. Completion curettage, if retained
degeneration of conceptus 3. Severe abdominal pain which may conceptus is suspected.
 The infection usually spreads to the progress to board-like abdomen 3. IV line
uterus and there is high chance of 4. Heavy bleeding 4. Culture and sensitivity
spreading systemically and may 5. Foul-vaginal discharge 5. Vasopressors
cause damage to distant organs. 6. Backache or pressure on the back 6. Antipyretics
7. Signs of shock 7. Blood volume expanders
8. Uterine tonic (misoprostol,
ergometrine)
9. Broad spectrum antibiotics
10. Blood transfusion (if with signs of
shock)