Reproduction:Bleeding in Pregnancy (spontaneous aboriton, ectopic pregnancy, placentaprevia, abruptio placentae), Hyperemesis gravidarum, Hypertensive disorders of pregnancy(preeclampsia, eclampsia, HELLP syndrome), DICCommon factors that might place a pregnancy at high risk:Anything that puts Mom & Baby at riskIncreases morbidity & mortalityMay be due to pregnancy or result off condition present before pregnancyBiophysical factors:Age, pre-existing conditions (HTN, <3 disease, DM), chromosomalPsychosocial factors:Addictive behaviorsSociodemographic factors:Economic, access to healthcare (urban vs. rural), insuranceEnvironmental factors:Secondhand smoke, chemical exposure, pollutionMost significant factor for Mom…biophysical factors b/c cannot changeMost significant factor from nursing perspective…Compare & contrast the causes of vaginal bleeding during early and late pregnancy:Early bleeding:Spontaneous abortion/miscarriage, ectopic pregnancyLate bleeding:Placenta previa, abruptio placentaeEarly Bleeding:Ectopic pregnancy:Pregnancy outside of the uterusSpontaneous abortion:A miscarriage. Loss of fetus from natural causes. Cause unknown &highly variable. Many causes. If occurs in earlier part of pregnancy, typically d/t abnormality withthe fetus. (If in 1sttrimester.) Often genetic, chromosomal problems. Reassure that it’s nothing thatMom did. If more in 2ndtrimester, other causes typically. S/sx: Vaginal bleeding,cramping/contractionsEctopic pregnancy:Anywhere outside the uterus. Results in an emergency. Rare cases, in theabdomen been able to deliver at some point. Any place else, is severely problematic. Mostcommon place to occur is in the fallopian tubes. Eventually the fallopian tube ruptures. This leadsto infection and peritonitis. AN EMERGENCY if it gets to this point. Typically d/t something slowingdown the passage of egg from ovary to uterus. Caused by: In tubes, scar tissue from STIs,endometriosis possibly. Sx: Severe, sharp, sudden pain, feeling faint, shoulder pain, hypotension,abd tender. Very early – if in tubes, 6-8 weeks when woman feels sx.Late Bleeding:Placentae previa:Several classifications: Low-lying, edge of os, partial, complete. Causeunknown. Interesting risk factor: # of c-sections. Can result in serious problems for Mom andBaby. Interruption of placenta impairs oxygenation.Abruptio placentae:Placenta separates from uterus. Typically occurs after 20 weeks. Can leadto hemorrhage. High mortality rate for Mom & Baby. Cause unknown. Peaks about 24-26 weeks.Lots of risk factors. Can abrupt behind the placenta (may not see any bleeding). Amount of blooddepends on degree of abruption. Often someone will come in with a little clot behind the placenta,monitored by US…fairly common. If someone actually has an abruption, very serious problem.
