Pregnancy Complications - 2

Vaginal Bleeding (after 20 weeks’ gestation)

The complications may be related to placenta previa or abruptio placentae.

Placenta Previa

It is a low-lying position of placenta in the uterus that partially or completely covers the cervical os. Clinical Findings:

• Painless bright red vaginal bleeding
• Bleeding may be reported after intercourse
• Uterine tone soft upon palpation
• Interventions dependent on amount of bleeding and labor status
• If partial placenta previa is noted in early gestation, then repeat ultrasound later in pregnancy (may demonstrate absence of previa as uterus grows)
• If labor active and os is covered, then cesarean birth necessary
• If bleeding controlled and labor absent, then conservative management is applied

Patient Teaching (Conservative Management)

• No tampon use
• No sexual intercourse
• Monitor and report bleeding
• Patient instructed to report placenta placement when admitted to hospital
• Cesarean preparation class
• Count fetal movements

Abrupto Placentae

Clinical Findings

• Abdominal pain (sudden onset, intense and localized)
• Fundus firm, boardlike, with little relaxation
• Vaginal bleeding
• Bleeding may be concealed within the uterine cavity
• Fetal heart tones may be non-reassuring

Nursing Care (vaginal bleeding/late pregnancy)

1. Monitor amount of bleeding
2. Check vital signs
3. Observe for signs of shock
4. Evaluate fetal heart tones
5. Palpate uterine tone
6. Apply electronic fetal monitor (EFM)
7. REPORT alterations in fetal heart rate pattern
8. REPORT hypertonic contractions with poor resting tone
9. Do not attempt vaginal exam until placenta placement verified
10. Initiate IV fluids
11. Report laboratory and ultrasound findings
12. Prepare staff for possible cesarean birth
13. Attend to patient’s emotional needs

Placenta Abruptio

Placenta abruptio is premature separation of placenta from the uterine wall after 20 weeks of gestation and before the fetus is delivered.

Signs and Symptoms:

• Painful vaginal bleeding (dark red)
• Uterine rigidity and tenderness
• Severe abdominal pain
• Signs of maternal shock
• Signs of fetal distress

Nursing Interventions:

• Monitor maternal vital signs and fetal heart rate
• Assess for excessive vaginal bleeding, abdominal pain, and increase in fundal height
• Bed rest, oxygen, IV fluids, and blood products as prescribed
• Monitor and report any uterine activity
• Prepare for the delivery of the fetus as quickly as possible
• Monitor for sings of disseminated intravascular coagulation in the postpartum period
• Administer Rh immune globulin if the mother is Rh-negative and has not been given the injection at 28 weeks of gestation