Safe Maternity and Pediatric Nursing Care 2nd
Edition All Chapters 1-38 | Complete Latest
Guide A+ 2025
_____________________________________________________________________________________
Nursing care of early pregnancy bleeding disorders
Document amount/character of bleeding
save anything that looks like clots or tissue for eval by pathologist
Perineal pad count with estimated amount per pad (i.e 50%)
Monitor vital signs
If actively bleeding, woman should be kept NPO in case of needed surgical intervention
Post-abortion teaching
Report increased bleeding
Take temp every 8h for 3 days
oral iron supplement if prescribed
Resume sexual activity as recommend by Health care provider
return to health care provider as recommend time for a checkup/contraception method
pregnancy can occur before 1st menstrual period returns after abortion procedure
Emotional Care
Spiritual support of family's choices and community support groups may help the family work through
grief of any pregnancy loss.
Supporting and encouraging the grieving process in families who suffer a pregnancy loss allows them to
resolve the grief.
Ectopic pregnancy
95% occur in Fallopian tube
scarring/tubal deformalitity may result from:
hormonal abnormalities
inflammation
adhesions
congenital defects
endometriosis
Ectopic Pregnancy Manifestations
,Lower abdominal pain and light vaginal bleeding.
If tube ruptures: possible sudden severe lower abd pain. Vaginal bleeding, signs of hypovolemic shock,
should pain may also be felt
Ectopic Pregnancy Treatment
To confirm location: pregnancy test, transvaginal ulatrasound, laparoscopic examination.
Priority is to control bleeding.
No action, treatment with methotrexate to inhibit cell division, and surgery to remove pregnancy from
the tube.
Signs and Symptoms of Hypovolemic shock
Fetal heart rate change
Rising, weak pulse (tachycarida)
Rising respiration rate
Falling BP (hypotension)
Decreased or absent urinary output (usually less than 30ml/hour)
Pale skin/mucous membranes
cold, clammy skin
faintness
thirst
Bleeding disorders in Late Pregnancy
Vaginal bleeding after 20 weeks gestation
Antepartum hemorrhage occurs in 2-5% of all pregnancies
In the 3rd trimester the uterus receives approx 20% of cardiac output (compared to 1% non-pregnant),
uterine bleeding in the third trimester can be massive and can result in a hemodynamically unstable
individual.
Identifiable causes of Significant Antepartum hemorrhage
Placental abruption (abruptio placentae) 1 in 100 births.
Placenta previa -1 in 200-300 births
lower genital tract lesion
Unclassified
Placenta previa
abnormal implantation of placenta
bright-red bleeding occurs when cervix dilates resulting in painless bleeding.
Placental abruption
Normal implantation of placenta
dark red bleeding with pain, enlarging uterus suggest blood is accumulating within the cavity.
Placenta previa complications
, infection becasue of vaginal organisms
postpartum hemorrhage, because of lower segment of uterus was site of attachment there are fewer
muscle fibers so weaker contractions may occur
Placental abrutpion
predisposing factors
hypertension
cocaine use
cigarette smoking/poor nutrition
blows to the abdomen
Prior history of PA
Folate deficiency
Placental abruption vs placenta previa
pain is an important symptom distinguishes placenta abruption from placenta previa
Care of Woman with excessive Bleeding
Document blood loss
Closely mointor VS, I&O
Observe for pain, uterine rigidity or tenderness
Verify orders fro blood typing and cross-match have been carried out
Monitor IV infusion
Prepare for surgery if indicated
Monitor fetal hr and contractions
Monitor lab results, coagulation studies
Administer O2 by mask
Prepare for newborn resuscitation
Hypertensive Disorders of Pregnancy
Gestational hypertension
-preeclampsia
-Eclampsia
Chronic hypertension
Preeclampsia with superimposed chronic hypertension
Presents 20 weeks before pregnancy
Risks for Gestational Hypertension
First pregnancy
Obesity
Family history of GH
age over 40 or under 19
multi-fetal pregnancy
chronic hypertension
Edition All Chapters 1-38 | Complete Latest
Guide A+ 2025
_____________________________________________________________________________________
Nursing care of early pregnancy bleeding disorders
Document amount/character of bleeding
save anything that looks like clots or tissue for eval by pathologist
Perineal pad count with estimated amount per pad (i.e 50%)
Monitor vital signs
If actively bleeding, woman should be kept NPO in case of needed surgical intervention
Post-abortion teaching
Report increased bleeding
Take temp every 8h for 3 days
oral iron supplement if prescribed
Resume sexual activity as recommend by Health care provider
return to health care provider as recommend time for a checkup/contraception method
pregnancy can occur before 1st menstrual period returns after abortion procedure
Emotional Care
Spiritual support of family's choices and community support groups may help the family work through
grief of any pregnancy loss.
Supporting and encouraging the grieving process in families who suffer a pregnancy loss allows them to
resolve the grief.
Ectopic pregnancy
95% occur in Fallopian tube
scarring/tubal deformalitity may result from:
hormonal abnormalities
inflammation
adhesions
congenital defects
endometriosis
Ectopic Pregnancy Manifestations
,Lower abdominal pain and light vaginal bleeding.
If tube ruptures: possible sudden severe lower abd pain. Vaginal bleeding, signs of hypovolemic shock,
should pain may also be felt
Ectopic Pregnancy Treatment
To confirm location: pregnancy test, transvaginal ulatrasound, laparoscopic examination.
Priority is to control bleeding.
No action, treatment with methotrexate to inhibit cell division, and surgery to remove pregnancy from
the tube.
Signs and Symptoms of Hypovolemic shock
Fetal heart rate change
Rising, weak pulse (tachycarida)
Rising respiration rate
Falling BP (hypotension)
Decreased or absent urinary output (usually less than 30ml/hour)
Pale skin/mucous membranes
cold, clammy skin
faintness
thirst
Bleeding disorders in Late Pregnancy
Vaginal bleeding after 20 weeks gestation
Antepartum hemorrhage occurs in 2-5% of all pregnancies
In the 3rd trimester the uterus receives approx 20% of cardiac output (compared to 1% non-pregnant),
uterine bleeding in the third trimester can be massive and can result in a hemodynamically unstable
individual.
Identifiable causes of Significant Antepartum hemorrhage
Placental abruption (abruptio placentae) 1 in 100 births.
Placenta previa -1 in 200-300 births
lower genital tract lesion
Unclassified
Placenta previa
abnormal implantation of placenta
bright-red bleeding occurs when cervix dilates resulting in painless bleeding.
Placental abruption
Normal implantation of placenta
dark red bleeding with pain, enlarging uterus suggest blood is accumulating within the cavity.
Placenta previa complications
, infection becasue of vaginal organisms
postpartum hemorrhage, because of lower segment of uterus was site of attachment there are fewer
muscle fibers so weaker contractions may occur
Placental abrutpion
predisposing factors
hypertension
cocaine use
cigarette smoking/poor nutrition
blows to the abdomen
Prior history of PA
Folate deficiency
Placental abruption vs placenta previa
pain is an important symptom distinguishes placenta abruption from placenta previa
Care of Woman with excessive Bleeding
Document blood loss
Closely mointor VS, I&O
Observe for pain, uterine rigidity or tenderness
Verify orders fro blood typing and cross-match have been carried out
Monitor IV infusion
Prepare for surgery if indicated
Monitor fetal hr and contractions
Monitor lab results, coagulation studies
Administer O2 by mask
Prepare for newborn resuscitation
Hypertensive Disorders of Pregnancy
Gestational hypertension
-preeclampsia
-Eclampsia
Chronic hypertension
Preeclampsia with superimposed chronic hypertension
Presents 20 weeks before pregnancy
Risks for Gestational Hypertension
First pregnancy
Obesity
Family history of GH
age over 40 or under 19
multi-fetal pregnancy
chronic hypertension
