BLEEDING DURING

PREGNANCY
1ST TRIMESTER BLEEDING

ABORTION
Loss of pregnancy usually before 20th
week of pregnancy or before age of
viability (20-24 week)
Loss of fetus weighing 500 grams
SPONTANEOUS or INDUCED

ETIOLOGY AND PREDISPOSING

FACTORS
1st trimester Abortion Causes:
Abnormal embryonic development/
fetal genetic abnormalities
Chromosomal defects
Blood group and Rh incompatibility

ETIOLOGY AND PREDISPOSING

FACTORS
2nd trimester abortion Causes:
Incompetent Cervix
Congenital (Bicornuate uterus) or acquired
(myoma, fibroids or cysts)anomaly of uterine
cavity
Hypothyroidism, Type 1 DM, inadequate
progesterone
Immunologic factor: Antiphospholipid antibodies
Infections: Syphilis, Rubella, CMV, Herpes
simplex virus, bacterial vaginosis,
toxoplasmosis, intraabdominal infections

ETIOLOGY AND PREDISPOSING

FACTORS
Chronic nephritis
Systemic Lupus erythematosus
Use of cocaine

Types/ Categories

Threatened abortion
Inevitable abortion
Incomplete abortion
Complete abortion
Missed abortion
Habitual/Recurrent abortion

Threatened Abortion
- Vaginal bleeding but products of conception
(POC)are not expelled; under 16 weeks; late 1624 wks
- s/sx: slight bright red vaginal bleeding, no
cervical dilation or effacement, Mild abdominal
cramping,backkache closed cervical os, no
passage of fetal tissues
DX test:
1. Transvaginal USD confirm if gestational sac is
empty
2. Serum hCG and progesterone level decreasing
. Tx: CBR, control bleeding, analgesic

Inevitable/Imminent
Abortion
Abortion cannot be stopped when there is
rupture of membrane and dilation of
cervix
s/sx: vaginal bleeding greater than that of
threatened abortion, rupture of
membranes or BOW, cervical dilation,
strong,persistent abdominal cramping,
possible passage of POC
Dx: USD and hCG levels indicate

Inevitable Abortion
Tx:
1. Vacuum curettage (if POC are not
passed); reduce risk of excessive
bleeding and infection
2. Misoprostol prostaglandin analogs;
used to empty uterus or retained
tissues if fragments are not
completely passed
3. Oxtocin

Incomplete Abortion
Passage of some POC
s/sx: intense abdominal cramping,
heavy vaginal bleeding, cervical
dilation
Dx: USD (confirmation that POC still
in uterus)
Tx: D&C, oxytocin

Complete Abortion
Entire POC are expelled
spontaneously
s/sx: vaginal bleeding, abdominal
cramping, passage of fetal and
placental tissues, cervical dilation
Dx: USD, hgb&Hct, hCG
Tx: oxytocin and methylergonovine
maleate (stimulate uterine
contraction and control bleeding)

Missed Abortion
Fetus dies in utero without being expelled
S/sx: vaginal bleeding (dark-colored), absent
uterine contractions, signs and symptoms of
pregnancy disappears, uterus stops growing
Dx: USD hgb & Hct, bleeding and clotting
time
Tx: Suction Curretage (1st tri); D&C (2nd tri);
induction of labor with Prostaglandin analog
(vaginal suppository)/misoprostol- used to
empty uterus without surgical intervention;
HYSTERECTOMY (severe cases); antimicrobial
(if there is uterine infection)

Habitual/ Recurrent Abortion

Loss of 3 or more consecutive pregnancies
s/sx: clients history
Causes: genetic/ chromosomal disorders
(biconuate uterus and incompetent
cervix); endocrine problems (untreated
DM; immune factors (increase uterine NK
cells prevents formation of placenta)
TX: identification and tx of underlying
cause (genetic screening, identify and
treat immunologic factors, examination of
cervix and uterus, cervical cerclage) ; D&C

Complications
1. Hemorrhage (excessive bleeding)
Interventions:
a. Position woman in flat and massage
the uterus
b. Blood transfusion as ordered
c. Prepare for D&C/suction curettage
d. Administer methylergonovine
maleate (methergine) postpartum
as ordered

Complications
2. Infection (E. Coli)
Interventions:
a. Teach woman to watch out and report
signs and symptoms of infection (fever,
abdominal pain or tenderness, and foul
vaginal discharges)
b. Teach her wipe perineal area from front
to back
c. Caution her not to use tampons

Complications
3. Powerlessness (anxiety)
Interventions:
a. Assess womans adjustment to
spontaneous abortion

Complications
4. Isoimmunization
- If mother is Rh (negative) and fetus is
Rh (positive); blood from placental villi
enter maternal circulation
isoimmunization (mother produces
antibodies against Rh (+) blood of fetus
- Interventions: administer Rh (D antigen)
immune globulin (Rhogam) 72 hrs post
abortion prevent build up of antibodies

Medical Management
IV fluids to replace fluid loss
Blood transfusion replace blood loss

Nursing Assessment
Assess vital signs, amount and color
of bleeding (bright red and peripad
saturation in an hour are significant),
pain (abdominal cramping and level
of understanding about what is
happening)
When pregnant woman calls and
reports vaginal bleeding, she must
be seen ASAP by a health care
professional

Nursing Interventions

Monitor vaginal bleeding through pad counts

Observe passage of POC
Pain management
Provide emotional support (sensitive listening,
counselling and anticipatory guidance)
Allow to verbalize their feelings and ask
questions concerning pregnancies
Offer factual explanation of the cause (reassure
that spontaneous abortion usually result from an
abnormality and not her actions)
Assist woman in preparing for procedures and
treatment