11) Hemorrhage during the 2nd Half of Pregnancy - Placenta Previa and Placental Abruption Flashcards
What is the Definition of “Antepartum Hemorrhage”?
- Bleeding in the 3rd trimester
What are the Gynecological Reasons for Antepartum Hemorrhage?
- Varicose Veins of Vulva / Vagina
- Vaginal Lacerations
- Erosion of Cervix
- Cervical Polypus
- Cervical Cancer
What are the Obstetrical Reasons for Antepartum Hemorrhage?
- Marginal Sinus of Placenta - leading to placental abruption
- Placental Previa
- Vasa Previa
- Uterine Rupture
What is the Definition of “Placenta Previa”?
- It’s the presence of placenta in lower uterine segment
- Covering either part / entire Internal Cervical Os
- Presenting with painless vaginal bleeding AFTER 24th Week
What are the Types of Placenta Previa?
1) Total, Complete = Placenta completely covers internal os
2) Central = Internal Cervical Os is centered in Placenta
3) Isthmico-Cervical = PART of Placenta is attached to ENDOCERVIX
4) Partial = Placenta PARTIALLY covers internal os
5) Marginal = Placental EDGE extends to MARGIN of internal cervical os
6) Low-Lying = Placenta’s implanted in lower uterine segment w/ edge
NB! Normally the Placenta is at the FUNDUS of Uterus
What are the Risk Factors of Placenta Previa?
- Previous C-Section
- Multiparity
- Older Maternal Age
- Smoking
- Septic Abortions
What are the Clinical Features of Placental Previa?
- Painless SUDDEN BRIGHT RED Vaginal Bleeding
- NO Uterine Contractions
- ONLY External Bleeding
- Anemia / Hemorrhagic Shock
- Preterm Labor
- Fetal ARDS
How is Placental Previa Diagnosed & Treated?
DIAGNOSIS
- Previous Pregnancy with Placental Previa
- Complicated Placental Stage Previously
- Previous Surgery of Uterus
- Transabdominal / Transvaginal Ultrasound
TREATMENT
- Tocolysis with Magnesium Sulfate
- Spasmolytics
- Treat Anemia
- Monitoring Fetus
- IMMEDIATE C-Section - in case of Poor Hemodynamic Status of Mother
- Vaginal Delivery = For Low-Lying Placenta, and Fetal Death
What is the Definition of “Placental Abruption”?
- It’s PREMATURE separation of placenta from uterine wall
- Occurs BEFORE 37th Week
What are the Causes of Placental Abruption?
- Hypertension
- Preeclampsia
- Abdominal trauma
- History of Placental Abruption
- Decompression of Uterus
- Uterine Fibroids
What are the Clinical Features of Placental Abruption?
- Sudden, Sharp Abdominal Pain
- DARK / CLOTTED Blood
- Increased *Uterine Tone
- Shock
- DIC
- Fetal Distress, Demise
COUVELAIRE Uterus - It’s BLUISH discolouration of Cervix
How is Placental Abruption Diagnosed & Treated?
DIAGNOSIS
- Transabdominal Ultrasound - Retroplacental Hematoma to RULE OUT Previa
- Foetal Monitoring
- Thrombocytopenia, Anemia
TREATMENT
- IMMEDIATE C-Section - in case of Poor Hemodynamic Status of Mother
- Induction of Labour
- Correct Shock
- Maternal Oxygenation
- Tocolytics, IM Dexamethasone
