6 Nursing Diagnosis for Antepartum Haemorrhage

Antepartum haemorrhage (APH) is vaginal bleeding that occurs after 20 weeks of pregnancy. APH complicates 3–5% of pregnancies and is a leading cause of perinatal and maternal mortality worldwide. The common causes of bleeding during pregnancy are cervical ectropion, vaginal infection, placenta praevia, placental edge bleed or placental abruption. It can also be due to local problems with the cervix (such as cervical erosion or a polyp) or vagina (such as a ruptured vein), which are usually less serious. It occurs more often in mothers with pre-eclampsia or high blood pressure. In almost half of all cases, your doctor may not be able to diagnose the exact cause but will need to investigate you nevertheless.

Predisposing conditions for a placenta previa are multiparity, multiple pregnancies or a previous caesarean section. The predisposing conditions for abruptio placenta on the other hand, include multiparity, hypertensive disorders, trauma to the maternal abdomen or rarely, a sudden release of liquor in polyhydramnios, for example, at amniotomy.

Once a diagnosis of placenta previa or abruptio placenta has been excluded, only then should a speculum examination be done to inspect the vagina and cervix. It must be reemphasized that to effectively exclude latter two diagnoses, both a physical examination and an ultrasound examination must be done.

The amount of bleeding with which the patient presents can vary substantially. It can range from a mere spotting to a 'torrential' bleed that becomes life threatening.

You may be admitted to hospital for observation and assessment of the cause of your bleeding. You will have an ultrasound scan and your baby may have a cardiotocograph (CTG) which checks your baby's heart beat.

In some cases of antepartum haemorrhaging, it may be sufficient just to monitor your clinical status and that of your baby for a few days, and if the bleeding stops and your condition is satisfactory then you may be allowed to go home.

1. Fluid Volume Deficit related to excessive vomiting and inadequate inputs (ireneM. Bobak, 1995: 637)

2. Imbalanced Nutrition: less than body requirements related to nausea and vomiting continuously (Irene M.Bobak: 638)

3. Acute pain: epigastric related to recurrent vomiting (Marie S Jaffe. 1989 pages: 37)

4. Altered Bowel Elimination - Constipation related to inadequate food intake (Marie S. Jaffe. 1989 pages: 37)

5.Ineffective self defense pattern related to the psychological effects of pregnancy and changes as a mother (Sharon J Reeder .1987 pages: 748)

6. Imbalanced Nutrition: Fetal related to reduced blood circulation to the fetus food (Sharon J Reeder .1987 pages: 748)