Hemorrhagic Complications: Chapter 21 – pp. 643-658
 Hemorrhagic disorders in pregnancy are medical emergencies o Incidence & type of bleeding vary by trimester
• Ectopic pregnancy & abruptio placentae have highest maternal mortality rate

 Maternal blood loss ↓ oxygen-carrying capacity o ↑ risk for hypovolemia, anemia, infection, preterm labor, and preterm labor o Adversely affects oxygen delivery to fetus o Fetal risks include blood loss or anemia, hypoxemia, hypoxia, anoxia, and preterm birth

 Early Pregnancy Bleeding
• Miscarriage (spontaneous abortion) o A pregnancy that ends as a result of natural causes prior to 20 weeks gestation
• 20 weeks is considered point of viability
• 10-15% of all clinically recognized pregnancies end in miscarriage
• 80% of those miscarriages occur before 12weeks
• At least 50% are from chromosomal abnormalities
• Late miscarriage occurs 12-20 weeks gestation
• Advancing maternal age & parity
• Chronic infections
• Premature dilation of cervix & other anomalies of reproductive tract
• Chronic debilitating diseases
• Inadequate nutrition
• Recreational drug use

o Clinical Manifestations of Miscarriage
 Uterine bleeding, UCs, uterine pain  ominous sign during early pregnancy
 Before 6th week: may only have heavy menstrual flow
 Weeks 6-12: Moderate discomfort & blood loss
 After 12 weeks: Severe pain, similar to labor b/c the fetus must be expelled

o Types of Miscarriages

Threatened • Spotting of blood
• Closed cervical os
• Mild uterine cramping may be present

Inevitable/Incomplete • Moderate to heavy amount of bleeding
• Open cervical os
• Tissue may be present
• Mild to severe