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High-Risk Pregnancy

Bleeding Disorders of Pregnancy

First Trimester Bleeding

I Abortion- is the most common bleeding disorder of early pregnancy. Abortion is the termination of
pregnancy before viability that is, before 20 weeks.

• Abortus- a fetus that is aborted before it is 500 gms in weight.


• Blighted ovum- a small macerated fetus, sometimes there is no fetus, surrounded by a fluid inside
the sac.
• Maceration- a dead fetus undergoing necrosis.

• Early abortion- termination of pregnancy before 16 weeks.


• Late abortion- abortion that occurs between 16 to 20 weeks.

Causes of abortion:

• FETAL CAUSES
• The most common cause of early spontaneous abortion is abnormal development of the zygote,
embryo, and fetus.
• This abnormalities are incompatible with life and would have resulted to severe congenital
anomalies if pregnancy has not been aborted.

MATERNAL CAUSES
• These are congenital or acquired conditions of the mother and environmental factors that had
adversely affected the pregnancy outcome and led to abortion.
• Such conditions include DM, incompetent cervix, exposure to radiation and infection.

Types of abortion:
1. Threatened abortion- possible loss of product of conception
• Light vaginal bleeding
• None to mild uterine cramping
• Vaginal examination at this stage usually reveals a closed cervix. 25% to 50% of
threatened abortion eventually will result in loss of the pregnancy.
2. Inevitable abortion- the loss of the products of conception cannot be prevented
• Moderate to profuse bleeding, moderate to severe uterine cramping
• Open cervix
• Rupture of membrane
3. Complete abortion- spontaneous expulsion of the products of conception after the fetus has
died in utero
• Light bleeding
• Mild uterine cramping
• Passage of tissue
• Closed cervix
4. Incomplete abortion- expulsion of some parts and retention of other parts of conceptus in
uterus
• Heavy vaginal bleeding
• Severe uterine cramping
• Open cervix
• Passage of tissue
5. Missed abortion- retention of all products of conception after the death of the fetus in the
uterus
• No FHT
• Signs of pregnancy disappear
6. Habitual abortion- abortion occurring in 3 or more successive pregnancies
• The most common cause is a significant genetic abnormality of the conceptus.
7. Septic abortion- abortion complicated by infection
• Foul smelling vaginal discharge
• Uterine cramping
• Fever

Nursing responsibilities
1. Save all tissue passed (histopathology examination)
2. Strict bed rest and monitor bleeding
3. Increased fluid PO or IV as ordered
4. Prepare client for surgical intervention (D & C or suction evacuation) if needed