Midterm-3rd Trimester Bleeding Flashcards
DDx of 3rd trimester bleeding
Abruption of placenta or vessel at os
Cervical/vaginal bleeding
Bloody show
Uterine rupture
Placental abruptions associated factors
Multiparas
Older women
Twins
Dietary deficiencies
Uterine anomaly or tumor
Pressure on vena cava
Drug use –> esp cocaine
Etiologic factors of placental abruption
Chronic htn
Trauma
Short umbilical cord
Sudden decompression of uterus
Increased stretch of uterus
Placental abruption pathophysiology
Hemmorhage into decidua basilis causes decidue to split –> causes a hematomoa and loss of function of adjacent placenta
Prognosis for placental abruption
Perinatal mortality up to 50%
Maternal mortality 1.8-2.8%
Mortality factors for mother in placental abruption
Amount of blood loss
Whether hemorrhage is concealed or apparent
Clotting rxn
Time between abruption and tx
Mortality factors for fetus in placental abruption
Extent of decreased placental function
Time between abruption and tx
Prematurity
Ssx placental abruption
- vaginal bleeding 2. uterine tenderness or very painful contractions (blood irritant to uterus and induces contractions) 3. fetal distress 4. hypertonic uterus 5. severe back pain 6. ssx of shock 7. idiopathic premature labor
Lab tests for placental abruption
- US 2. Non-stress test 3. Complete CBC, coagulation panel, electrolytes 4. Ab screen on Rh= moms
Placental abruption management: non-severe bleeds
US
Fetal hrt tones
Bedrest
Vaginal rest
Fetal mvmnt counts
Non stress test or biophysical profile
RTC in 3-7 days or sooner if bleeding returns
Placental abruption management: moderate to severe bleeds
Same as for non-severe bleeds but you need to refer -asses coagulation status
Referring doc will asses and consider induction or C-section
Complications of placental abruption
- DIC 2. Fetal death 3. Maternal hemorrhage leading to maternal shock: renal damage, Sheehan’s syndrome 4. Preterm labor
Ssx of rupture of marginal sinus
- mild vaginal bleeding which does not continue 2. painless 3. not associated with uterine rigidity 4. not associated w/ fetal heart tone changes
Rupture of marginal sinus rupture management
- US 2. Fetal heart tones, uterine exam, vitals 3. Bed rest 4. Vaginal rest 5. Mom monitors fetal mvmnt 6. Consider biophysical profile or non-stress test 7. RTC in 3-7 days
Tx marginal sinus rupture
Viburnum prunifolium: 30 qtt tincture Q 30 minutes to TID
Homeopathy: Arnica. -Bell, cinnam, Ip, Sabina, Secale. Repertorize.
Placenta Previa
Placenta implanted over or near internal os.
4 degrees: 1. Total: Internal os completely covered 2. Partial: Internal os partially covered 3. Marginal: Edge of placenta at margin of internal os 4. Low-lying: placental edge does not touch internal os, but is close to it
Risk factors for placenta previa
>3 multiparity
>30 y/o
Previous C-section or other uterine surgery
Poor quality of uterine lining
Endometritis following previous pregnancy
Ssx placenta previa
Painless vaginal bleeding usu at 28-30 wks -usu small but can be life threatening hemorrhage
-intermittent or continuous bright red bleeding -can be precipitated by trauma or intercourse
Possibly early spontaneous abortion
Dx of placenta previa
US to determine placement of placenta
Do NOT do a vaginal exam w/ a 3rd trimester bleed before doing an US
PE placenta previa
- Gently check presentation 2. Presenting part high 3. Uterus soft and non-tender 4. Fetal heart tones usu normal
Management of placenta previa
Delayed delivery with the following conditions: 1. blood loss is not life threatening 2. labor hasn’t begun, membranes intact 3. baby alive and not in distress 4. premature fetus
Management of delayed delivery in palcenta previa
- bed rest 2. pt must go to hospital immediately with any bleeding or w/ onset of labor 3. IV fluids or dx and tx of anemia 4. L/S ratio at 36 wks to determine fetus maturity 5. No fetal anomalies or erythroblastosis 6. Mom will stay in bed and there is adequate blood supply ready
Indications for C-section in placenta previa
- usu wait until fetus is mature but may not wait is profuse uncontrollable bleeding or fetal distress
- total or partial placeta previa: MUST DO C-SECTION
- abnormal presentation: MUST DO C-SECTION
Indications for vaginal birth in placenta previa
- placental <10% of internal os
- cervix well effaced and >/= 3 cm dilated
- fetal head in pelvis
- minimal bleeding
Vasa Pevia
Fetal blood vessel lying across os
Complications of vasa previa
- compressed vessel leads to decreased fetal heart tones and fetal distress
- torn vessel leads to fetal exsanguination
Dx of vasa previa
- vaginal exam
- Wright stain of vaginal blood shows nucleated RBCs
- Kleinhauer test of vaginal blood: differentiates maternal and fetal blood
- Amount of bleeding
Management vasa previa
Transport Immediately!
Monitor fetal heart tones
C-section
Poor prognosis if vessel has ruptured
Cervical/Vaginal bleeding may be due to..
- Cervicitis, cervical erosion, polyps, cancer
- Lacerations, foreign bodies
- Varicosities
Tx for varicosities
- Decrease standing
- Truss w/ foam pad along perineum supported by sanitary belt
- Botanicals
a. Collinsonia
b. Hamamelis - Homeopathics: calc, carb-v, ham, lyc, thuj, zinc
- Pycnogenols
