VAGINAL BLEEDING IN - Systemic diseases

PREGNANCY - Environmental hazards

- Potentially life-threatening - RH incompatibility
- Always a deviation from the normal. - Uterus or cervix infections
- May occur at any point during can be dangerous to a
pregnancy. developing baby and lead to
miscarriage
Conditions associated with early bleeding: - Other infections that may
- Spontaneous abortion pass to the baby or placenta
- Ectopic Pregnancy can also affect a developing
- Gestational Trophoblastic Disease pregnancy and may lead to
- Cervical Insufficiency loss.
- Listeria, Rubella, herpes
ABORTION simplex, Cytomegalovirus.
- Any interruption of a pregnancy
before a fetus is viable Types of Spontaneous Abortion
1.) Threatened
Viable Fetus o During the first 20 weeks of
- Able to survive outside the uterus if pregnancy.
born at that time o Bleeding: Slight/Scant,
- Fetus of more than 20 to 24 gestation Usually, Bright Red.
- One that weighs at least 500 g o Abdominal Cramps: May or
- A fetus born before this point is may not be present
considered a miscarriage of o Cervical Dilation: none
premature or immature birth. o Tissue Passage: None
o Fever: No
Types of Abortion o Diagnosis
a. Spontaneous
 Vaginal ultrasound to
- Without medical or mechanical
confirm if sac is
intervention
empty
 Declining maternal
Causes of Spontaneous Abortion
serum hCG and
a.) Defective ovum/congenital
progesterone levels
defects
o Therapeutic Management
- Most common type
b.) Unknown Causes  Conservative
c.) Maternal Causes supportive treatment
- Viral Infection  Avoidance of
- Malnutrition strenuous activity for
- Trauma 24 to 48 hours
- Congenital Defects  Coitus may be
- Incompetent Cervix (most restricted for 2 weeks.
common cause of habitual 2.) Inevitable/Imminent
abortion) o Most often the product of
- Hormonal conception is not expelled
- Increase temperature o Most common in 1st
Trimester
 o Bleeding: Moderate o No therapy other than
o Abdominal Cramps: advising the woman to
Moderate report heavy bleeding.
o Cervical Dilation: Open o Bleeding: Small to
o Tissue Passage: None negative
o Fever: No o Abdominal Cramps:
o Medication: Moderate
 Misoprostol o Cervical Dilation:
(CYTOTEC) Partially Open
 Stimulates o Tissue Passage: The
uterine entire products of
contractions to conception
terminate o Fever: No
pregnancy o Diagnosis
 Mifepristone (RU- o Ultrasound
486) demonstrating an
 Acts as empty uterus.
progesterone o Therapeutic Management
antagonist o No medical or
 Allowing surgical
prostaglandins intervention
to stimulate necessary.
uterine 4.) Incomplete
contractions o Danger of maternal
 May be hemorrhage
followed by o Bleeding: Severe (bleeds the
administration most)
of misoprostol o Abdominal Cramps: Severe
within 48hrs. o Cervical Dilation: Open with
o Diagnosis tissue in the cervix
 Ultrasound and o Tissue Passage: Part of the
hCG levels to conceptus (usually the fetus)
indicate o Fever: No
pregnancy loss o Diagnosis:
o Therapeutic Management
 Ultrasound
 Medication confirmation that
(Misoprosol) to products of
help the conception still in
pregnancy pass uterus.
 Dilatation and o Therapeutic Management
Curettage (D&C)
 Evacuation of uterus
3.) Complete
via dilatation and
o Bleeding usually slows
curettage (D&C) or
within 2hrs and then prostaglandin analog
ceases within a few days 5.) Missed
 o Commonly referred to as
early pregnancy failure
o Fetus dies in utero but is not
expelled
o Bleeding: None (painless
vaginal bleeding)
o Abdominal Cramps: None
(No fetal heart rate) (No
increase in size)
o Cervical Dilation: none
o Tissue Passage: None
o Fever: No
o Diagnosis
 Ultrasound to identify
products of
conception in uterus
 Often the embryo
actually died 4-6
weeks before the
onset of miscarriage
symptoms or failure
of growth was noted
o Therapeutic Management:
 If no heart rate: D&C
may be done to
evacuate the
pregnancy
 If the pregnancy is
over 14 weeks:
Prostaglandin
suppository or
misoprostol followed
by oxytocin
stimulation or
administration of
Mifepristone
6.) Habitual
o May represent signs of any of
the above, usually detected in
the threatened phase.
o Cervical closure may be
employed
 McDonald Surgery
 Shirodkar-Barter
Surgery
o Diagnosis
 Validation via client’s
history
o Therapeutic Management
 Identification and
treatment of
underlying cause
 Cervical cerclage in
second trimester if
incompetent cervix is
the cause
7.) Septic
o Bleeding: Mild to severe
o Abdominal Cramps: Severe
o Cervical Dilation: Close or
open, with or without tissue
o Tissue Passage: Possibly
foul, discharge
o Fever: YES
b. Induced
- With medical or mechanical
intervention.
Signs of Abortion
a. Vaginal bleeding/spotting
- Mild to severe
b. Uterine/abdominal cramps/pain in
the lower back.
- Mild to severe
- Constant or intermittent.
c. Passage of tissues or products of
conception
- The tissue and heaviest bleeding
should be passed in about 3-5 hours.
d. Signs related to blood loss/shock
Emergency Interventions
- Alert healthcare team of emergency
situation
- Urge patient to rest in a side-lying
position.
- Begin intravenous fluid
- Administer oxygen
- Monitor uterine contractions and
Fetal Heart Rate
- Omit vaginal examination
- Nothing per Orem.
- Order type and cross-match of 2
units of whole blood
- Measure I and O
- Assess vital signs
- Measure maternal blood loss by
weighing perineal pads; save any
tissue passed