26 28 bleeding during 1st trimester cô liên

Bleeding during the first trimester of pregnancy DAM THI QUYNH LIEN, MD CAUSES ◆Spontaneous Abortion ◆Ectopic pregnancy ◆Vesicular mole ◆Local lesions — cervical polyps — cervical cancer General principles of nursing intervention ◆Monitor blood pressure and pulse frequently The frequency is determined by the extent of the bleeding and the stability of the woman’s condition ◆Observe the woman for indications of shock, such as pallor, clammy skin, perspiration, dyspnea, or restlessness General principles of nursing intervention ◆Count and weigh pads to assess amount of bleeding over a given time period; save any tissue or clots expelled ◆Assess fetal heart tones with a Doppler General principles of nursing intervention ◆Prepare for intravenous (IV) therapy There may be standing orders to start IV therapy on bleeding patients ◆Prepare equipment for examination ◆Have oxygen therapy available General principles of nursing intervention ◆Collect and organize all data, including antepartum history, onset of bleeding episode, any associated pain, laboratory studies (Hb, Ht, Rh status, and hormonal assays) ◆Application: Potential Pregnancy Complications ◆Obtain an order to type and cross-match for blood if there is evidence of significant blood loss General principles of nursing intervention ◆Assess coping mechanisms and support system of the woman in crisis Give emotional support to enhance her coping abilities by continuous, sustained presence, by clear explanation of procedures, and by communicating her status to her family General principles of nursing intervention ◆Most important, prepare the woman for possible fetal loss Assess her expressions of anger, denial, guilt, depression, or self-blame ◆Assess the family’s response to the situation Spontaneous Abortion ◆ It is the termination of pregnancy before 22 weeks, or products of conception weighing below 500 grams ◆ The termination is either spontaneous or induced, before the fetus develops sufficiently to survive Spontaneous Abortion Incidence ◆ Spontaneous abortion occurs in 10-15% of pregnancy , 80% of them occur in the first trimester ◆Ultrasonography may also contribute to the diagnosis of partial molar pregnancy by demonstrating focal cystic spaces in the placental tissues and an increase in the transverse diameter of the gestational sac Differential diagnosis abortion; multiple pregnancy; polyhydramnios Treatment  the uterus should be evacuated as soon as possible after the diagnosis is made (by suction curettage) suction; oxytocin administration:we can use blood transfusion or/and fluid infusion.it is used to decrease the size of the uterus; tissue sent for histology: it should be routine practice with all cases of incomplete miscarriage; acute pulmonary complications  total abdominal hysterectomy in older multiparas hysterectomy may be indicated management of theca-lutein cysts these tumors should not be excised because they regress after the trophoblastic tissue has been removed chemotherapy HM don’t need usually chemotherapy because HM is benign disease Follow-up examinations follow up mode in the years after discharge on each follow-up check, the following should be addressed  symptom abnormal vaginal bleeding, cough, hemoptysis signs of metastasis  pelvic examination  hCG evaluation  B-ultrasound  chest X-ray film contraceptive method required for 1-2 years condom is recommended IUD (intrauterine device)and pills are contraindicated for their potentiality of causing abnormal vaginal bleeding Complications ◆Hemorrhage ◆shock ◆ perforation ◆Uterine sepsis ◆Choriocarcinoma Nursing assessment and interventions ◆Monitor VS and evidence of bleeding ◆Assess emotional state and coping ability ◆Provide emotional support through grieving process ◆Provide explanation of procedures ◆Reinforce importance of follow-up care Ask question 1.What is the etiology of GTD? 2.What is the classification of HM? 3.What is the main pathologic changes of HM? 4.What is the clinical course of HM? 5.How Follow-up examinations is we? ◆About 80% of the cases of HM have a benign course one-half of patients become pregnant subsequently about 16% of HM become invasion moles and some 2.5% progress into choriocarcinoma Thank you for listening! ... mellitus Spontaneous Abortion Types ◆Threatened ? ?Bleeding, no dilation, + FHT ◆Inevitable (imminent) ? ?Bleeding, dilated, may or may not have FHT ◆Incomplete ? ?Bleeding, dilation, retained products of... abortion: ◆There is minimal bleeding ◆Pain stops ◆Uterus is hard and much smaller ◆The cervix is closed Septic abortion Signs ◆Tender and painful uterus ◆Offensive vaginal bleeding ◆High temperature.Rapid... Pregnancy ◆Any pregnancy outside the uterine cavity ◆Risk – hemorrhage and death ◆Leading cause of 1st trimester maternal death ◆Second leading cause of all maternal deaths ◆More common in AA population