5 Late Pregnancy Bleeding Flashcards
Late trimester painful bleeding
Normal placental implantation
DIC
Abruptio Placentae
Retroplacental hemorrhage
Concealed or Internal Abruptio placenta
25-50% of placental separation
Fetal status : ⬆️HR, ⬇️variability, mild late deceleration
Moderate A/P
Risk Fx in A/P
Previous abruptio, HTN,
Maternal blunt trauma
Cocaine, smoking, PROM
A/P with evidence of fetal and/or maternal jeopardy
Emergency CS
A/P with heavy bleeding that is controlled or pregnancy > 36w
Vaginal Delivery
Extravasation of blood between myometrial fibers
Couvelaire Uterus
PP is an abN implantation of placenta in the LUS causing painless late trimester vaginal bleeding. The bleeding is caused by
Avulsion of anchoring villi as LUS stretching occurs
Intractable bleeding with PP occurs when it occurs overs a PUS causing the villi to invade into the deeper layers of decidua basalis and myometrium. This requires ____________.
CS Hysterectomy
PP on preterm gestations with both fetomaternal satatus stable
Conservative Management
Profound ⬇️BP causing APG necrosis
Sheehan Syndrome
Accreta, Increta, Percreta
Deeper layers of decidua basalis
Myometrium, incomplete
Uterine serosa or bladder
ROM
Painless vaginal bleeding
Fetal bradycardia
Vasa previa
Risk factors for V/P
- Velamentous insertion of the umbilical cord
- Accessory placental lobes
- Multiple gestation
Late trimester painful bleeding
Previous (classic) uterine incision/excessive oxytocin stimulation
DMS
Loss of station of fetal head
May/not include visceral peritoneum
Uterine rupture
