O+G
THIRD TRIMESTER BLEEDING
PromptCommon causes of 3rd trimester bleeding
ResponsePlacenta previa
Placental abruption
Vasa previa
PROM/preterm labour
Cervical lesions (polyps, ectropion, malignancy)
Vaginal lesions (malignancy, trauma (?SA), STI)
Placental abruption
Vasa previa
PROM/preterm labour
Cervical lesions (polyps, ectropion, malignancy)
Vaginal lesions (malignancy, trauma (?SA), STI)
PromptDefine placental Abruption
ResponsePlacental abruption = Abruptio placentae:
>24/40 gestation, Bleeding from a normally situated placenta causing its complete or partial detachment from the uterine wall.
Constant pelvic pain, tense uterus on examination, fetal distress, shock out of proportion to PV loss (As bleeding is intrauterine)
Expect shock, DIC if severe.
Associated with Htn and preeclampsia
>24/40 gestation, Bleeding from a normally situated placenta causing its complete or partial detachment from the uterine wall.
Constant pelvic pain, tense uterus on examination, fetal distress, shock out of proportion to PV loss (As bleeding is intrauterine)
Expect shock, DIC if severe.
Associated with Htn and preeclampsia
PromptRisk factors placental abruption
ResponseHtn, Preeclampsia
Trauma
Smoking
Advanced maternal age
EtOH + Drugs (Cocaine in particular)
Previous placental abruption
Previous C secion or other uterine surgery
Trauma
Smoking
Advanced maternal age
EtOH + Drugs (Cocaine in particular)
Previous placental abruption
Previous C secion or other uterine surgery
PromptDefine Placenta previa
ResponsePlacenta located in lower non contractile part of uterus. When stretched in last few weeks of pregnancy/labour placental separation and haemorrhage will occur.
Painless, non tender uterus, no signs of foetal distress, shock in proportion to PV loss
Severe needs C section, mild may consider NVD
Painless, non tender uterus, no signs of foetal distress, shock in proportion to PV loss
Severe needs C section, mild may consider NVD
PromptDefine Vasa previa
ResponseVasa praevia is a condition in which fetal blood vessels cross or run near the internal opening of the uterus. These vessels are at risk of rupture when the supporting membranes rupture, as they are unsupported by the umbilical cord or placental tissue.
- wiki
PromptPV examination in 3rd trimester bleeding
ResponsePV exam may worsen bleeding in placenta previa. Avoid digital vaginal examination
PromptManagement 3rd trimester bleeding
Response2 large bore IV cannulae, fluid resuscitation
HF oxygen
Cross match 6 units and transfuse as necessary
Urgent O+G consultation
Bloods - FBC, Coags, G+H, EUC’s
CTG monitoring of foetus
Alternative:
Resuscitate with blood - O neg >> Crossmatched. Consider MTP
Reverse coagulopathy - FFP, cryo, platelets
Steroids for foetal lung maturation
Urgent O+G consultation
HF oxygen
Cross match 6 units and transfuse as necessary
Urgent O+G consultation
Bloods - FBC, Coags, G+H, EUC’s
CTG monitoring of foetus
Alternative:
Resuscitate with blood - O neg >> Crossmatched. Consider MTP
Reverse coagulopathy - FFP, cryo, platelets
Steroids for foetal lung maturation
Urgent O+G consultation