BLEEDING DISORDERS IN PREGNANCYSPONTANEOUS ABORTION

THREATENED ABORTION

INCOMPLETE ABORTION

INEVITABLE / IMMINENT ABORTION

COMPLETE ABORTION

MISSED ABORTION

Vaginal Bleeding

(+) Positive;With brownish vaginal bleeding or discharge

(+) Positive;Parietal fragments are usually left

(+) Positive (+) Positive;But minimal; Blood clots only; No placental fragments

Light manifestation; Just brownish vaginal discharge

Abdominal Pain May be present or absent; Cramping may be present

(+) Positive; Because uterus contracts trying to expel the fragments

(+) Positive (-) Negative Occasional slight dysmenorrhea

Cervical Dilatation

Closed Open Open Closed Closed

Bag of Water / Membranes

Intact Not Intact Intact Fetal Membrane

Not Intact Intact

Management Gold Standard is BEDREST for two (2) weeks;Restriction of coitus for two (2) weeks but as long as there is bleeding, continue to restrictGive PROGESTERONE HORMONE

Dilatation and Curettage;Consent;Give large bore needle, 16 – 18 gauge for fluid hydration (hemorrhage anticipated)Secure all specimen taken out from the mother and send for examination to prove they are fragments of the placenta;Place specimen in bottle – put name of client, date, time, name of doctor, procedure the logMonitor Vital Signs every fifteen (15) minutes for two hours; Receive RHOGAM within seventy-two (72) hours

Wait spontaneously for the products of conception to be expelled, then Dilatation and Curettage will follow

None; Continue abortion

If intrauterine fetal death occurs:Send client home; Tell mother to monitor abdominal pain, bleeding.If positive, come back;If no manifestations, wait for two (2) weeksAfter two weeks, no manifestation – Client obliged to go back to clinic.When missed abortion is diagnosed: Induce labor to expel products of conceptionDilatation and Curettage follows