Late Pregnancy PV Bleed Flashcards
What are the causes of late pregnancy bleeding?
- Placenta praevia
- Abruption
- Ruptured vasa praevia
- Uterine scar disruption
- Cervical polyp
- Bloody show
- Cervicitis or cervical ectropion
- Vaginal trauma
- Cervical cancer
These are potential causes that need to be assessed in cases of late pregnancy bleeding.
What is placenta praevia?
A condition where the placenta partially or completely covers the internal cervical os.
It is diagnosed based on the development of the lower segment of the uterus.
What are the types of placenta praevia?
- Low lying - >2cm from internal os
- Marginal – encroaching placenta but not covering
- Complete – covering internal os
These classifications help in assessing the severity and management of the condition.
What are the risk factors for placenta praevia?
- Previous CS and uterine instrumentation
- High parity
- Advanced maternal age
- Smoking
- Multiple gestation
Understanding these factors can aid in identifying at-risk patients.
What are the complications of placenta praevia?
- Maternal haemorrhage
- Operative delivery complications
- Transfusion
- Placenta accrete, increta, or percreta
- Prematurity
These complications can significantly affect maternal and fetal outcomes.
What is a common history finding in patients with placenta praevia?
Painless bleeding in the 2nd or 3rd trimester or at term.
It often occurs after intercourse and may be accompanied by preterm contractions.
What findings are assessed during the physical exam for placenta praevia?
- Vital signs – IMEWS
- SFH and Leopolds
- Gentle speculum exam
- NO digital VE unless known placental location
These assessments help evaluate the condition without risking further bleeding.
What investigations are performed for placenta praevia?
- Bloods: FBC, G+H, coags, LFTs, U&Es
- U/S: confirm diagnosis
Transvaginal ultrasound can help locate the placental edge and internal os.
What is the treatment approach for placenta praevia without active bleeding?
- Expectant management – deliver at 37/40
- No intercourse or digital exam
This conservative approach minimizes risks to both mother and fetus.
What is placental abruption?
Premature separation of the placenta from the uterine wall.
This condition can be partial or complete, with complete abruption leading to stillbirth.
What are the risk factors for placental abruption?
- Hypertensive disease of pregnancy
- Smoking or drug abuse
- Trauma
- Overdistension of the uterus
- Hx of previous abruption
- Unexplained ↑ MSAFP
- Placental insufficiency
- Maternal thrombophilia metabolic abnormalities
Identifying these factors is crucial for prevention and management.
