Pregnancy Complications - 1

Vaginal Bleeding (before 20 weeks’ gestation)
It may be related to spontaneous abortion, ectopic pregnancy, or gestational trophoblastic disease.

Spontaneous Abortion
It is a loss of pregnancy before viability, clinical Findings:

  • Vaginal spotting (may pass clots)
  • Abdominal cramping
  • Cervical changes
  • Fetal heartbeat may be present or absent

Ectopic Pregnancy
It is a product of conception implant outside the uterus, clinical findings:

  • Vaginal spotting
  • hCG lower than expected for dates
  • Lower abdominal pain
  • Ultrasound findings: absence of intrauterine gestational sac
  • If rupture occurs, it would be: Positive Cullen’s sign (periumbilical bluish hue), Shoulder pain, and Signs of shock

Gestational Trophoblastic Disease
It is an abnormal proliferation of trophoblastic cells without viable fetus, Clinical Findings:

  • Vaginal spotting (dark brown)
  • Fundal height greater than expected for dates
  • hCG greater than expected for dates
  • Excessive nausea and vomiting
  • Absence of fetal heart tones
  • Ultrasound findings: Snowflake-like clusters, absence of fetus

Nursing Care (vaginal bleeding/early pregnancy)

  1. Monitor amount of bleeding
  2. Assess vital signs
  3. Observe for signs of shock
  4. Auscultate for fetal heart tones (FHTs)
  5. Collect passed tissue/clots
  6. Monitor patient comfort
  7. Check blood type and Rh factor
  8. Administer Rh(D) immunoglobulin if indicated
  9. Initiate IV fluids as ordered
  10. Report lab/ultrasound findings
  11. Attend to patient’s emotional needs


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