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Definition
Vaginal bleeding during pregnancy can be scary. Its common, however, and it isnt
always a sign of trouble. Most women who experience vaginal bleeding during
pregnancy particularly during the first trimester (weeks one through 12) go on to
deliver healthy babies.
Still, its important to take vaginal bleeding during pregnancy seriously. Sometimes
vaginal bleeding during pregnancy indicates an impending miscarriage or a problem that
needs prompt treatment. By understanding the most common causes of vaginal bleeding
during pregnancy, youll know what to look for and when to contact your health care
provider.
Causes
Vaginal bleeding during pregnancy has many causes. Some are serious, and some arent.
First trimester
Possible causes of vaginal bleeding during the first trimester include:
- Cervical cancer
- Cervical changes, including more blood flow to the cervix and softening of the cervix,
which may result in harmless vaginal bleeding after sex or a pelvic exam
- Ectopic pregnancy
- Implantation bleeding, which occurs about 10 to 14 days after fertilization when the
fertilized egg attaches to the lining of the uterus
- Miscarriage
- Some cervical infections
Second or third trimester
Possible causes of vaginal bleeding during the second or third trimester include:
Miscarriage
Placenta previa
Placental abruption
Premature opening of the cervix (cervical insufficiency), which can lead to preterm birth
Problems with the cervix, such as a cervical infection, inflamed cervix or growths on the
cervix
Placental Abruption
The placenta is attached to the uterine wall. separation of the placenta from the inner wall
of the uterus before the baby is delivered. It may detach from the wall before or during
labor. This may cause vaginal bleeding. It often causes pain, even if bleeding is light or
not seen.It may be classified as partial,complete,or marginal.
Types of placental abruption. (A) Revealed placental abruption, where blood tracks
between the membranes, and escapes through the vagina and cervix. (B) Concealed
placental abruption where blood collects behind the placenta, with no evidence of vaginal
bleeding
When the placenta becomes detached, the fetus may get less oxygen and nutrients . This
can pose a danger. The larger the area that detaches, the greater the amount of bleeding.
Placental abruption occurs about once in every 120 births. It is also called abruptio
placenta.
cigarette smoking
multiple pregnancy
Nursing assessment
1. Determine the amount and type of bleeding and the presence or absence of pain.
2. Monitor maternal and fetal vital signs ,especially maternal Bp ,pulse ,fetal heart rate.
Nursing Diagnosis::
- Ineffective tissue perfusion:placental related to excessive bleeding,hypotention,and
decreased cardiac output,causing fetal compromise.
- Deficient fluid volume related to excessive bleeding.
- Fear related to excessive bleeding,procedures,and unknown outcome.
Nursing Intervention
1. Maintaining tissue perfusion by: Evaluate amount of bleeding by weighing all
pads,monitor CBC and v/s.
Position in left lateral position,with the head elevated to enhance placenta perfusion.
Maintain oxygen saturation level above 90% by using pulse oximetry monitoring.
Evaluate fetal status with continuous external fetal monitoring.
Encourage relaxation techniques.
Prepare for possible cesarean delivery if maternal or compromise is evident.
2. Maintaining fluid volume by :Maintain large bore I.V line for fluids and blood
products,Evaluate coagulation studies,Monitor maternal v/s and contractions,Monitor
vaginal bleeding .
3. Decreasing fear by :Inform the women and her family about the status of her-self and
the fetus,Explain all procedures in advance when possible,Answer questions in a calm
manner using simple terms,Encourage the presence of asupport person.
Placenta Previa
When the placenta lies low in the uterus, it may cover the cervix, condition in which the
placenta attaches to the uterine wall in the lower portion of the uterus and covers all or
part of the cervix. That means it partly or completely blocks the opening. This is called
placenta previa. It may cause vaginal bleeding. This type of bleeding often occurs
without pain.
Placenta previa occurs in 1 in 200 women. It is more common in those who Causes
placenta previa:
The cause of placenta previa is unknown, but it is associated with certain conditions
including the following
women who have scarring of the uterine wall from previous pregnancies
women who have fibroids or other abnormalities of the uterus
women who have had previous uterine surgeries or cesarean deliveries
older mothers (over age 35)
African-American or other minority race mothers
cigarette smoking
placenta previa in a previous pregnancy
Previous abortion
Multiple births
Preventing infection:
13. Use septic technique when providing care .
14. Evaluate white blood cell (WBC) .
15. Teach perineal care and hand-washing techniques.
16. Assess odor of all vaginal bleeding or lochia.
Decreasing anxiety:
17. Explain all treatments and procedures ,and answer all related questions.
18. Provide information on a cesarean delivery ,and prepare patient emotionally.
19. Encourage verbalization of feelings by patient and family .
20. Inform the women and her support persons that long term hospitalization or
prolonged bed rest may be necessary and inform them of the effects.
- Women who have had placenta previa at risk for postpartum hemorrhage because of the
decrease contractility of the lower uterine segment .
Like placental abruption, placenta previa is a serious condition that needs to be treated
quickly.
Spontaneous abortion
Is the unintended termination of pregnancy at any time before the fetus has attained
viability (20 weeks gestation or fetal weight of more than 500g)
Causes of Spontaneous abortion
1. Cause frequently unknown ,but 50% are due to chromosomal anomalies
2. Poor maternal nutritional status.
3. Maternal illness with virus ,such as rubella ,active herpes ,and toxoplasmosis .
4. History of diabetes ,thyroid disease.
5. Smoking or drug abuse or both .
6. Post mature sperm or ova .
3. Establish and maintain an I.V with large bore catheter for possible transfusion and
large quantities of fluid replacement.
2. Preventing infection:
1. Evaluate temperature every 4 hours if normal ,and every 1 to 2 hours if elevated .
2. Check vaginal drainage for increased amount and odor,which may indicate infection .
3. Instruct on and encourage perineal care after each urination and defecation to prevent
contamination.
3. Promoting comfort:
1. Instruct patient on the cause of pain to decrease anxiety .
2. Instruct and encourage the use of relaxation techniques to augment analgesics.
3. Administer pain medications as needed and as prescribed.
Ectopic pregnancy
An ectopic pregnancy is one in which the fertilized egg implants in tissue outside of the
uterus and the placenta and fetus begin to develop there. The most common site is within
a Fallopian tube(96% of ectopic pregnancies occur in fallopian tube), the term (tubal)
pregnancy is commonly used, however, ectopic pregnancies can occur in the ovary, the
abdomen, and in the lower portion of the uterus (the cervix)
3. Structural factors that prevent or delay the passage of the fertilized ovum include
adhesions of the tube ,congenital and developmental anomalies of the fallopian or uterine
tube .
4. Previous ectopic pregnancy.
5. Use of an intrauterine device for more than 2 years .
6. Multiple induced elective abortions .
7. Functional factors include menstrual reflux and decrease tubal motility.
8. Maternal age and race , previous tubal surgery ,history of pelvic inflammatory disease
,surgical correction of fallopian tube occlusions.
1. Establish an I.V line with a large-bore catheter ,and infuse fluids and packed RBCs as
prescribed .
2. Obtain blood samples for complete blood count (CBC) and type and screen for whole
blood ,as directed.
3. Monitor vital signs and urine output frequently ,depending on condition .
Promoting comfort :
1. Administer analgesic as needed and prescribed .
2. Encourage the use of relaxation techniques .
Providing support through the grieving process :
1. Be available to patient and provide emotional support .
2. Listen to concerns of patient and significant others.
3. Be aware that family may be experiencing denial or other stage of grieving .
Hydatidiform mole
Hydatidiform mole (gestational trophoblastic disease) is an abnormal pregnancy resulting
from a developmental anomaly of the placenta ,It is characterized by the conversion of
the chorionic villi into a mass of clear vesicles .there may be no fetus , or a degenerating
fetus may be present , In this type of mole, the abnormal placental tissue has villi, clusters
of tissue ,swollen with fluid, giving it the appearance of a cluster of grapes
If a fetus begins to develop along with a hydatidiform mole, it typically has many
malformations and almost never can be delivered as a living baby
. The mole develops for a while the same as a normal pregnancy but there is no embryo.
Only the placenta develops and, because of this, the hormones develop which will make a
woman feel pregnant, and also test positive.
This condition may be picked up by a routine ultrasound scan.
2. Assess the amount and type of vaginal bleeding ,note the presence of any other vaginal
discharge .
3. Assess the urine for the presence of protein.
4. Palpate uterine height .
5. Determine date of last menstrual period and date of positive pregnancy test.
6. Evaluate CBC results and Rh type.
Source: http://www.nursing-lectures.com/2011/09/bleeding-during-pregnancy-and-nursingcare-plan.html