third trimester bleeding Flashcards
1
Q
definition
A
- vaginal bleeding from 24 week to delivery of the baby
2
Q
causes
A
- placental
- placenta previa
- placenta abruption : accidents, high parity uterine overdistension - entrons
- vasa previa - local
- cervicitis
- cervical erosion
- erosion
- cervical carcinoma
- vaginal trauma
- vaginal infection
3
Q
risk factors
A
- multiple gestation
- previous C – section
- uterine structural abN
- assisted conception
- abdominal trauma, accidents
- hypertension
- smoking, drug cocaine
- anticoagulant therapy
- polyhydramniosis
- low socioeconomic
- rupture of vasa in PPROM
- trauma, infection, inflammation of cervix, vagina
4
Q
differential diagnosis between abruptio placentae and placenta previa
A
Placenta previa Placenta abruption
1. painless abdomen Painful abdomen
- bright red colour of blood, small amount recurrent bleeding
Dark, non clotting, continuous large amount of blood visually at the onset of labour
- non agitated, less distressed Agitated and distressed
- abdomen is soft, relaxed Woody hard abdomen, tense, painful (tender)
- abnormal lie, presentation Normal lie presentation
- blood loss is proportional to the shock
Blood loss is not proportional as 1/3 of abruption is concealed - abN CTG, hypoxia is less probable abN CTG, hypoxia is more probable
- random association with PE Marked association with PE
- coagulation defects are later Coagulation defects are early
- fetus is normally alive Fetus is dead in 50 %
5
Q
clinical approach
A
- history of vaginal bleeding, amount of blood loss triggering factors, associated with pain or not
- L cervical smear character - condition of mother and / or fetus by external examination of mother
- pale, tachycardia, decrease fetal movement, underwear soaked in blood - should check for other abdominal conditions, appendicitis, pyelitis
Examination
- pulse, BP
- uterine tenderness ( soft or firm / tense )
- fetal heart auscultation / CTG
- speculum vaginal examination
- ultrasound examination for finding the placental sight and diagnose PP, PA, fetal size, presentation
- cross matching of 6 units of blood depending on the degree of blood loss
