High Risk Pregnancy

Hemorrhagic Disorders
General Management
CBR
Avoid sex
Assess for bleeding (per pad 30 – 40cc) (wt – 1gm =1cc)
Ultrasound to determine integrity of sac
Signs of Hypovolemic shock
Save discharges – for histopathology – to determine if product of
conception has been expelled or not

First Trimester Bleeding – abortion or eptopic

A. Abortions – termination of pregnancy before age of viability (before 20 weeks)
Spontaneous Abortion- miscarriage
Cause:
1.) chromosomal alterations
2.) blighted ovum
3.) plasma germ defect

Classifications:
a. Threatened – pregnancy is jeopardized by bleeding and cramping but the cervix is closed

b. Inevitable – moderate bleeding, cramping, tissue protrudes form the cervix (Cervical
dilation)
Types:
- Complete – all products of conception are expelled. No mgt just
emotional support!
- Incomplete – Placental and membranes retained. Mgt: D&C
Incompetent cervix – abortion
McDonalds procedure – temporary circlage on cervix
S/E: infection. During delivery, circlage is
removed. NSD
Sheridan – permanent surgery cervix. CS
c. Habitual – 3 or more consecutive pregnancies result in abortion usually related to
incompetent cervix. Present 2nd trimester

d. Missed – fetus dies; product of conception remain in uterus 4 weeks or longer; signs of
pregnancy cease. (-) preg test, scanty dark brown bleeding
Mgt: induced labor with oxytocin or vacuum extraction
e. Induced Abortion – therapeutic abortion to save life of mom. Double effect choose
between lesser evil.
Ectopic Pregnancy – occurs when gestation is located outside the uterine cavity.
common site: tubal or ampular
Dangerous site - interstitial