Gestational Conditions Affecting Pregnancy Outcomes
Vaginal Bleeding during Pregnancy
● Vaginal bleeding during pregnancy is
always a​ deviation from normal.
● It is ​potentially serious and ​may occur at
any point​ during pregnancy.
● Gestational condition of pregnancy
○ Health difficulties that happens
throughout the duration of
pregnancy
○ Affects the baby and mother's
wellbeing
○ Recommended: constant and
consistent maternal check up
● Hemorrhage​- A rapid loss of more than 1 %
of body weight in blood.
● Hypovolemic shock​- blood loss to 1.5 to 2
liters.
● Perinatal hemorrhage​- occurs during
pregnancy, labor and delivery
Classifications
1. Ante partum hemorrhage
○ It occurs anytime during pregnancy
before 20th weeks.
○ Commonly caused by ​abortion and
ectopic pregnancy
2. Intrapartum hemorrhage
○ It occurs ​during labor.
○ Commonly due to abruptio placenta,
uterine rupture, uterine inversion,
and even the abnormal adhesion of
the placenta
3. Postpartum hemorrhage
○ It is when blood loss is greater than
500ml in NSVD or ​1000 ml in
Cesarean Section.
Bleeding Disorders of Pregnancy
1. First Trimester
○ Abortion & Ectopic pregnancy
2. Second Trimester
○ H- Mole & Incompetent cervix.
3. Third Trimester
○ Abruptio placenta and Placenta
Previa.
Abortion
● It is the ​termination of pregnancy before
viability that is before 20 weeks AOG from
LMP​ and the fetus weighs ​500 grams.
● Early abortion
○ termination of pregnancy before 12
weeks AOG
● Late Abortion
○ termination of pregnancy ​between
12 to 20 weeks
● Classification based on weight
○ Below 500 grams- ​Abortus
○ 501-1000 grams- ​Immature
○ 1001- 2,500 grams-​ Preterm
○ 2,500 above grams – ​Full term
Fetal Causes of Abortion
● Defective Germ Plasma
○ Imperfect ova - irregularities and
defects will eventually affect the
physiologic development of the
fetus.
○ Trisomy 16 - defective sperm;
chromosomal abnormalities, in
which there are 3 copes of
chromosome on the pair 16 rather
than 2; most common trisomy
leading to miscarriage
● Implantation Abnormality
○ Inadequate placental circulation that
would alter and affect the expected
physiologic response of pregnancy;
will not sustain and even maintain
the needed demands of the
pregnancy
Maternal Causes of Abortion
● Advanced maternal age.
○ After 35 years of age and maternal
nutrition
● Maternal infections like Rubella virus & UTI.
● Inadequate progesterone production by the
corpus luteum.
● Abnormal reproductive organ like inverted
uterus.
● Incompetent cervix.
○ Cannot handle the pressure of the
weight during pregnancy
● Over fatigue.
 ● CHF (congenital heart failure), GDM
(gestational diabetes mellitus), Severe HPN
(hypertension)
Threatened Abortion
● It refers to the ​possible loss of the products
of conception.
● Early​: Under 16 weeks
● Later:​ 16-24 weeks
● Signs/Symptoms and Management.
○ Can be prevented if treated
immediately
○ Vaginal bleeding - bright red, scanty
to moderate amount
○ Cervical dilatation - none , closed
cervix
○ CBR for 24-48 hrs (complete bed
rest)
● Sexual Intercourse is ​restricted for 2 weeks
● Hormonal Therapy​- Duvadilan (vasodilator,
can relax the uterus; treatment of premature
labor), Bricanyl -save Pregnancies
● Nursing Management: ​Monitor uterine
contraction and Fetal heart beat
Inevitable Abortion
● Unknown reasons but possibly poor
placental attachment.
● Bleeding in the first trimester
● Most of the time, the conception products
are not expelled and extra cervical contents
are present at the time of medical
examination
● Signs/Symptoms
○ Loss of the products of conception
that cannot be prevented
○ Vaginal bleeding become profuse
○ Uterine cramping increased
○ Cervical dilatation- present or open
cervix or dilatation of cervix.
Missed Abortion
● retention of all products of conception ​after
the death of fetus​ in the uterus.
● Stillbirth / IUFD (Intrauterine Fetal Death)
● Will know she had miscarriage when she
will subject herself into a medical visual
examination
● Degenerative changes in fetus
○ Maceration
■ softening, amniotic fluid is
greenish to brownish; fetus
could be 2 weeks dead.
○ Mummification
■ fetus will become leaner-like
appearance, could be about
2-4 weeks dead
■ Can lead to womb stone or
lithopedion
○ Lithopedion
■ Stony appearance
■ Dead more than a month
● Signs/Symptoms
○ Fetus dies in uterus but is not
expelled
○ Absence of FHB, no fetal parts on
palpation
○ No increase in abdominal size, signs
of pregnancy disappear
○ Anorexia with nausea and vomiting
with brownish vaginal discharges
○ If the mother did not come for check
up after 2 weeks, she may suffer
from hypofibrinogen or sepsis
infection that can affect both the
mother and the fetus
Ectopic Pregnancy
● It is ​implantation of the zygote outside the
uterine cavity or in abnormal location inside
the uterus
● Pregnancy ​outside the uterus, ovary, cervix,
fallopian tube and intestine.
● Also called as​ tubal pregancy
● Causes
○ Narrowing, constriction of the tubes
due to inflammation (salpingitis) ,
kinking and congenital narrowing of
the tubes
○ Pelvic inflammatory disease (PID).
● Types
○ Tubal - more than 95% occur in the
fallopian tube.
■ Ampulla - common site of
implantation 55%.
■ Isthmus​- 25%
■ Fimbria​-17%
 ○ Ovarian - Management is
oophorectomy
○ Abdominal - Implantation outside the
tube or abdomen
● Signs and Symptoms
○ Early pregnancy, amenorrhea.
(absence of menstruation)
○ Late pregnancy, there is severe
sharp, knife like stabbing in the right
or left lower quadrant radiating to
the neck and shoulder
○ Hard beardlike abdomen.
○ Cullen’s signs or bluish discoloration
of the umbilicus due to the presence
of blood in the peritoneal cavity
○ Signs of shock; cyanosis, pallor, cold
clammy skin, rapid pulse rate
○ Cervical pain during internal
examination.
■ Cold synthesis
■ Aspiration of bloody fluid
■ HCG testing
○ Transvaginal ultrasounds (tvus).
■ Can reveal an extra uterine
pregnancy and serial HCG
● Surgical interventions
○ Salphingotomy
■ removal of pregnancy and
preserving the tubes
○ Salphingectomy
■ removal of pregnancy and
the tubes
○ Salphingectomy with Oophorectomy
■ removal of tubes & ovary
Hydatidiform mole
● Abnormal proliferation of trophoblastic cells;
fertilization or cell division defect.
● It is a ​benign disorder of the placenta
characterized by ​degeneration of the
chorion and death of the embryo.
● The chorionic villi rapidly proliferate and
become grapelike vesicles that pr​oduce
large amounts of HCG
● Types
○ Complete Molar pregnancy
■ have only placental parts,
there is no baby or no
embryo and form when the
sperm fertilized an empty
egg.
■ HCG develop rapidly;
enlargement of uterus
○ Partial Molar pregnancy
■ In most cases the mother 23
chromosomes remain, but
there are two sets of
chromosomes from the
father, so the embryo has 69
chromosomes instead of 46
chromosomes.
■ Development is not complete
● Signs and Symptoms
○ Excessive nausea and vomiting due
to increase or elevated HCG
○ Large abdominal size not proportion
to AOG (too big)
○ Brownish vaginal bleeding with
some passage of grapelike vesicles
around 4th month
○ Bleeding from spotting to profuse
hemorrhage
○ Presence of quickening but no FHT
and fetal skeleton
○ Ultrasounds reveal a mass of fluid
filled vesicles
○ HPN, edema and proteinuria
○ High or elevated HCG beyond 100
days when it is supposed to have
already declined
Premature Labor
● It is when the ​uterine contractions occurs
between 20-37 weeks AOG.
● Cervix begins to dilate and pregnancy is lost
at about 20 weeks.
● Signs and symptoms
○ Contractions occurs every 10
minutes without pain
○ Low abdominal cramping without
diarrhea
○ Low back ache pain.
○ Increased vaginal discharge-pinkish
tingled
○ Leaking BOW.
● Immediate Actions
 ○ Empty the bladder & lying on left
side position, bed rest
○ drink 3 to 4 cups of water
○ Monitor uterine contractions, if 10
minutes refer to hospital
○ Administer tocolytic agents .
■ Drugs that help stop uterine
contractions
■ Ritodrine or ritopar
■ Terbutaline
■ Magnesium sulfate
■ Betamethasone
Placenta Previa
● Abnormal implantation of placenta near or
over the Internal OS​-mouth of the cervix.
● It is common bleeding disorder of the third
trimester​ of pregnancy
● Third trimester - lower uterine segment
begins to stretch and shorten in the
preparation for labor
● Gradual thinning of the lower segment
causes the placental villi attached to the
lower uterine wall to tear and eventually
separate from its attachment.
● Detachment of the portion of the placenta
over the cervix causes bleeding
● Types
○ Complete or Total placenta
■ Placenta completely covers
the internal OS when the
cervix is fully dilated
○ Partial placenta previa.
■ Placenta partially covers the
internal OS
○ Marginal placenta.
■ The edge of the placenta is
lying in the margin of your
internal OS
○ Low lying placenta previa
■ Placenta will implant near the
internal OS with its margin
located about 2 cm to 5 cm
from the internal OS, edges
can be felt by the examining
finger
● Signs and symptoms
○ Painless vaginal bleeding between
24 -30 weeks
○ Bright red bleeding may be
intermittent
○ Placement of the placenta in the
lower segment which prevents fetal
head from entering the true pelvis
○ Decreased urinary output
Abruptio Placenta
● It is the premature separation of a normally
implanted placenta after 20 weeks of
gestation​ and ​before delivery of the fetus.
● Deciduas tissues and the blood vessel
undergo the term necrosis, blood vessels
rupture, bleeding occurs, blood escaping
from these ruptured vessels collects
between the deciduous and in the placenta
● This collection of blood creates ​increasing
amounts of pressure against the placenta
that pushes the placenta further away
thereby enlarging the degree of placental
separation from the deciduas.
● As the placenta separates from the uterus,
blood supply from the uterus to the placenta
will be cut off preventing the proper
exchange of substances.
● Deprives the fetus from the necessary
oxygen and nutrients
● Causes
○ Maternal HPN is the most common
and persistent factors
○ Advanced maternal age and grand
multiparty - increased endometrial
damage, thinning of the
endometrium that prevents
attachment
○ Trauma to the uterus
○ Pressure of the enlarging uterus or
rapid decompression of an
distended.
○ Short umbilical cord
○ PROM causing sudden release of
pressure
○ Hyperfibrinoginemia
● Signs and symptoms
○ Vaginal bleeding - dark red, covert
type of abruptio placenta
○ Bright red vaginal bleeding - overt
type of placenta
 ○ A painful rigid board like abdomen. - ○ Hereditary
caused by accumulation of blood ● Management
behind the placenta with fetal parts ○ Roll-over test
hard to palpate ■ assess the probability of
○ Couvelaire uterus- the uterus developing toxemia
becomes bluish-purple, signs of ■ 28-32 weeks AOG
shock and fetal distress ■ Lateral recumbent position
● Types for 15 minutes until baby has
○ Central/Covert Abruptio placenta stabilized
■ separation begins at the ■ The mother will roll over into
center of placental a supine position
attachment. ■ Pressure is measured after 5
■ Blood trapped behind the minutes
placenta ■ BP is taken at 1 minutes and
■ Bleeding is internal, not 5 minutes after having rolled
obvious over
○ Overt/ marginal Abruptio placenta ■ If diastolic increases into 20
■ separation begins at the mmhg or more, patient is
edges of the placenta . prone to toxemia
■ Blood escapes from the ○ Tolerance hyperbaric test (THT)
uterine caity ■ is a new test that can detect
■ Bleeding is external gestational HPN and
preeclampsia 23 weeks
earlier than clinical signs may
Gestational Hypertension appear.
● It is a condition in which ​vasopasm occurs
in both small and large arteries during Polyhydramnios
pregnancy causing ​increased blood ● It is characterized by ​excessive amount of
pressure. amniotic fluid is more than 2000 ml.
● BP140/90mmhg develops for the first time ● The normal amount of amniotic fluid-
during pregnancy but there is ​no proteinuria. 500-1000ml
● Preeclampsia​- hypertension of BP 140/90 ● Signs and symptoms
that develops after 20weeks of gestatio​n ○ Excessive uterine size, out of
accompanied by ​ proteinuria an edema​. proportion to AOG with difficulty
● Eclampsia​- all signs of preeclampsia palpating fetal parts and finding
accompanied by convulsions. FHT.
● Triad symptoms of PIH ○ Shortness of breath caused by
○ Hypertension pressure of the overly distended
○ Edema uterus.
○ Proteinuria (albuminuria) ○ Backpain, varicosities, constipation
● Predisposing Factors of PIH and frequency of urination
○ Age - primipara below 20 and above ● Causes
35 years old ○ Fetal abnormalities
○ Gravid 5 or more pregnancies ■ Anencephaly
○ Low socioeconomic status and ■ absence of fetal skull.
inadequate care. ■ Esophageal atresia
○ Poor nutrition ■ fetal swallowing
○ Preexisting diseases like Diabetes, amniotic.
Vascular disease ■ Spina bifida
 ■ absence of vertebrae
■ heart failure and congenital
infection.
○ Maternal factors
■ Multiple pregnancy and
diabetes mellitus

Oligohydramnios
● It is when the​ amniotic fluid less than 300ml.
● Signs and symptoms
○ Leaking of amniotic fluid when the
cause is rupture of membrane
○ Decreased amount of amniotic fluid
on ultrasounds
○ Uterus is small for gestational age
SGA