Late Pregnancy Bleeding 6

Question 1

Late pregnancy bleeding is

Answer 1

vaginal bleeding that occurs after 20 weeks’ gestation. Prevalence is <5%, but when it does occur, prematurity and perinatal mortality quadruple.

Question 2

Cervical causes of late pregnancy bleeding include

Answer 2

erosion, polyps, and, rarely, carcinoma

Question 3

Vaginal causes of late pregnancy bleeding include

Answer 3

varicosities and lacerations

Question 4

Placental causes of late pregnancy bleeding include

Answer 4

abruptio placentae, placenta previa, and vasa previa

Question 5

Prevalence is

Answer 5

<5%, but when it does occur, prematurity and perinatal mortality quadruple.

Question 6

The most common cause of obstetric DIC

Answer 6

Abruptio placenta

Question 7

Initial Investigation of any late pregnancy bleeding

Answer 7

Complete blood count
disseminated intravascular coagulation (DIC) workup (platelets, prothrombin time, partial thromboplastin time, fibrinogen, D-dimer),
type and cross-match,
and sonogram for placental location.

Question 8

Initial management of late pregnancy bleeding

Answer 8

Start an IV line with a large-bore needle; if maternal vital signs are unstable → run isotonic fluids and
place a urinary catheter to monitor urine output.

Question 9

A normally implanted placenta (not in the lower uterine segment) separates from the uterine wall
before delivery of the fetus.

Answer 9

Abruptio placenta

Question 10

the retroplacental hematoma remains within the uterus.

Answer 10

bleeding remains concealed or interna

Question 11

bleeding remains concealed or interna

Answer 11

the retroplacental hematoma remains within the uterus .

Question 12

Risk Factors of Abruptio placentae is seen more commonly with

Answer 12

HTN, previous abruption placenta, maternal blunt trauma
Smoking, cocaine abuse.

Question 13

Is the most common cause of painful late-trimester bleeding, occurring in 1% of pregnancies at term.

Answer 13

Abruption placenta

Question 14

Diagnosis of abruption placenta

Answer 14

This is based on the presence of painful late-trimester vaginal bleeding with a normal fundal or lateral
uterine wall placental implantation not over the lower uterine segment.

Question 15

Crystalloid such as

Answer 15

Saline or lactated Ringer ‘ solution

Question 16

Crystalloid are given as a first choice for Conservative in-hospital observation management of late pregnancy bleeding for

Answer 16

increase blood volume and help stabilize the patient’s circulation.

Question 17

is performed if mother and fetus are stable and remote from term, bleeding is minimal or decreasing, and contractions are subsiding.

Answer 17

Conservative in-hospital observation

Question 18

couvelaire uterus

Answer 18

Is a complication of abruption placenta , in which cause entering of blood in the myometrium , and thus this accumulation will cause bruised uterus .

Question 19

refers to blood extravasating between the myometrial fibers, appearing like bruises on the serosal surface

Answer 19

Couvelaire uterus

Question 20

when the placenta is implanted in the lower uterine segment.

Answer 20

Placenta previa

Question 21

painless late-trimester vaginal bleeding associated with

Answer 21

Placenta previa

Question 22

Placenta previa is seen more commonly with

Answer 22

previous placenta previa, multiparity, and multiple gestation (increase placental surface area), advance maternal age . And increase Caesarian delivery rates will increase possibility of placenta previa deuce to scares and change of vasculity .

Question 23

presence of painless late-trimester vaginal bleeding with an obstetric ultrasound showing placental implantation over the lower uterine segment.

Answer 23

In placenta previa

Question 24

Complications of placenta previa

Answer 24

Caesarian hysterectomy , hypovolemia will cause Sheehan syndrome or acute tubal necrosis

Question 25

• If these fetal vessels rupture the bleeding is from the fetoplacental circulation, and fetal exsanguination will rapidly occur, leading to fetal death.

Answer 25

Vasa previa

Question 26

▪ Clinical Presentation of vasa previa

Answer 26

The classic triad is rupture of membranes and painless vaginal bleeding, followed by fetal bradycardia.

Question 27

Management of vasa previa

Answer 27

Immediate cesarean delivery of the fetus is essential, or the fetus will die from hypovolemia.

Question 28

is complete separation of the wall of the pregnant uterus with or without expulsion of
the fetus that endangers the life of the mother or the fetus, or both.

Answer 28

Uterine rapture

Question 29

Most uterine ruptures occur in patients with a

Answer 29

history of uterine surgery ( myomectomy) as the inelastic scar may not be able to withstand labor contractions.

Question 30

Uterine accrue during

Answer 30

Labor, after labor or both

Question 31

The most common findings of uterine rapture

Answer 31

are painful vaginal bleeding, loss of electronic fetal heart rate signal due to
disruption of the maternal-placental circulation, and loss of station of fetal head. Rupture may occur
both before labor as well as during labor