2-7.
THIRD-TRIMESTER BLEEDING
a. Signs and Symptoms. Bleeding in the last three months of pregnancy must
be considered to be placenta abruptio or placenta previa until proven otherwise. Both of
these conditions may be rapidly life-threatening because of massive hemorrhaging.
(1) Placenta abruptio -- premature separation of the placenta from the
uterine wall resulting in bleeding from the separation site.
(2) Placenta previa -- placenta that is implanted in the lower uterine
segment, possibly totally or partially covering the opening of the cervix.
b. Treatment. The goal of treatment is to prevent shock. Treat as follows:
(1)
Administer 100 percent oxygen.
(2) Establish an IV and run crystalloid or colloid as rapidly as necessary to
maintain the patient's blood pressure.
(3) Transport the patient rapidly to the hospital in the lateral recumbent
position (also called the obstetrical position, the patient lies on her left side with her right
thigh and knee drawn up).
CAUTION:
NEVER perform a vaginal examination on any woman with third-
trimester bleeding.
2-8.
PREECLAMPSIA
Preeclampsia is the first stage of a pregnancy condition commonly called
toxemia. The earliest signs of toxemia (preeclampsia) must be detected to prevent the
condition from progressing to full eclampsia, which involves convulsions and coma and
can result in death.
a. Signs and Symptoms. Problems indicating preeclampsia may develop over
the period of a few days or appear suddenly within a 24-hour period. They Include the
following.
(1) High blood pressure. The patient's circulation changes, affecting the
blood flow to the kidneys. The kidneys start losing track of how much sodium they are
supposed to excrete to maintain the body's salt balance. At this time, the kidneys begin
to control the patient's blood pressure, causing the blood pressure to rise.
(2)
Edema, usually of the face, hands, and/or feet.
(3)
Headaches.
MD0584
2-9
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