Chapter 21

Nursing Care of a Family

Experiencing a Sudden Pregnancy
Complication
 2

Objectives:
1. Describe sudden complications of pregnancy that
place a pregnant woman and her fetus at high
risk.
2. Assess a woman who is experiencing a
complication of pregnancy.
3. Formulate nursing diagnoses that address the
needs of a woman and her family experiencing a
complication of pregnancy.
4. Identify expected outcomes to minimize the risks
to a pregnant woman and her fetus when a
sudden complication of pregnancy occurs.
5. Using the nursing process, plan nursing care.
 3

Objectives:
6. Implement nursing care specific to a woman
who has developed a sudden complication of
pregnancy,
7. Evaluate expected outcomes for effectiveness
and achievement of care.
8. Integrate knowledge of complications of
pregnancy with the interplay of nursing process.
 4

BLEEDING DURING
PREGNANCY
 5

Nursing Diagnoses and Related

Interventions
• Nursing Diagnosis:
• Risk for deficient fluid volume related to bleeding during
pregnancy
• Outcome Evaluation:
1. Patient’s blood pressure is maintained at above 100/60
mmHg; pulse rate is below 100 beats/min;
2. only minimal bleeding is apparent;
3. fetal heart rate (FHR) is maintained at 120 to 160
beats/min with adequate short- and long-term variability;
4. maternal urine output is greater than 30 ml/hr.
 6

Nursing Diagnoses and Related

Interventions
Goals of Therapy for hypovolemic shock
1. restoring blood volume
2. halting the source of hemorrhage as quickly as
possible.
 7

Nursing Diagnoses and Related

Interventions
• If the blood deficit continues so blood cannot
reach other major organs, multi-organ failure can
result.
1. Obtaining hemoglobin and hematocrit levels
and securing a blood sample for typing or
cross-matching
2. A woman suspected of having serious bleeding
will need intravenous fluid replacement, such as
Ringer’s lactate, as an early intervention.
 8

Nursing Diagnoses and Related

Interventions
• If the blood deficit continues so blood cannot reach other
major organs, multi-organ failure can result.
3. Use a large-gauge Angiocath (16 or 18) for rapid fluid
expansion as this will also allow a blood transfusion to
be administered through the same site as soon as blood
is available.
4. If respirations are rapid, administer oxygen by mask
5. monitor oxygen saturation levels by pulse oximetry.
 9

Nursing Diagnoses and Related

Interventions
6. Assessments of vital signs and continuous fetal
monitoring;
7. Urge the woman to rest in a side-lying position
(left lateral is preferred)
❖If this is not possible, position her on her back, with a
wedge under one hip to minimize uterine pressure on
the vena cava and prevent blood from being trapped in
the lower extremities (supine hypotension syndrome).
8. Continue to provide information about care and
emotional support to her and her family
members.
 10

Nursing Diagnoses and Related

Interventions
10. A woman may have a central venous pressure catheter
(measures the right atrial pressure or the pressure of
blood within the vena cava) or a pulmonary capillary
wedge catheter (measures the pressure in the left
atrium or the filling pressure in the left ventricle) inserted
after bleeding is halted.
Common Causes of Bleeding
According to Trimester
First Trimester Second Trimester Third Trimester
• Spontaneous • Gestational • Placenta previa
miscarriage trophoblastic • Abruptio placentae
• Threatened disease • Preterm labor
(hydatidiform mole)
• Imminent
• Premature cervical
• Complete
dilatation
• Missed • Disseminated
• Incomplete intravascular
• Ectopic pregnancy coagulation (DIC)
• Abdominal
pregnancy
 12

1st Trimester Bleeding

❖Spontaneous Miscarriage
• Abortion
−A medical term for any interruption of a
pregnancy before a fetus is viable (20-24
wks. AOG or at least 500 g).
• Miscarriage
−Interruption of pregnancy occurs
spontaneously.
 13

1st Trimester Bleeding

❖Causes of Spontaneous Miscarriage
1. Abnormal fetal development
−Teratogenic factors
−Chromosomal aberration
2. Implantation abnormalities
3. Corpus luteum in the ovary fails to produce
enough progesterone to maintain the desidua
basalis
4. Systemic infection
−Rubella, syphilis, poliomyelitis, cytomegalovirus,
toxoplasmosis,UTI
5. Ingestion of teratogenic drug
−E.g. isotretinoin (Accutane)
6. Alcohol ingestion
 14

1st Trimester Bleeding

❖Assessment of Spontaneous Miscarriage
1. Confirmation of pregnancy
2. Pregnancy length
3. Duration of bleeding
4. Intensity/amount of blood loss
5. Description
6. Frequency
7. Associated symptom
8. Action
9. Blood type of the woman
 15

Threatened Miscarriage
• Symptoms:
1. Vaginal bleeding
➢Initially scant, bright red
2. Slight cramping
3. No cervical dilation
• Diagnostic tests:
1. Ultrasound
2. Blood test for hCG and is repeated in 48 hrs.
➢↑hCG means placenta is still intact.
 16

Threatened Miscarriage
• Interventions:
1. Avoid strenuous activity for 24 – 48 hrs.
2. Restrict coitus for 2 wks.
 17

Imminent/ (Inevitable) Miscarriage

• Symptoms:
1. Uterine contractions
2. Cervical dilation
• Diagnostic tests:
1. Check for FHT
2. Ultrasound
• Interventions:
1. D & E (dilation & evacuation)
2. After discharge following D & E, assess for
bleeding by recording no. of pads used.
 18

Complete Miscarriage

➢Entire products of conception

(fetus, membranes, and placenta)
are expelled spontaneously without any
assistance.

➢Bleeding usually slows within 2 hrs. and then

stops after a few days after passage of the
products of conception.
 19

Incomplete Miscarriage
• Part of the conceptus (usually the fetus) is
expelled, but the membrane or placenta is
retained in the uterus.

• Intervention:
1. D & C
2. Suction curettage
 20

Missed Miscarriage
• Fetus dies in utero but is not expelled.
• Symptoms:
1. No increase in fundal height
2. FHS cannot be heard
3. May have had symptoms of
threatened miscarriage
• Interventions:
1. D & E
2. If pregnancy is ↑14 wks. Labor may
be induced by:
• Prostaglandin suppository or
misoprostol to dilate the cervix
• Oxytocin is administered
to stimulate uterine contraction
 21

Complications of Miscarriage
1. Hemorrhage
➢Therapeutic Management:
1) Monitor V/S
2) Position the woman flat and massage the
uterine fundus to aid in contraction if
there is excessive bleeding.
3) D & C may be needed to
empty the uterus.
4) Blood transfusion may be
necessary to replace blood
loss.
 22

Complications of Miscarriage
2. Infection (endometritis)
• Signs:
1) Fever
2) Abdominal pain or tenderness
3) Foul vaginal discharge
• Causative organism:
➢Escherichia coli (spread from the rectum
into the vagina).
 23

Complications of Miscarriage
2. Infection (endometritis)
• Therapeutic management:
1) Antibiotic (Clindamycin)
2) Oxytocic agent (methylergonovine)
➢To encourage uterine contraction
3) Analgesic for abdominal discomfort.
4) Sitting in a Fowler’s position or walking
➢Encourages lochia drainage by gravity.
5) Wear gloves when helping the woman
change her perineal pads.
6) Use good handwashing techniques before &
after handling the contaminated pads.
 24

Complications of Miscarriage
3. Septic Abortion
➢Abortion that is complicated by infection.
➢Occurs in women who tried self-abortion or
were aborted illegally using a non-sterile
instrument.
➢Therapeutic management:
1) Monitor urine output/hr. to assess kidney
function.
2) IVF is started to restore fluid volume
3) Broad spectrum antibiotic is started
• Penicillin (gm+), gentamicin (gm- aerobic),
Clindamycin (gm- anerobic)
4) TT and TIG is ordered for prophylaxis of tetanus
5) D & C will be performed.
 25

Ectopic Pregnancy
• Implantation occurs outside
the uterine cavity.
• Sites of implantation:
1. Fallopian tube (most common)
2. Surface of ovary
3. Cervix
• Predisposing factors:
1. Smokers
2. Use of IUDs
3. Following in vitro fertilization
4. Who had 1 ectopic pregnancy
 26

Ectopic Pregnancy
• Diagnostic tests:
1. Ultrasound
2. MRI (magnetic resonance imaging)
• Signs & Symptoms:
1. Sharp, stabbing pain in one of her lower
abdominal quadrants at the time of rupture
(6 – 12 wks. AOG).
2. Scant vaginal spotting
3. If internal bleeding progresses to acute
hemorrhage, a woman may experience:
➢Lightheadedness
➢Rapid pulse
➢Signs of shock
 27

Ectopic Pregnancy
• Assessment findings:
1. Falling hCG or serum progesterone level
2. Rigid abdomen from peritoneal irritation
3. Umbilicus may develop a bluish tinge
(Cullen’s sign)
4. Movement of cervix on pelvic exam may
cause excruciating pain.
5. Pain in the shoulders from blood in the
peritoneal cavity causing
irritation to the phrenic nerve.
6. Tender mass palpable in
Douglas’ cul-de-sac on
vaginal exam.
 28

Ectopic Pregnancy
• Therapeutic Management:
1. For unruptured ectopic pregnancy:
1) Methotrexate
➢Attacks and destroy fast-growing cells.
➢Treatment is continued until hCG titer is
negative.
2) Mifepristone
➢Cause sloughing of the tubal implantation
site.
 29

Ectopic Pregnancy
• Therapeutic Management:
2. For ruptured ectopic pregnancy:
1) IVF with large-gauge catheter to restore
intravascular volume (19 gauge needle)
2) Blood transfusion can be started after
cross-matching
3) Laparoscopy
➢To ligate the bleeding vessels
➢To remove or repair the damaged fallopian tube.
4) Women with Rh-negative blood should receive
Rh (D) immune globulin (RhIG) after ectopic
pregnancy for isoimmunization protection in
future childbearing.
 30

2nd Trimester Bleeding

• GESTATIONAL TROPHOBLASTIC
DISEASE (Hydatidiform Mole)
➢Abnormal proliferation and degeneration of the
trophoblastic villi
cells degenerate
become filled with fluid and appear
as fluid-filled, grape-sized vesicles
embryo fails to develop
 31

2nd Trimester Bleeding

• GESTATIONAL TROPHOBLASTIC
DISEASE (Hydatidiform Mole)
• Risk factors:
1. Low protein intake
2. Older than 35 y.o.
3. Asian heritage
 32

2nd Trimester Bleeding

• GESTATIONAL TROPHOBLASTIC
DISEASE (Hydatidiform Mole)
• Types:
1. Complete Mole
➢All trophoblastic villi swell and become
cystic
➢If an embryo forms, it dies early at only 1
– 2 mm in size
➢No fetal blood formed in the villi
 33

2nd Trimester Bleeding

• GESTATIONAL TROPHOBLASTIC
DISEASE (Hydatidiform Mole)
• Types:
2. Partial Mole
➢Some of the villi form normally.
➢Macerated embryo of approximately 9 wks.
Gestation may be present
➢Fetal blood present in the villi
➢Has 69 chromosomes (a triploid formation
in which there are 3 chromosomes instead
of 2 for every pair.
 34

GESTATIONAL TROPHOBLASTIC
DISEASE (Hydatidiform Mole)
• Signs & Symptoms:
1. Rapid increase of uterine size
2. No FHT is heard
3. Level of hCG continue to be strongly (+)
after day 100 of pregnancy (1 – 2 milli-IU)
4. Marked nausea & vomiting due to high hCG.
5. Symptoms of PIH:
1) Hypertension
2) Edema
3) Proteinuria
6. Vaginal spotting of dark brown blood
accompanied with clear fluid-filled vesicles.
 35

GESTATIONAL TROPHOBLASTIC
DISEASE (Hydatidiform Mole)
• Therapeutic Management:
1. Suction & curettage
2. Pelvic exam, chest X-ray, and a serum test for
hCG
3. Level of hCG is analyzed every 2 wks. until
normal; reassessed every 4 wks. For 6 – 12
months thereafter.
4. Health care providers usually will continue to test
hCG levels after a pregnancy loss to ensure they
return back to <5.0.
5. A contraceptive method is used for 12 months.
6. Methotrexate may be prescribed for
prophylaxis.
 36

hCG levels in weeks from LMP (gestational

age)
• 3 weeks LMP - - - - - - 5 – 50 mIU/ml
• 4 weeks LMP - - - - - - 5 – 426 mIU/ml
• 5 weeks LMP - - - - - - 18 – 7,340 mIU/ml
• 6 weeks LMP - - - - - - 1,080 – 56,500 mIU/ml
• 7 – 8 weeks LMP - - - 7, 650 – 229,000 mIU/ml
• 9 – 12 weeks LMP - - 25,700 – 288,000 mIU/ml
• 13 – 16 weeks LMP - - 13,300 – 254,000 mIU/ml
• 17 – 24 weeks LMP - - 4,060 – 165,400 mIU/ml
• 25 – 40 weeks LMP - - 3,640 – 117,000 mIU/ml
 37

Premature Cervical Dilatation

• Incompetent cervix
➢Cervix dilates prematurely and therefore
cannot hold a fetus until term.
➢Cervical dilatation is painless, no uterine
contractions
➢Commonly occurs at the week 20 of
pregnancy.
• Risk factors:
1. Increased maternal age
2. Congenital structural defects (short cervix)
3. Trauma to the cervix (e.g. repeated D & C)
 38

Premature Cervical Dilatation

• Risk factors:
4. History of traumatic birth
5. Client’s mother treated with
diethylstilbestrol (DES) when pregnant
with the client
• Diethylstilbestrol is a synthetic nonsteroidal estrogen that
was used to prevent miscarriage and other pregnancy
complications.
• Women who were exposed to diethylstilbestrol in utero
may have structural reproductive tract anomalies, an
increased infertility rate, and poor pregnancy outcomes.
6. Uterine anomalies
 39

Premature Cervical Dilatation

• Pathophysiology
➢Connective tissue structure of the cervix
is not strong enough to maintain closure
of the cervical os during pregnancy.
 40

Premature Cervical Dilatation

• Signs & Symptoms:
1. Pink-stained vaginal discharge (show);
first symptom
2. Rupture of the membranes
3. Discharge of the amniotic fluid
4. Uterine contractions begin.
 41

Premature Cervical Dilatation

• Medical Management:
1. Cervical Cerclage
➢Performed at approx. week 12 – 14 of the next
pregnancy.
➢Purse-string sutures are placed in the cervix
by vaginal route under regional anesthesia.
➢Strengthens the cervix and prevents it from
dilating.
➢McDonald or Shirodkar procedure
➢Sutures removed at week 37 – 38 of
pregnancy.
 42

Premature Cervical Dilatation

• The McDonald procedure
➢is done with a 5 mm band of
permanent suture is placed
high on the cervix.
➢This is indicated when there
is significant effacement of the
lower portion of the cervix.
➢It is generally removed at 37 weeks, unless
there is a reason to remove it earlier, like
infection, preterm labor, premature rupture of
the membranes, etc.
 43

Premature Cervical Dilatation

• The Shirodkar
➢is also frequently used
technique.
➢this was previously a
permanent purse string
suture that would remain
intact for life.
➢When this type of cerclage
is done, a cesarean section
will always be performed.
➢There are physicians performing modified
techniques, where the delivery does not necessarily
have to be by cesarean, nor the suture left intact.
 44

Premature Cervical Dilatation

• Nursing Management
1. Provide client and family teaching.
➢Describe problems that must be reported immediately
(ie,pink-tinged vaginal discharge, increased pelvic
pressure, and rupture of the membranes).
2. Maintain an environment to preserve the
integrity of the pregnancy.
➢Prepare for cervical cerclage, if appropriate.
➢Maintain activity restrictions as prescribed.
➢Discuss the need for vaginal rest (ie, no intercourse or
orgasm)
3. Prepare for the birth if membranes are
ruptured.
4. Address emotional and psychosocial
needs.
 45

3rd Trimester Bleeding

• Placenta Previa
➢Low implantation of the placenta
➢Occurs in 4 degrees:
1. Low-lying placenta
• Implantation in the lower rather than in the
upper portion of the uterus.
2. Marginal implantation
• Placenta edge approaches that of the cervical os.
 46

3rd Trimester Bleeding

• Placenta Previa
➢Low implantation of the placenta
➢Occurs in 4 degrees:
3. Partial placenta previa
• Implantation that occludes a portion of the
cervical os.
4. Total placenta previa
• Implantation that totally obstructs the
cervical os.
 47

3rd Trimester Bleeding

• Placenta Previa
➢Risk factors:
1. Increased parity
2. Advanced maternal age
3. Past cesarean births
4. Past uterine curettage
5. Multiple gestation
6. Male fetus.
 48

3rd Trimester Bleeding

• Pathophysiology of Placenta Previa
➢Bleeding occurs when the lower uterine
segment begins to differentiate from the
upper segment late in pregnancy (wk. 30) and
cervix begins to dilate.
➢Bleeding results from placenta’s inability to
stretch to accommodate the differing shape of
the lower uterine segment or the cervix.
➢Signs & Symptoms:
1. Abrupt
2. Painless
3. Bright red bleeding
 49

Placenta Previa
• Therapeutic Management:
• Immediate Care Measures:
1. Place woman immediately on bed rest on a
side-lying position.
2. Assess for the following:
➢Duration of pregnancy
➢Time the bleeding began
➢Woman’s estimation of the amount of blood
➢Accompanying pain if any
➢Color of the blood
 50

Placenta Previa
• Therapeutic Management:
• Immediate Care Measures:
1. Place woman immediately on bed rest on a
side-lying position.
2. Assess for the following (continued…)
➢Woman’s actions to halt bleeding, if any.
➢Any prior episodes of bleeding during the
pregnancy.
➢Prior cervical surgery for premature cervical
dilatation
3. Inspect the perineum for bleeding.
 51

Placenta Previa
• Therapeutic Management:
• Immediate Care Measures:
4. Determine vaginal blood loss by weighing
perineal pads before and after use.
5. Identify the origin of the blood (maternal or
fetal) through Apt or Kleihauer-Betke test
(test strip procedures)
• is a blood test used to measure the amount of fetal
hemoglobin transferred from a fetus to a
mother's bloodstream.
• It is usually performed on Rh-negative mothers to
determine the required dose of Rho(D) immune globulin
(RhIg) to inhibit formation of Rh antibodies in the mother
and prevent Rh disease in future Rh-positive children.
 52

Placenta Previa
• Therapeutic Management:
• Immediate Care Measures:
• Rho(D) immune globulin (RhIg)
• Administer 1 syringe (1,500 units) at
approximately 26 to 28 weeks' gestation,
followed by another full dose, preferably within
72 h following delivery, if the infant is Rh
positive.
 53

Placenta Previa
• Therapeutic Management:
• Immediate Care Measures:

6. Obtain baseline V/S.

7. Assess Bp every 5 – 15 min.
8. Monitor urine output every hour.
9. Never attempt a pelvic or rectal exam with
painless bleeding late in pregnancy.
 54

Placenta Previa
• Therapeutic Management:
• Immediate Care Measures:
10. Begin IVF therapy
11. Attach an external fetal monitor and begin
recording FHT and uterine contractions.
12. Blood test for:
• Hemoglobin
• Hematocrit
• Prothrombin time, partial thromboplastin time,
fibrinogen, platelet count
• Blood type and cross-matching
• Antibody screen
 55

Placenta Previa
• Therapeutic Management:
• Immediate Care Measures:
13. Determine the placental location for
possible vaginal delivery through
ultrasound.
14. Vaginal exam is done in an operating
room.
15. Have O2 equipment available.
 56

Placenta Previa
• Therapeutic Management:
• Continuing Care Measures:
16. If labor has begun, bleeding is continuing,
or the fetus is being compromised, birth
must be accomplished regardless of
gestational age.
17. Woman remains in the hospital on bed
rest for close observation for 48 hrs.
18. Betamethasone may be prescribed for the
mother to encourage the maturity of fetal
lungs if the fetus is less than 34 wks.
 PREMATURE SEPARATION OF THE
PLACENTA
(ABRUPTIO PLACENTA)
• Premature separation of the placenta (abruptio
placentae)
• placenta appears to have been implanted correctly.
Suddenly, however, it begins to separate and bleeding
results.
• is the most frequent cause of perinatal death (Ananth,
Lavery, Vintzileos, et al., 2016).
• The separation generally occurs late in pregnancy; even
as late as during the first or second stage of labor.
PREMATURE SEPARATION OF THE
PLACENTA (ABRUPTIO PLACENTAE)
• Always be alert to both the amount and kind of
pain and vaginal bleeding a woman is having in
labor.
• The primary cause:
• Unknown
• Predisposing factors:
1. high parity
2. advanced maternal age
3. short umbilical cord
PREMATURE SEPARATION OF THE
PLACENTA (ABRUPTIO PLACENTAE)
• Predisposing factors:
4. chronic hypertensive disease
5. hypertension of pregnancy
6. direct trauma (as from an automobile accident or
intimate partner violence)
7. vasoconstriction from cocaine or cigarette use
8. thrombophilic conditions that lead to thrombosis
formation (Boisramé, Sananès, Fritz, et al., 2014)
PREMATURE SEPARATION OF THE
PLACENTA (ABRUPTIO PLACENTAE)
• Predisposing factors:
9. chorioamnionitis or infection of the fetal membranes
and fluid (Hackney, Kuo, Petersen, et al., 2016).
10. rapid decrease in uterine volume, such as occurs
with sudden release of amniotic fluid as can happen
with polyhydramnios.
o Usually, the fetal head is low enough in the pelvis that when
membranes rupture, this prevents loss of the total volume of
the amniotic fluid at one time, so normally a rapid reduction
in amniotic fluid does not occur.
Assessment
1. sharp, stabbing pain high in the uterine fundus as
the initial separation occurs.
2. If labor begins with the separation, each
contraction will be accompanied by pain over and
above the pain of the contraction.
3. Tenderness can be felt on uterine palpation.
4. Heavy bleeding usually accompanies premature
separation of the placenta, although it may not be
readily apparent.
• External bleeding will only be evident if the
placenta separates first at the edges.
Assessment
5. If the center of the placenta separates first, blood
can pool under the placenta, and although
bleeding is just as intense, it will be hidden from
view.
• Whether blood is evident or not, signs of hypovolemic
shock usually follow quickly.
6. The uterus becomes tense and feels rigid to the
touch.
7. If blood infiltrates the uterine musculature,
Couvelaire uterus or uteroplacental apoplexy,
forming a hard, boardlike uterus occurs.
Assessment
8. As bleeding progresses, a woman’s reserve of
blood fibrinogen becomes diminished as her body
attempts to accomplish effective clot formation,
and DIC syndrome can occur.
▪ s/sx of Disseminated Intravascular Coagulation
✓ bleeding, bruising, low blood pressure, shortness of
breath, or confusion.
✓ blood clots may reduce blood flow and block blood
from reaching bodily organs resulting to multiple
organ failure.
Assessment
• If a woman is being admitted to the hospital after
experiencing symptoms at home, assess:
1. when the time the bleeding began
2. whether pain accompanied it
3. the amount and kind of bleeding,
4. if trauma could have led to the placental separation.
 Assessment
• Initial blood work should include:
1. hemoglobin level
✓ Normal adult female = 12 – 16 gm/dl
2. typing and cross-matching
3. fibrinogen level and fibrin breakdown products to detect
DIC.
✓ normal level of fibrinogen in the blood = 1.5 to 3.0 grams per
liter
✓ D-Dimer is a fibrin degradation product. It is named as such
because it contains two cross-linked D fragments of the fibrin
protein.
 Assessment
• D-dimer Range
• In Conventional Units: ≤ 250 ng/mL D-dimer units (DDU)
• In SI Units: ≤ 0.50 mcg/mL fibrinogen equivalent units
(FEU)
• Increased levels imply increased fibrinolysis and can be
seen in DIC and thrombotic states.
Types of Placental Separation
Grading of Placental Separation
Therapeutic Management
• Because of the threat to both the woman and the fetus,
separation of the placenta is immediately an emergency
situation (Heavey & Dahl Maher, 2015).
1. A woman needs a large-gauge intravenous catheter
inserted for fluid replacement.
2. oxygen by mask to limit fetal anoxia.
3. Monitor fetal heart sounds externally
Therapeutic Management
4. record maternal vital signs every 5 to 15 minutes to
establish baselines and observe progress.
5. The baseline fibrinogen determination will be followed
by additional determinations up to the time of birth.
6. Keep a woman in a lateral, not supine, position to
prevent pressure on the vena cava and additional
interference with fetal circulation.
Therapeutic Management
7. Do not perform any abdominal, vaginal, or pelvic
examination on a woman with a diagnosed or
suspected placental separation.
• It is important not to disturb the injured placenta any further.
8. Unless the separation is minimal (grades 0 and 1), the
pregnancy must be ended because the fetus cannot
obtain adequate oxygen and nutrients.
Therapeutic Management
9. If vaginal birth does not seem imminent, cesarean birth
is the birth method of choice.
10. Intravenous administration of fibrinogen or
cryoprecipitate (which contains fibrinogen) can be used
to elevate a woman’s fibrinogen level prior to and
concurrently with surgery.
• If DIC has developed, cesarean birth may pose a grave risk
because of the possibility of hemorrhage during the surgery
and later from the surgical incision.
Fresh frozen plasma

a lifelong bleeding disorder in which

your blood doesn't clot well
Therapeutic Management
11. With the worst outcome, a hysterectomy might be
necessary to prevent exsanguination (loss of blood to a
degree sufficient to cause death).
• Prognosis:
• Fetal
• depends on the extent of the placental separation and the degree of fetal
hypoxia.
• Maternal
• depends on how promptly treatment can be instituted.
Therapeutic Management
• Death can occur from massive hemorrhage leading to
shock and circulatory collapse or renal failure from
circulatory collapse.
• Any woman who has had bleeding before birth is more
prone to infection after birth than the average woman.
• A woman with a history of premature separation of the
placenta, therefore, needs to be observed closely for the
development of infection in the postpartum period.
76