الفهرس 
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Abstract
Antepartum hemorrhage is defined as bleeding from the vagina after
24weeks of pregnancy and before the onset of labor. It occurs in 2-5% of
pregnancies and is an important cause of fetal and maternal death. Thirty
percent of maternal deaths are caused by antepartum hemorrhage of
which 50% are associated with avoidable factors. The causes of
antepartum hemorrhage can be divided into three main groups, placenta
previa, placental abruption and others. Placenta previa exists when the
placenta is implanted wholly or partially into the lower segment of the
uterus. An abruption placenta is the condition whenever bleeding occurs
due to premature separation of a normally sited placenta. Other causes are
cervical polyp, cervical carcinoma, local lesions of vagina and cervix.
Systemic diseases like leukemia & bleeding disorders are rare causes of
antepartum hemorrhage. Placenta praevia and placenta abruption account
for almost half cases of antepartum hemorrhage.
Maternal complications of antepartum hemorrhage are malpresentation,
premature labor, postpartum hemorrhage, shock, retained placenta. They
also include higher rates of caesarean section, peripartum hysterectomy,
coagulation failure, puerperal infections and even death. Fetal
complications are premature delivery, low birth weight, intrauterine
death, congenital malformations and birth asphyxia.
Nurse plays an important role in assessing and management of
antepartum hemorrhage. The immediate management of antepartum
hemorrhage includes estimation of blood loss, insert large bore cannula,
vaginal digital examination is contraindicated .Quick attention to the
presenting vital signs looking for hypotension, tachycardia, confusion, or
breathlessness, assess fetal heart rate, and assess presence of uterine
contractions. Immediate intravenous access, fluid resuscitation as doctor
order, Give oxygen if needed, lie women in lateral position-not supine,
laboratory tests should be done as soon as possible according to doctor
order and prepare for blood transfusion if necessary.
The present study purposed to assess maternity nurses’ practices of
women with late antepartum hemorrhage.
Research Questions:
What is the level of maternity nurses’ practices of women with late
antepartum hemorrhage?
Are maternity nurses’ practices of women with late antepartum
hemorrhage affected by receiving previous training program for
antepartum hemorrhage?
Do socio-demographic characteristics affect maternity nurses’
practices of women with late antepartum hemorrhage?
The study was descriptive design; a convenient sample type consisted
of two main groups; nurses group (106) who are responsible for
providing direct nursing care to women, and women group (250) with late
antepartum hemorrhage and Free from any medical and obstetric
diseases. The study was conducted in three settings of the highest flow
rate at Al-Buhayrah Governorate; one of them is antenatal unit in the
Obstetric & Gynecological Department of Damanhour National Medical
Institution (Previously Damanhour Teaching Hospital). It is an institute
affiliated to General Organization for Teaching Hospitals and Institutes,
and two other hospitals affiliated to the Ministry of Health, one of them is
Kafr El-Dawar Central Hospital and Etay El- Barood General Hospital is
the other.Instruments of data collection
Instrument l: A structured Interviewing Questionnaire of studied
nurses including the following:
Socio demographic data of studied nurses: It recorded staff nurse’s
personal data about age, marital status and educational
qualification.
Occupational characteristics of studied nurses: It recorded data
about nursing years of experience, number of women cared, source
of information, and attend any training programs for antepartum
hemorrhage.
Instrument II: A structured Interviewing Questionnaire of studied
women included the following:
Socio demographic data of women: age, level of education, marital
status….etc.
Past obstetric history: gravidity, parity….etc.
Current pregnancy history: gestational age….etc.
Instrument III: Menstrual profile: this instrument used to measure
blood loss.
Instrument IV: Numeric pain intensity scale for assessment of
pain: This 0 to 10 pain scale is commonly and successfully used to assess
the degree and severity of pain
Instrument V: Observational check list: it was used to observe and
assess maternity nurses’ practices of women with late antepartum
hemorrhage, this instrument contained 76 items covered all maternity
nurses’ practices and subdivided under eight main subscales, 27 items for
initial assessment when women arrived in the hospital and emergency
measures, 11 items for patient/caregiver teaching (instructions and explanations), 6 items for preparation for investigations and operations, 5
items for psychological support and keeping privacy, 3 items for
administration of medication,9 items for infection control and prevention
- standard precautions,10 items for communication skills and 5 items for
documentation.
The findings of this study are as following:
Maternity nurses` practices of women with late antepartum
hemorrhage fell in the category of good performance, while none of the
nurses had poor level of performance.
Age of the studied nurses did not significantly affect their performance
with patients. However, marital status, educational level, duration of
experience in nursing & number of nursed patients significantly affected
nurses` performance with pregnant women.
Receiving previous training program for APH significantly affected
the practice level of the studied nurses.
Nurses who had previous training program had significantly higher
mean practice score compared to those who did not have training
program. However, source of information did not significantly affect the
practice level of the studied nurses.
The researcher recommends that it is necessary to enhance the
awareness of pregnant women especially rural areas antenatal mothers to
the dangers concealed in vaginal bleeding and the urgent need for
gestational surveillance in order to, minimize the rate of the obstetrical
complications through:
Design a simple Arabic health education pamphlets regarding
antepartum hemorrhage distributed to all pregnant women in
antenatal clinic. Encouragement of pregnant women to visit antenatal clinic from the
beginning of pregnancy to identify the risk factors that may have
an adverse effect on the mother and her fetus and to reduce the risk
of future antepartum hemorrhage.
The researcher also, recommends maintaining good performance
of maternity nurses regarding antepartum hemorrhage through:
Develop a clear protocol for the management of massive
hemorrhage, which should be regularly updated and rehearsed.
Educational program, regular seminars and work shop should be
presented monthly to maternity nurses by head nurses and doctors.
Head nurses should be more aware about antepartum hemorrhage
and its adverse effect on the mother and the fetus.
Further study:
Studies on more wide scale are recommended to clearly assess
maternity nurses’ practices of women with late antepartum
hemorrhage.
A suggestion for future study is to assess maternity nurses’
knowledge regarding late antepartum hemorrhage. Careful
surveillance, including fetal monitoring, is suggested in these
cases in order to reduce the adverse perinatal outcome