NCM – 109 (OB)

1st Semester A.Y. 2023-2024

Bleeding Disorders in Pregnancy

Name: Me, Bemadetta Date: January 14, 2024

Section: BSN-2E
Prof: Floraine N. Saldana

Bleeding Disorders in Pregnancy

Complication Description Assessment Findings Nursing Considerations
1. Abortion - Termination of pregnancy - Bright red vaginal bleeding - Monitor the Vital Sign
before the age of viability - Vaginal bleeding or - Providing emotional support and counseling to
- Abortion refers to the spotting the patient and family members about the
termination of a - Cramping or abdominal decision to terminate the pregnancy
pregnancy before the fetus pain - Administering medications to manage pain and
is viable, or able to survive - Passage of tissue or clots discomfort, such as ibuprofen or acetaminophen
outside the womb - Decreased pregnancy - Monitoring for complications, such as excessive
symptoms, such as nausea bleeding or infection
or breast tenderness - Educating the patient on post-abortion care,
including avoiding sexual activity and using
contraception to prevent future pregnancies.

2. Ectopic Ectopic pregnancy refers to
Pregnancy the implantation of a
fertilized egg outside of the
uterus, most commonly in
the fallopian tubes.
Bleeding disorders in
pregnancy can increase the
risk of complications in
ectopic pregnancies.
- Vaginal bleeding - Prompt assessment and monitor Vital
- Abdominal pain - Fluid resuscitation: In cases of significant
- Low blood pressure bleeding and signs of shock, intravenous fluids
- Rapid heart rate may be necessary to restore blood volume and
- Signs of shock stabilize the woman's condition.
- Blood product administration: Depending on
the severity of the bleeding disorder and the
woman's blood levels, blood products such as
packed red blood cells or clotting factors may be
required.

3. Hydatidiform Hydatidiform mole, also
Mole known as a molar
pregnancy, is a rare
condition that occurs
when abnormal cells grow
in the uterus instead of a
normal pregnancy. It is
characterized by the
formation of a mass or
cluster of fluid-filled sacs
that resemble a bunch of
grapes. This condition can
lead to various
complications, including
bleeding disorders in
pregnancy.
- Pain management: Nurses should provide
appropriate pain relief measures to alleviate the
woman's discomfort. This may include
administering analgesics as prescribed.
- Emotional support: Ectopic pregnancy can be
emotionally distressing for women. Nurses
should provide empathetic and supportive care,
offering information, counseling, and resources
for emotional support.
- Education: Nurses should educate women with
bleeding disorders about the signs and
symptoms of ectopic pregnancy, the importance
of seeking early medical attention, and the
potential complications associated with their
condition.
- Vaginal bleeding - Monitor vital signs
- The uterus may be larger - Monitor the amount and characteristics of
than expected for the vaginal bleeding.
gestational age due to the - Provide emotional support to the patient and
presence of abnormal her family
growth. - Educate the patient about the condition and its
- Absence of fetal heart potential complications.
sounds. - Blood transfusion in cases of severe bleeding, a
- High blood pressure. blood transfusion may be necessary
- Hyperemesis gravidarum: - Prepare for dilation and curettage.
Severe nausea and
vomiting.
4. Incompetent An incompetent cervix is a
Cervix condition where the cervix
is weak and unable to
support the weight of the
growing fetus. This can
lead to premature dilation
and effacement of the
cervix, often resulting in
preterm labor and
delivery.
5. Placenta A condition in which the
Previa placenta partially or
completely covers the
cervix, leading to bleeding
during pregnancy and the
risk of bleeding is
increased due to the
fragile blood vessels in the
placenta.
- History of previous
second-trimester pregnancy
losses or preterm deliveries.
- Painless cervical dilation
and effacement in the
second trimester.
- Vaginal bleeding, which
may be intermittent or
continuous.
- Sensation of pressure or
heaviness in the pelvic area.
- Preterm contractions or
labor.
- It is painless vaginal
bleeding during the second
or third trimester of
pregnancy.
- Other symptoms may
include contractions,
abdominal pain, and a
decrease in fetal
movement.
- Assess the patient's medical history and
previous obstetric history to identify any risk
factors for incompetent cervix.
- Monitor vital signs and assess the amount and
characteristics of vaginal bleeding.
- Perform regular cervical assessments to
evaluate cervical length and dilation.
- Administer tocolytic medications as prescribed
to suppress preterm contractions and delay
labor.
- Educate the patient about signs and symptoms
of preterm labor and the importance of seeking
immediate medical attention.
-Provide emotional support and counseling to
the patient and her family.
- Encourage the patient to avoid activities that
may increase intra-abdominal pressure, such as
heavy lifting or straining.
- Monitor vital signs and fetal heart rate to
assess for signs of distress.
- Administer blood products as needed to
manage bleeding.
- Encourage bed rest and limit physical activity
to reduce the risk of bleeding.
- Educate the patient on the signs and
symptoms of bleeding and when to seek
medical attention.
- Prepare the patient for a possible cesarean
delivery if the bleeding cannot be controlled.
Collaborate with the healthcare team to ensure
the patient receives appropriate care and
management of her bleeding disorder.
6. Abruptio It is a condition in which - Vaginal bleeding and the
Placenta the placenta separates bleeding may be bright red
from the uterine wall or dark in color, depending
before delivery. It is a on the extent of placental
serious complication that separation.
can lead to significant - Abdominal pain which
bleeding and jeopardize may be localized or diffuse.
the health of both the The pain is usually constant
mother and the baby. and may be accompanied
by uterine contractions.
- The uterus may feel
tender or firm to the touch
due to the separation of the
placenta.
- Fetal distress: The baby
may show signs of distress,
such as a rapid heart rate,
decreased fetal movement,
or abnormal fetal heart rate
patterns on a fetal monitor.
7. Preterm It is defined as labor that - Uterine contractions the
Labor occurs before 37 weeks of woman may experience
gestation. In women with regular uterine contractions
bleeding disorders, the risk that occur more frequently
of preterm labor is than every 10 minutes.
increased due to the - Cervical changes
increased risk of placental - Vaginal bleeding: The
abruption and other woman may experience
complications. vaginal bleeding, which can
be a sign of placental
abruption or cervical
incompetence.
- Pelvic pressure: The
woman may feel pressure in
- Immediate assessment the nurse should assess
the severity of bleeding and monitor vital signs
to determine the stability of the mother.
- The nurse should closely monitor the fetal
heart rate and patterns to assess the baby's
well-being.
- Administering blood products.
- The nurse should assist the mother in finding a
comfortable position that promotes optimal
blood flow to the placenta.
- The nurse should provide emotional support,
education, and reassurance throughout the
process, addressing any concerns or fears they
may have.
- Monitoring monitor, the woman's uterine
contractions, cervical changes, and vaginal
bleeding closely.
- Medications: The nurse may administer
medications to stop or slow down preterm
labor, such as tocolytics or corticosteroids.
- Bed rest: The nurse may recommend bed rest
to reduce the risk of preterm labor.
- Education: The nurse should educate the
woman about the signs and symptoms of
preterm labor and when to seek medical
attention.
 her pelvis or lower
abdomen, which can be a
sign of premature rupture
of membranes.

References:

Bsn, P. M., RN. (2023, October 12). 6 Bleeding in pregnancy (Prenatal hemorrhage) nursing care plans. Nurseslabs.

https://nurseslabs.com/bleeding-in-pregnancy-prenatal-hemorrhage-nursing-care-plans/

Ghassemzadeh, S. (2023, May 22). Hydatidiform mole. StatPearls - NCBI Bookshelf.

https://www.ncbi.nlm.nih.gov/books/NBK459155/

Schmidt, P. (2022, December 19). Placental abruption. StatPearls - NCBI Bookshelf.

https://www.ncbi.nlm.nih.gov/books/NBK482335/#:~:text=Placental%20abruption%20is%20a%20leading,intravascular%20coagulop

athy%20and%20renal%20failure

Professional, C. C. M. (n.d.-b). Incompetent Cervix. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17912-

incompetent-cervix