3. 3
• Chairman of obstetrics &woman health
nursing department
• Pre. Vice of dean for students &Education
Affair
Faculty of nursing
Benha University
Thursday, April 5, 2018 Dr. Soad Abd El salam Ramdan
4.
5. Learning objectives:-
Describe causes of bleeding in early pregnancy.
Apply nursing care plan for woman with
bleeding in late pregnancy.
Enumerate types of associated medical
problems during pregnancy.
Describe the nurses responsibilities in relation
to various types of associated medical problems
during pregnancy.
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7. 1- Bleeding
in early pregnancy
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8. 1-Bleeding In Early Pregnancy
(Before 20 weeks Gestation)
Causes:-
Abortion.
Vesicular mole.
Ectopic pregnancy.
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9. Related to pregnant state
Abortion
Ectopic pregnancy
Molar pregnancy
Bleeding in early pregnancy
abortion ectopic Vesicular
mole
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11. Hydatidiform Mole (Vesicular
Mole)
Hydatidiform mole is a gross
malformation of the trophoblast
in which the chorionic villi
proliferate and become avascular.
The villi are filled with fluid forming
vesicles, which look like a bunch of
grapes.
It is an abnormal development of
the chorionic villi of conceptus.
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13. Causes:-
The exact cause is unknown
◘ Risk factors are:-
age ; old than 45 years or younger than
20 years
Parity ;more with high parity
Socioeconomic ;more in poor
Previous obstetric performance
;common with one or more abortion .
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14. Types:
Partial molar pregnancy:
This is where a baby starts to develop, but is
unable to survive, often being absorbed into
the vesicles that continue to multiply.
Complete molar pregnancy:
This is where a baby never develops, but the
placenta implants and grows many small
cysts, like sacs filled with fluid.
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15. Causes
◘ The exact cause is unknown.
◘ Risk factors are:
Maternal age above 40 years
or below 19 years.
Malnutrition (deficiency of
proteins).
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16. Signs and Symptoms
◘ Signs and symptoms of early pregnancy are
present.
◘ Excessive frequent vomiting.
◘ Over distension of the uterus and larger than
expected for weeks of gestation.
◘ vaginal bleeding with passage of vesicles.
◘ No fetal movements are reported by the mother.
◘ No fetal parts can be palpated and no fetal
heartbeats can be detected.
◘ On palpation the uterus may have an elastic
consistency or it may be doughy.
◘ There is an increased incidence of pre-eclampsia.
◘ Positive pregnancy test result in highly diluted
urine 1:500.
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17. Investigations:-
◦ Pregnancy test is +ve in high dilution.
◦ Ultrasound.
◦ X-ray (no fetal skeleton.
◦ If 1/200 is +ve it is highly suggestive.
◦ If 1/500 is +ve it is surely diagnostic
Complications:-
◘ Hemorrhage.
◘ Uterine sepsis.
◘ Choriocarcinoma
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18. Management:-
◘ Admit the woman into hospital.
◘ Fluid replacement and packed RBCs.
◘Prepare the woman for evacuation of the uterus
under general anesthesia.
◘ HCG levels should be checked periodically.
◘ Health education on the following:
Need for monitoring HCG levels for two years
(monthly for the first 3 months, then every three
months for one year).
Birth spacing methods to prevent pregnancy for
two years.
If HCG levels remain more than five international
units per liter eight weeks postpartum,
prophylactic chemotherapy is indicated.
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