Midwifery Management of First Trimester Bleeding and Early Pregnancy Loss

Abstract

As many as 25% of women experience bleeding in the first and early second trimester of pregnancy; about half of these will have a miscarriage or, more rarely, ectopic or molar pregnancy loss. This can be a difficult time for women because of the uncertainty of the outcome, lack of preventative measures, and emotional significance of early pregnancy loss. The qualities that characterize midwifery care, including providing complete information, encouraging self-determination, and being sensitive to the emotional state, are particularly important at this time. This article reviews the epidemiology; physiologic process; signs and symptoms of first trimester bleeding; miscarriage and other early pregnancy losses; and methods of clinical, biochemical, and sonographic evaluation. A framework to guide midwifery evaluation and management, based on confirmation of an intrauterine pregnancy followed by the determination of viability, is presented. Surgical, medical, and expectant management of nonviable pregnancy, management of viable pregnancy when bleeding persists, and follow-up care, including screening for psychological sequelae, are discussed. Case studies and specific clinical guidelines for midwifery care, consultation, collaboration, and referral are included. Understanding the emotional significance of first trimester bleeding and loss as a basis for sensitive care throughout the management process is addressed.

First trimester bleeding and pregnancy outcome

“…The studies of Deutchman et al and Thorstensen et al it was seen that in pregnancies with first trimester vaginal bleeding the most important diagnostic actions were transvaginal ultrasound and evaluating the rising of serum level of βHCG. 7,8 It was seen in previous studies that due to numerous disorders of placenta in the pregnant women with first trimester bleeding, the length of pregnancy in these women is less and the possibility of premature delivery is more and as a result such pregnancies developed growth failure and newborn had low birth weight due to premature delivery. 9,10 Many studies agreed with low birth weight of newborns and Apgar of 5 minute less than 7 in pregnancies with first trimester bleeding.…”

Guilt and Emptiness: Women's Experiences of Miscarriage

“…Women who experience miscarriage of an unplanned pregnancy are at a greater risk of intensified grief reactions (Kennell, Howard, & Marshall, 1970). While miscarriage has similarities with other losses in life, some of the unique aspects of miscarriage necessitate additional emotional support (Mahan & Calica, 1997;Stiritzinger, Robinson, & Stewart, 1999;Thorstensen, 2000;Worden, 1999).…”

High Evaluation of Medical Staff by Women after Miscarriage during Hospitalization

“…Midwives usually recognize these needs and provide the women with support in especially difficult situations (Thorstensen 2000;Adolfsson et al 2006). According to the assumptions of Swanson's Caring Theory, a midwife is a sympathetic person who treats a woman with dignity, respect and delicacy, possesses the indispensable communication skills to help a woman after miscarriage in understanding the process of grieving, while at the same time recognizing and satisfying her needs.…”