5. Antepartum Hemorrhage Flashcards
Two major causes of antepartum hemorrhage
Placenta previa (20%)
Placental abruption (30%)
Placenta previa
Abnormal implantation of the placenta over the internal cervical os
Differential Dx of Antepartum Bleeding
Obstetric causes & Nonobstetric causes
Obstetric:
- Placental
- Previa, abruption, vasa previa
- Maternal
- Uterine rupture
- Fetal
- Fetal vessel rupture
Nonobstetric:
- Cervical
- Severe cervicitis, polyps, cervical dysplasia/cancer
- Vaginal/vulvar
- Lacerations, varices, cancer
- Other
- Hemorrhoids, congenital bleeding disorder, abdominal/pelvic trauma, hematuria
Fetal Complications Associated with Placenta Previa (6)
- Preterm delivery and its complications
- Preterm premature rupture of membranes
- IUGR
- Malpresentation
- Vasa previa
- Congenital abnormalities
Patients with placenta previa classically present with sudden _______________
Exam maneuver that is contraindicated?
profuse painless vaginal bleeding
C/I: Digital exam
Predisposing factors for placenta previa (7)
- Prior c-section and uterine surgery (e.g., myomectomy)
- Multiparity
- Multiple gestation
- Erythroblastosis
- Smoking
- Hx of placenta previa
- Increasing maternal age
Placenta Previa:
Treatment
STRICT PELVIC REST (i.e., no intercourse)
- Stabilize pt if necessary
- Prepare for catastrophic hemorrhage
- Prepare for preterm delivery
Additional considerations: plan for total abdominal hysterectomy at the time of c-section
Placental abruption:
Predisposing and precipitating factors
Presentation
Complications
Presentation:
Vaginal bleeding, painful contractions, firm tender uterus
Complications:
Hypovolemia, DIC, preterm delivery
Fetal vessel rupture:
Pathogenesis
Dx
Tx
Velamentous cord insertion where the blood vessels insert between the amnion and chorion away from the placenta instead of inserting directly into the chorionic plate
Dx: Apt test (exam blood for nucleated fetal RBCs)
Tx: emergent section given high risk of fetal exsanguination and death (vascular volume of term fetus <250 mL)
