Late Pregnancy Bleeding (3rd Trimester) Flashcards
What are the four primary causes of third trimester bleeding?
- Placenta praevia
- Placental abruption
- Uterine rupture
- Vasa praevia
How are the presentations of placenta praevia and placental abruption differentiated?
Praevia - painless PV bleeding
Abruption - pain and PV bleeding
How is late pregnancy bleeding managed?
ABC
Insertion of two wide bore IV cannulas
Bloods (FBC, group and save, Rh status)
Steroids if <34 weeks
Expedite delivery
How is placenta praevia classified?
Marginal and complete
When does the lower uterine segment develop?
When can placenta praevia be diagnosed?
28 weeks
At the 32 week growth scan (before this it is called low-lying placenta)
What are 5 risk factors for placenta praevia?
Areas of deficiency
1. Previous C-section
2. Previous gynae surgery
3. High parity
4. Advanced maternal age
5. Smoking
What are 5 complications of placenta praevia?
- Haemorrhage
- Transfusion reaction
- Prematurity
- Surgical complications
- Accreta/increta/percreta
Define placenta accreta, increta and percreta.
Accreta - adheres to myometrium
Increta - invades myometrium
Percreta - penetrates myometrium to other organs
How is a patient presenting with painless bleeding in the third trimester managed?
ABC
Two IV cannulas
Bloods
Speculum exam
TVUS
CTG
Expedite delivery
When should a patient with placenta praevia be delivered?
Minimum 34 weeks, ideally 37-38 weeks
What is placental abruption?
Give 5 risk factors for abruption.
Give 3 complications for abruption.
How is abruption managed?
What are the three classes in Sher’s classification (abruption)?
