ddx of 3rd trimester bleeding Flashcards
what is placenta previa?
abnormal placenta that is close or covers the ox
what are the three types of placenta previa?
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
what is the s/sx of placenta previa?
3rd trimester bleeding, painless, bright red
- 20-30wks
- resolves w/in 1-2 hrs
- no abdominal pain, uterine soft and nontender
what happens to fhr in placenta previa?
normal
how is PPrevia dx?
US (NO PELVIC)
what is the tx for PPrevia?
hospitalization- stabilize baby
tocolytics: Mag
amniocentesis: to fetal lung maturity, steroids btw 24-24 wks
- delivery when stable (complete-c section)
what is abruption placentae?
premature separation of the placenta from the uterine wall after 20 wks gestatsion
what are the types of Abruption?
I: mild, slightly bleeding
II: moderate/partial
III: complete
s/sx of abruption?
3rd trimester bleeding, often dark red, continuous
**severe abdominal pain!
rigid uterus
+/-back abdominal pain, shock x
FHR in abruption?
bradycardia, baby distressed bc it interferes w/ oxygen
dx of abruption
US, NO PELVIC
tx of abruption
immediate delivery; c section preferred
what are some complications of abruption?
DIC (disseminated intravascular coagulation)
what are RF for abruption?
maternal HTN (most common cause) -smoking, etoh, coke, folate deficiency, high parity, increased age, trauma, chorioamnionitis
what is vasa previa?
-fetal vessels transverse the fetal membranes over the cervical os
what are the s/sx of vasa previa?
rupture of membranes= painless vaginal bleeding
FHR in vasa previa?
bradycardia
dx for vasa previa?
pelvic US
what is the management of vasa previa?
immediate C section
what is cervical insufficiency?
the inability to maintain pregnancy secondary to premature cervical dilation, especially in the 2cd trimester
RF for cervical insufficiency?
previous cervical trauma or procedure (tx for CIN), uterus defects, DES exposure in utero, multiple gestations
what are s/sx of cervical insufficiency?
bleeding, vag d/c, especially in 2 cd trimester
PE of cervical Insuff?
painless dilation and effacement of cervix
how is cervical insuff tx?
cerclage and bed rest
+/- wkly injection of 17 X hydroxyprogesterone (makena) in some women with preterm birth hx
when can a cerclage be performed?
in women who develop a short cervix (<25 mm) before 24 wks as determined by US surveillance
