Third Trimester Bleeding

Question 1

Obstetrical causes of third trimester bleedgin

Answer 1

Obstetrical Causes:

vaginal/vulva → varicose veins, tears, lacerations

Cervix → dilation, bloody show, labour, threatened labour

Placental → abruption, placenta previa, vasa previa

Uterus → rupture/abruption

Question 2

Gyencolocial causes of third trimester bleeding

Answer 2

Gynecological Causes

• Gential lesions/trauma
• Post coital: friable ectocervix
• Cervical polyps
• Cervical cancer (rare)

Question 3

nongynecological causes of third trimester bleeding

Answer 3

Nongynecological

Hemorrhoids

hematuria

Question 4

Risk factors for placental abruption

Answer 4

Prior placental abruption

Trauma

Smoking

Cocaine

Hypertension

PPROM

Rupture of membranes with twins or polyhydramnios

Question 5

matenral and fetal Clinical Presentation of Placental Abruption:

Answer 5

aginal bleeding, abdominal pain, uterine tenderness, uterine contractions, maternal shock and DIC.

Fetal symptoms: normal/atypical/abnormal heart rate tracing, prematurity, anemia, intrauterine fetal demise

Question 6

management of placental abruption

Answer 6

Management of Placental Abruption: history and PE, investigations (CBC, TandS, crossmatch, fibrinogen, INR/PTT), pelvic U/S to locate placenta.

If preterm: betamethasone, admit for maternal/fetal monitoring, delivery if unstable maternal or fetal status

If term: delivery

Question 7

risk factors for placenta previa

Answer 7

Risk factors:

Grand multiples

Increased maternal age

Prior placenta previa

Prior C section

Multiple gestation

Smoking

Question 8

maternal and fetal symptoms of placent previa

Answer 8

Symptoms: spontaneous painless vaginal bleeding, often around 29-30 weeks, PPH, rH sensitization, anesthetic/surgical risks

Fetal symptoms: tracing can be normal/atypical/abnormal, malpresentation, prematurity, intrauterine demise.

Question 9

management of placenta previa

Answer 9

Management of Placenta Previa: history and physical (nothing in vagina), investigations (CBC, tandS, crossmatch, U/S to assess placental location).

Admit and monitor.

Antenatal community care, delivery→ immediate vs at 36 weeks

Delivery

Question 10

what is vasa previa

Answer 10

Vasa previa is a rare condition where the fetal vessels run within the membranes in close proximity to the internal os

Question 11

Vasaprevia diagnosis and management

Answer 11

Risk factors: velamentous cord insertion, bilobed placenta, succenturiate placenta

Diagnosis: transvaginal ultrasound, abnormal FHR tracing and vaginal bleeding

Management: NO VAGINAL EXAMS OR INTERCOUSE, admit to antepartum unit at 32 weeks with betamethasone, delivery via CSection at 34-26 weeks (or STAT c-section if bleeding on the unit).

Question 12

3 key questions when someone presents with third trimester bleeding

Answer 12

abdomianl pain

placental location

fetal movement