ddx of 3rd trimester bleeding

Question 1

what is placenta previa?

Answer 1

abnormal placenta that is close or covers the ox

Question 2

what are the three types of placenta previa?

Answer 2

1) marginal: w/in 2-3 cm of the cervical os
2) partial: covering of cervix ahead of fetal presenting part
3) complete: total coverage of os

Question 3

what is the s/sx of placenta previa?

Answer 3

3rd trimester bleeding, painless, bright red

• 20-30wks
• resolves w/in 1-2 hrs
• no abdominal pain, uterine soft and nontender

Question 4

what happens to fhr in placenta previa?

Answer 4

normal

Question 5

how is PPrevia dx?

Answer 5

US (NO PELVIC)

Question 6

what is the tx for PPrevia?

Answer 6

hospitalization- stabilize baby

tocolytics: Mag
amniocentesis: to fetal lung maturity, steroids btw 24-24 wks
- delivery when stable (complete-c section)

Question 7

what is abruption placentae?

Answer 7

premature separation of the placenta from the uterine wall after 20 wks gestatsion

Question 8

what are the types of Abruption?

Answer 8

I: mild, slightly bleeding
II: moderate/partial
III: complete

Question 9

s/sx of abruption?

Answer 9

3rd trimester bleeding, often dark red, continuous
**severe abdominal pain!
rigid uterus
+/-back abdominal pain, shock x

Question 10

FHR in abruption?

Answer 10

bradycardia, baby distressed bc it interferes w/ oxygen

Question 11

dx of abruption

Answer 11

US, NO PELVIC

Question 12

tx of abruption

Answer 12

immediate delivery; c section preferred

Question 13

what are some complications of abruption?

Answer 13

DIC (disseminated intravascular coagulation)

Question 14

what are RF for abruption?

Answer 14

maternal HTN (most common cause)
-smoking, etoh, coke, folate deficiency, high parity, increased age, trauma, chorioamnionitis

Question 15

what is vasa previa?

Answer 15

-fetal vessels transverse the fetal membranes over the cervical os

Question 16

what are the s/sx of vasa previa?

Answer 16

rupture of membranes= painless vaginal bleeding

Question 17

FHR in vasa previa?

Answer 17

bradycardia

Question 18

dx for vasa previa?

Answer 18

pelvic US

Question 19

what is the management of vasa previa?

Answer 19

immediate C section

Question 20

what is cervical insufficiency?

Answer 20

the inability to maintain pregnancy secondary to premature cervical dilation, especially in the 2cd trimester

Question 21

RF for cervical insufficiency?

Answer 21

previous cervical trauma or procedure (tx for CIN), uterus defects, DES exposure in utero, multiple gestations

Question 22

what are s/sx of cervical insufficiency?

Answer 22

bleeding, vag d/c, especially in 2 cd trimester

Question 23

PE of cervical Insuff?

Answer 23

painless dilation and effacement of cervix

Question 24

how is cervical insuff tx?

Answer 24

cerclage and bed rest

+/- wkly injection of 17 X hydroxyprogesterone (makena) in some women with preterm birth hx

Question 25

when can a cerclage be performed?

Answer 25

in women who develop a short cervix (<25 mm) before 24 wks as determined by US surveillance