Vaginal bleeding during pregnancy is always a deviation from the normal, is always potentially serious, may occur at any point during pregnancy, and is always frightening. Approximately 25% of pregnant women experience bleeding before 12 weeks’ gestation (Hendricks et al., 2019). Several bleeding disorders can complicate early pregnancy, including spontaneous abortion, ectopic pregnancy, and hydatidiform mole. Maternal blood loss decreases the oxygen-carrying capacity of the blood, resulting in fetal hypoxia, and places the fetus at risk. Show
A client with any degree of bleeding needs to be evaluated for the possibility that she is experiencing a significant blood loss or is developing hypovolemic shock. Because the uterus is a non-essential body organ, danger to the fetal blood supply occurs when the client’s body begins to decrease blood flow to peripheral organs. Signs of hypovolemic shock occur when 10% of blood volume, approximately 2 units of blood, have been lost; fetal distress occurs when 25% of blood volume is lost. The primary causes of bleeding during the first and second trimester of pregnancy include threatened spontaneous miscarriage, imminent miscarriage, missed miscarriage, incomplete spontaneous miscarriage, complete spontaneous miscarriage, ectopic pregnancy, hydatidiform mole, and premature cervical dilatation. Causes of bleeding during the third trimester of pregnancy include placenta previa, abruptio placentae, and preterm labor. Bleeding during pregnancy happens due to certain physiological problems in the early or late stages of pregnancy, each with its own signs and symptoms, which aids in determining a differential diagnosis and in formulating a care plan. This nursing care plan focuses on managing hemorrhages during the pregnancy period. Specific interventions are identified to address each physiological problem as indicated. Nursing Care Plans Nurse care planning for a client with pregnancy includes assessing maternal/fetal condition, maintaining circulatory fluid volume, assisting with efforts to nurture the pregnancy, if possible, avoiding complications, providing emotional support to the client/couple, and providing knowledge on short- and long-term complications of the hemorrhage. Here are 9 nursing care plans and nursing diagnoses for bleeding during pregnancy (prenatal hemorrhage):
1. Risk for BleedingRisk for BleedingWithin the circulatory system, blood must flow normally and yet if vessels are damaged it must form a clot quickly to restrict excessive bleeding. Due to the competing demands of flow and hemostasis, the coagulation system is necessarily complex. Pregnancy results in increased levels of fibrinogen and bleeding factors. An altered fibrinolytic state is part of a normal physiological response to pregnancy due to increased fibrinolytic inhibitors and tissue plasminogen activators (Lefkou & Hunt, 2018). Nursing Diagnosis
Possibly evidenced by
Desired Outcomes
Nursing Assessment and Rationales1. Assess the client’s reproductive history. 2. Assess maternal vital signs. 3. Auscultate and report FHR; note bradycardia or tachycardia. Note change in hypoactivity or hyperactivity. 4. Note expected date of birth (EDB) and fundal
height. 5. Monitor and record maternal blood loss and uterine contractions. 6. Assess for signs of hypovolemia. Nursing Intervention and Rationales1. Place the client in a lateral position. 2. Schedule the client’s periods of rest and activities. 3. Avoid vaginal examinations. 4. Obtain
vaginal specimen for alkali denaturation test (APT test), or use Kleihauer-Betke test to determine maternal serum, vaginal blood, or products of gastric lavage. 5. Carry out/repeat NST, as indicated. 6. Assist with ultrasonography and amniocentesis. Explain procedures. 7. Prepare client for appropriate procedures as
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See alsoOther recommended site resources for this nursing care plan:
Other care plans related to the care of the pregnant mother and her baby:
References and SourcesRecommended journals, books, and other interesting materials to help you learn more about bleeding in pregnancy nursing care plans and nursing diagnosis:
Reviewed and updated by M. Belleza, R.N. What does it mean if my baby is large for gestational age?Information. Large for gestational age (LGA) refers to a fetus or infant who is larger than expected for their age and gender. It can also include infants with a birth weight above the 90th percentile. The LGA measurement is based on the estimated gestational age of the fetus or infant.
How is large for gestational age determined?Babies may be called large for gestational age if they weigh more than 9 in 10 babies or 97 of 100 babies of the same gestational age. In the U.S., this means babies born at 40 weeks' gestation who weigh more than 8 pounds 13 ounces (4,000 grams) or 9 pounds, 11 ounces (4,400 grams) at birth.
Why are large for gestational age babies at risk for hypoglycemia?All the extra sugar and the extra insulin that is made can lead to fast growth and deposits of fat. This means a larger baby. It also means a risk for low blood sugar right after birth. At that point, the mother's supply is no longer there, but the baby's insulin levels stay high.
When documenting the newborn's weight on a growth chart the nurse recognizes the newborn is large for gestational size based on which percentile on growth charts?Those who fall above the 90th percentile in weight are considered large for gestational age (LGA).
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