Week 7 n360 ch28 antepartal hemorrhagic
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Transcript of Week 7 n360 ch28 antepartal hemorrhagic
Chapter 28Chapter 28Antepartal Hemorrhagic Disorders
Mosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 1
Antepartal Hemorrhagic Antepartal Hemorrhagic Disorders Disorders Bleeding in pregnancy
jeopardizes both maternal and fetal well-being
Maternal blood loss decreases oxygen-carrying capacity, increases risk for:
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Antepartal Hemorrhagic Antepartal Hemorrhagic Disorders Disorders Fetal risks from maternal
hemorrhage◦Blood loss, anemia◦Hypoxemia ◦Hypoxia◦Anoxia◦Preterm birth
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Antepartal Hemorrhagic Antepartal Hemorrhagic Disorders Disorders
Remember:In pregnancy, increases in plasma
volume and red blood cell mass serve to
So:Hemorrhagic disorders in pregnancy
are medical emergenciesMosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
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Timing of Hemorrhagic Timing of Hemorrhagic DisordersDisorders
Early Pregnancy Bleeding◦Miscarriage◦Premature dilation of cervix◦Ectopic pregnancy◦Hydatidiform mole
Late Pregnancy Bleeding◦Placenta previa◦Abruptio placentae◦Cord insertion and placental variations◦Clotting disorders in pregnancy
Early Pregnancy Bleeding Early Pregnancy Bleeding Miscarriage (spontaneous abortion, SAB)
before 20 weeks, fetal weight less than 500g◦Incidence and etiology◦Types
Threatened, inevitable, incomplete, complete and missed
◦Clinical manifestations◦Care management
HCG levels, U/S Dilation and curettage ( D&C) Misoprostol (Cytotec), prostaglandins Psychosocial care
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Early Pregnancy BleedingEarly Pregnancy BleedingIncompetent cervix (recurrent
premature dilation of cervix)◦Etiology
Short cervix, previous cervical trauma or procedure, multiple gestation
◦Collaborative care Conservative management- bedrest, hydration
and tocolysis, antibiotics, antiinflammatory drugs
Cervical cerclage placement -11-15 weeks U/S
Early Pregnancy Bleeding Early Pregnancy Bleeding Ectopic pregnancy ( gestational
sac is implanted outside the uterine cavity)◦Incidence and etiology◦Clinical manifestations◦Collaborative care
Hospital care Home care
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Early Pregnancy Bleeding Early Pregnancy Bleeding Hydatidiform mole (molar
pregnancy)◦Gestational trophoblastic disease◦Two types
Complete Partial
◦Incidence and etiology◦Clinical manifestations◦Collaborative care
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Late Pregnancy Bleeding Late Pregnancy Bleeding Placenta previa
◦Placenta abnormally implants in lower uterine segment near or over internal cervical os
◦Degree to which the internal cervical os is covered by placenta used to classify types Complete (Total) placenta previa Partial placental previa Marginal placenta previa
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Late Pregnancy Bleeding Late Pregnancy Bleeding Placenta previa―continued
◦1 in 200 pregnancies at term◦Clinical manifestations
Painless bright red vaginal bleeding occurs in 70% of women in 2nd or 3rd trimester
◦Maternal and fetal outcomes Maternal complications: hemorrhage Fetal mortality risk is related to preterm
birthMosby items and derived items © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.
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Late Pregnancy BleedingLate Pregnancy BleedingPlacenta previa—continued
◦Hospital care Active management Expectant management
◦Home care Limitation of activities Fetal monitoring
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Late Pregnancy Bleeding Late Pregnancy Bleeding Premature separation of placenta
(abruptio placentae)◦1 in 75 to 1 in 226 of pregnancies◦Detachment of part or all of placenta
from implantation site◦Accounts for significant maternal and
fetal morbidity and mortality◦Classification systems
Grades 1, Grade 2, Grade 3
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Slide 16
Late Pregnancy Bleeding Late Pregnancy Bleeding Premature separation of placenta
(abruptio placentae)―continued◦Clinical manifestations
Separation may be partial, complete, or only involve margin of placenta
◦Maternal/perinatal outcomes Maternal- 1% mortality rate-leading cause
of maternal death Perinatal- 20%-30% mortality rate
◦Hospital care
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Slide 17
Late Pregnancy Bleeding Late Pregnancy Bleeding Cord insertion and placental variations
◦Velamentous insertion of the cord: rare placental anomaly associated with placenta previa and multiple gestation Cord vessels branch at membranes and then
onto placenta ◦Battledore insertion of cord: marginal
insertion Risk for fetal hemorrhage
◦Succenturiate placenta: rare. Divided into two or more separate lobes
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Slide 18
Late Pregnancy Bleeding Late Pregnancy Bleeding Clotting Disorders in Clotting Disorders in PregnancyPregnancy Normal clotting
◦Hemostatic system stops flow of blood from injured vessels,
first by a platelet plug, then formation of a fibrin clot.
◦Fibrinolytic system Process through which fibrin is split into
fibrinolytic degradation products and circulation is restored
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Late Pregnancy Bleeding Late Pregnancy Bleeding Clotting Disorders in Clotting Disorders in PregnancyPregnancyClotting problems
◦Concern is in immediate postpartum period
◦Recognition in antepartal period may decrease hemorrhagic problems
◦Disseminated Intravascular Coagulation (DIC) Pathologic form of diffuse clotting that
consumes large amounts of clotting factors, causing widespread external bleeding, internal bleeding, or both
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Slide 20
ATI QuestionA nurse is caring for a patient who
has been diagnosed with placenta previa. The nurse should expect which of the following findings?a. painful vaginal bleedingb. late fetal decelerationsc. painless vaginal bleedingd. early fetal decelerations
Key Points Key Points Blood loss during pregnancy should
always be regarded as warning sign until cause is determined
Some miscarriages occur for unknown reasons, but fetal or placental maldevelopment and maternal factors account for many others
Type of miscarriage directs care management
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Slide 22
Key Points Key Points Ectopic pregnancy is a significant
cause of maternal morbidity and mortality, even in developed countries
Two distinctive types of hydatidiform mole: complete and partial
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Slide 23
Key Points Key Points Premature separation of placenta
and placenta previa are differentiated by: ◦Type of bleeding◦Uterine tonicity◦Presence or absence of pain
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Slide 24
Key Points Key Points Clotting disorders are associated
with many obstetric complications
Management of late pregnancy bleeding requires immediate evaluation; care based on: ◦Gestational age◦Amount of bleeding◦Fetal condition
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