Gapuz Table for Blood Disorders in Pregnancy

BLEEDING DISORDERS IN PREGNANCY SPONTANEOUS ABORTION THREATENED INCOMPLETE ABORTION ABORTION Vaginal Bleeding (+) Positive; With brownish vaginal bleeding or discharge May be present or absent; Cramping may be present Closed Intact Gold Standard is BEDREST for two (2) weeks; Restriction of coitus for two (2) weeks but as long as there is bleeding, continue to restrict Give PROGESTERONE HORMONE (+) Positive; Parietal fragments are usually left (+) Positive; Because uterus contracts trying to expel the fragments Open Not Intact 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 log Monitor Vital Signs every fifteen (15) minutes for two hours; Receive RHOGAM within seventy-two (72) hours

INEVITABLE / IMMINENT ABORTION (+) Positive

COMPLETE ABORTION (+) Positive; But minimal; Blood clots only; No placental fragments (-) Negative

MISSED ABORTION Light manifestation; Just brownish vaginal discharge Occasional slight dysmenorrhea Closed Intact 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) weeks After two weeks, no manifestation – Client obliged to go back to clinic. When missed abortion is diagnosed: Induce labor to expel products of conception Dilatation and Curettage follows

Abdominal Pain

(+) Positive

Cervical Dilatation Bag of Water / Membranes Management

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

Closed Not Intact None; Continue abortion