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21 Cards in this Set
- Front
- Back
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What would be a differential for third trimester bleeding?
(5 areas) |
vulva- varicosities or lesions
vagina- lacerations cervix- recent intercourse, polyp, cervicitis, ectropion, labor uterine- placental previa or placental abruption or uterine rupture other- vasa previa or hemorrhoids |
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what should be asked/ found out in the history of a pt with third trimester bleeding?
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gestational age
placental location onset, duration, amount and color of blood is is painful or painless have they had a recent trauma or intercourse |
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what should be obtained in the physical exam?
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VS
FHR cardiorespiratory skin- petechiae or bruising vulva/ vagina via sterile speculum exam |
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when should you not do a pelvic exam in third trimester bleeding?
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if placental previa has not been R/O because could lead to bleeding
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what labs should be obtained in third trimester bleeding?
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gon/chlamydia
wet prep GBS type and TH, antibody screen, CBC, ?coags, ?type and cross catheterized urine specimen for UA |
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if significant bleeding has occurred what what other management should be taken in the initial work up?
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Iv and fluids PRN
RH-? Keilhauer- betke |
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what will US tell you in thrid trimester bleeding?
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placental location and fetal status
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epidemiology of placenta previa?
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1/200 pregnancies
5% in early pregnancy but usually resolve get US at 28 to 32 weeks if diagnosed early |
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what are risk factors for placenta previa?
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placental previa in prior pregnancy
prior C/S or other uterine surgery multiparity advanced maternal age smoking |
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what is placenta previa
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abnormal location of the placenta- over the cervical os
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what are maternal risks of placenta previa?
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mortality rate of 0.03%
risk is 33x for hysterectomy at delivery risk is 10x higher for blood transfusion |
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what are fetal risks of placenta previa?
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prematurity with complications
perinatal mortality from 2-3% |
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how to dx previa
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history of painless vaginal bleeding and a TVUS
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how to manage previa?
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admit to Labor and delviery
hemodynamic stabilization w/ IVF, blood transfusion prn delivery by c-section if pt or fetus is unstable bed rest and pelvic rest if pt and fetus is stable delivery by c section at 35/36 weeks |
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what is placental abruption?
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premature separation of an otherwise normally implanted placenta
produces abdominal pain with variable amount of blood |
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what are the three types of placental abruption?
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complete- entire placenta separates
partial- part of placenta separates margina- an edge of the placenta separates |
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what are risk factors for placental abruption
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chronic HTN
pre-eclampsia smoking cocaine or meth use multiple gestation trauma premature rupture of membranes abruption in prior pregancy |
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how to diagnose placental abruption
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clincally
vaginal bleeding iwth abdominal pain/contractions may have fetal distress or death coagulopathy may occur with severe abruption |
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does a normal US r/o abruption?
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no!
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how to manage a large abruption?
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stabilize mom with IV crystalloid, packed red blood cells and correction of coagulation abnormalites
delivery via C section if fetus is alive |
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how to manage small abruption?
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expectant management if fetus is stable
outpt management if bleeding stops and maternal- fetal status is reassuring delivery if term usually vaginal |
