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Bleeding disorders, also known as coagulopathy, are conditions that affect your body’s ability to
clot normally at the site of an injury, resulting in bleeding that can range from mild to severe.
The bleeding can be inside or outside the body.
During pregnancy, bleeding disorders can pose serious risks to the mother and baby.
Most bleeding disorders are inherited. Others are acquired, meaning they may develop at any
time, in some cases as a result of pregnancy.
Bleeding disorders may be diagnosed through blood tests or by clinical symptoms and signs.
Eclampsia
Medical Author:
The most common sign of preeclampsia is elevated blood pressure and is also
found in eclampsia. Again, the patient may be unaware that she is hypertensive.
Blood pressure may be only minimally elevated, or it can be dangerously high.
The degree of blood pressure elevation varies from woman to woman, and also
varies during the progression and resolution of the disease process. Some
women never have significant blood pressure elevation (including
approximately 20% of women with eclampsia).
A common belief is that the risk of eclampsia rises as blood pressure increases
above 160/110 mm Hg.
The kidneys may be unable to filter the blood efficiently. There may also be an
abnormal excretion of protein in the urine. The first sign of excess urinary
protein is usually determined on a urine specimen obtained at the time of a
routine prenatal visit. It is unusual for a patient to experience symptoms related
to excess urinary protein loss. In rare cases there may be excretion of a large
amount of urinary protein.
Nervous system changes can include blurred vision, seeing spots,
severe headaches, convulsions, and, occasionally, blindness. Any of these
symptoms require immediate medical attention, preferably at a hospital which
provides obstetrical care, as the emergent delivery of the infant may be
required.
Changes that affect the liver can cause pain in the upper abdomen. This pain
may be confused with the pain of indigestion or gall bladder disease. Other
more subtle changes that affect the liver can alter platelet function, thus
compromising the ability of the blood to clot. Excess bruising may be a sign of
impaired platelet activity.
The hypertension that is characteristic of preeclampsia can diminish placental
blood flow, thus impairing fetal development. As a result, the baby may not
grow properly and may be smaller than anticipated. In severe cases, fetal
movements may be lessened as a result of impaired oxygenation of the fetus. A
patient should call her physician immediately if she notices a marked decrease
in fetal movement.
If a pregnant woman has questions regarding her health or that of her baby.
If a pregnant woman has severe or persistent headaches or any visual
disturbance, such as double vision or seeing spots (This may be a harbinger of
impending eclampsia).
If, during pregnancy, the blood pressure rises above 160/110 mm Hg.
If a pregnant woman has severe pain in the middle of their abdomen or on the
right side of the abdomen under the rib cage. (This may indicate swelling and
possible rupture of the liver).
If there is any unusual bruising or bleeding during pregnancy.
If there is excessive swelling or weight gain during pregnancy.
If there has been a marked decrease in fetal activity.
If increasing vaginal bleeding or severe abdominal cramping is noted during
pregnancy.
Seizure treatment
Once the mother's condition is stabilized following a seizure, the physician will
prepare for emergent delivery of the infant. This can occur by either cesarean section
or induction of labor and vaginal delivery. If the patient is already in labor, labor can
be allowed to progress provided there is no evidence that the baby has become
"distressed " or compromised by the seizure.
Patients may require medication to treat high blood pressure during labor
and/or after delivery. Hydralazine
(Apersoline), labetalol (Normodyne, Trandate), and nifedipine are commonly
used products to reduce blood pressure to systolic levels below 160 mm Hg. It
is unusual to require medication for high blood pressure beyond six weeks post-
partum unless the patient has a problem with hypertension that is unrelated to
the pregnancy.
Medication to deliver the baby
The closer the patient is to her due date, the more likely her cervix will be favorable
for delivery, and that induction of labor will be successful. Sometimes medications,
such as oxytocin (Pitocin), are given to induce or shorten labor.
If the pregnancy is less than 34 weeks of gestational age, it is less likely that
induction of labor will be successful (although induction is still possible). More
commonly a Cesarean section will be necessary to forestall a bad outcome.
If the baby shows signs of compromise, such as decreased fetal heart rate, an
immediate cesarean delivery should be performed.
Some patients may be given intramuscular steroids to mature the fetal lungsif
the fetal gestational age is less than 32 weeks.
Most babies do well. Babies born prematurely will usually stay in the hospital longer.
A rule of thumb is to expect the baby to stay in the hospital until their due date.
Just as there were no tests to predict or prevent eclampsia, there are no tests to predict
whether preeclampsia or eclampsia will recur in a subsequent pregnancy.
Unfortunately, in a small number of women, preeclampsia and/or eclampsia will
recur. This chance seems to increase if the preeclampsia or eclampsia was particularly
severe in the previous pregnancy, occurred very early in that pregnancy (late second
trimester or early third trimester), or there is a new father for the subsequent
pregnancy. Because there are no tests to predict recurrent preeclampsia/eclampsia, a
previously affected patient should be followed more closely during a subsequent
pregnancy.
Source:
https://women.texaschildrens.org/program/high-risk-pregnancy-care/conditions/bleeding-disorders-and-
pregnancy
https://www.emedicinehealth.com/eclampsia/article_em.htm#what_is_the_prognosis_for_a_woman_with
_eclampsia