Bleeding: Concealed Internal Bleeding

Definition This is bleeding within the body that is invisible from the outside appearance of the casualty. Action Plan By gaining information about the accident and the medical history of the patient it may be possible to judge what injuries may be hidden from you. You should also check for indications of injury on the patients body, such as bruising and tenderness. It is possible that the signs of internal bleeding will not appear until well after the accident has happened, so it is important to be aware of the symptoms. These are some of the signs and symptoms that you should look out for:

Pale, cool and clammy skin Thirst Rapid, weak pulse Rapid, Shallow breathing Abdominal tenderness and or guarding of the abdomen Pain and/or discomfort Nausea and/or vomiting Shock

If you recognise these signs in a patient you should lay them down with their legs elevated and bent at the knees, this will relieve pressure on the abdomen and divert blood to the major organs. You should then reassure the patient and get urgent medical attention by calling your doctor and an ambulance. Do not give the patient anything by mouth and treat any obvious injuries.

What is a blighted ovum?

A blighted ovum (also known as anembryonic pregnancy) happens when a fertilized egg attaches itself to the uterine wall, but the embryo does not develop. Cells develop to form the pregnancy sac, but not the embryo itself. A blighted ovum usually occurs within the first trimester before a woman knows she is pregnant. A high level of chromosome abnormalities usually causes a womans body to naturally miscarry.

How do I know if I am having or have had a blighted ovum?

A blighted ovum can occur very early in pregnancy, before most women even know that they are pregnant. You may experience signs of pregnancy such as a missed or late menstrual period and even a positive pregnancy test. It is possible that you may have minor abdominal cramps, minor vaginal spotting or bleeding. As with a normal period, your body may flush the uterine lining, but your period may be a little heavier than usual. Many women assume their pregnancies are on track because their hCG levels are increasing. The placenta can continue to grow and support itself without a baby for a

short time, and pregnancy hormones can continue to rise, which would lead a woman to believe she is still pregnant. A diagnosis is usually not made until an ultrasound test shows either an empty womb or an empty birth sac. Your purchase supports the APA

What causes a blighted ovum?

A blighted ovum is the cause of about 50% of first trimester miscarriages and is usually the result of chromosomal problems. A womans body recognizes abnormal chromosomes in a fetus and naturally does not try to continue the pregnancy because the fetus will not develop into a normal, healthy baby. This can be caused by abnormal cell division, or poor quality sperm or egg.

How can a blighted ovum be prevented?

Unfortunately, in most cases a blighted ovum cannot be prevented. Some couples will seek out genetic testing if multiple early pregnancy loss occurs. A blighted ovum is often a one time occurrence, and rarely will a woman experience more than one. Most doctors recommend couples wait at least 1-3 regular menstrual cycles before trying to conceive again after any type of miscarriage. Chorioamnionitis is a condition that can affect pregnant women in which the chorion and amnion (the membranes that surround the fetus) and the amniotic fluid (in which the fetus floats) are infected by bacteria. This can lead to infection in both the mother and fetus, and, in most cases means the fetus has to be delivered as soon as possible.

What are the causes of chorioamnionitis?

Chorioamnionitis is caused by a bacterial infection that usually starts in the mothers urogenital tract. Specifically, the infection can start in the vagina, anus, or rectum and move up into the uterus where the fetus is located. Chorioamnionitis occurs in up to 2 percent of births in the United States.

What are the risk factors for chorioamnionitis?

Certain factors might create a higher risk for chorioamnionitis, including:

Premature birth Fetal membranes that are ruptured (the water has broken) for a prolonged time

What are the symptoms of chorioamnionitis?

Although chorioamnionitis does not always cause symptoms, some women with the infection might have the following:

High temperature and fever Rapid heartbeat (The fetus might also have a rapid heartbeat.)

Sweating A uterus that is tender to the touch A discharge from the vagina that has an unusual smell

How is chorioamnionitis diagnosed?

Chorioamnionitis is most often diagnosed by physical exam and the findings listed above. Other clues can be found by taking a blood sample from the mother and checking for bacteria. In addition, the doctor might take samples of the amniotic fluid to look for bacteria. The doctor might also use ultrasound to check on the health of the fetus.

How is chorioamnionitis treated?

If your doctor diagnoses chorioamnionitis, he or she will treat you with antibiotics to help to treat the infection. However, the treatment is to deliver the fetus. In addition, if the newborn has an infection, he or she will be given antibiotics, as well.

What are the complications of chorioamnionitis?

If the mother has a serious case of chorioamnionitis, or if it goes untreated, she might develop complications, including:

Infections in the pelvic region and abdomen Endometritis (an infection of the endometrium, the lining of the uterus) Blood clots in the pelvis and lungs

Cervical Cerclage
Email Print When a womans cervix is weak (sometimes called an incompetent cervix) she is more likely to have a baby born prematurely because the cervix shortens or opens too early. In order to prevent premature labor, a womans doctor may recommend a cervical cerclage. A cerclage is used to prevent these early changes in a womans cervix, thus preventing premature labor. A closed cervix helps a developing baby stay inside the uterus until the mother reaches 37-38 weeks of pregnancy.

What is cervical cerclage?

Treatment for cervical incompetence is a surgical procedure called cervical cerclage, in which the cervix is sewn closed during pregnancy. The cervix is the lowest part of the uterus and extends into the vagina.

Why is cervical cerclage used?

A cervical cerclage procedure may be used if a womans cervix is at risk of opening under the pressure of the growing pregnancy. A weak cervix may be the result of:

History of second-trimester micarriages A previous cone biospy or a LEEP procedure Damaged cervix by pregnancy termination

When is a cervical cerclage used?

The best time for the cervical cerclage procedure is in the third month (12-14 weeks) of pregnancy. However, some women may need a cerclage placed later in pregnancy; this is known as an emergent cerclage and is necessary after changes such as opening or shortening of the cervix have already begun. If an emergent cerclage is required, future pregnancies will probably also require a cervical cerclage.

What are alternatives to the cervical cerclage procedure?

If changes in the cervix are found very late in pregnancy, or if the cervix has already opened up significantly, bed rest may be the best alternative.

What are the benefits of a cerclage?

Cervical cerclage helps prevent miscarriage or premature labor caused by cervical incompetence. The procedure is successful in 85% to 90% of cases. Cervical cerclage appears to be effective when true cervical incompetence exists, but unfortunately the diagnosis of cervical incompetence is very difficult and can be inaccurate.

Why doesnt every woman who has had a preterm baby need a cerclage?
Only women with an abnormal or incompetent cervix can be helped by a cerclage. However, even with the help of a cerclage, other problems can cause labor to begin too early. Women who have a cerclage placed will need to be checked routinely for other complications such as infection and preterm labor.

What should I expect before my cervical cerclage is placed?

Your medical history will be reviewed A thorough exam of your cervix including a transvaginal ultrasound performed by a doctor who specializes in high risk pregnancies Your doctor will discuss pain control options for the procedure Write down any questions or concerns you may want to discuss with your health care provider

What happens during the cervical cerclage procedure?

Most women have general, spinal, or epidural anesthesia for pain control during the procedure. A doctor will stitch a band of strong thread around the cervix, and the thread will be tightened to hold the cervix firmly closed.

What can I expect after the procedure?

You may stay in the hospital for a few hours or overnight to be monitored for premature contractions or labor. Immediately after the procedure you may experience light bleeding and mild cramping, which should stop after a few days. This may be followed by an increased thick vaginal discharge, which may continue for the remainder of the pregnancy. You may receive medication to prevent infection or preterm labor. For 2-3 days after the procedure, plan to relax at home; avoid any unnecessary physical activity. Your doctor will discuss with you when would be the appropriate time to resume regular activites. Abstinence from sexual intercourse is often recommended for one week before and at least one week after the procedure.

How long is the cerclage stitch left in?

Generally the thread is removed at the 37th week of pregnancy, but it can be removed before if a womans water breaks or contractions start. Most stitches are removed in the doctors office without any problems. The procedure is similar to having a pap smear and may cause some light bleeding.

What are the risks of having a cerclage placed?

The likelihood of risks occuring is very minimal, and most health professionals feel a cerclage is a life saving procedure that outweighs the possible risks involved. Possible risks could include:

Premature contractions Cervical dystocia (inability of the cervix to dilate normally in the course of labor) Rupture of membranes Cervical infection Cervical laceration if labor happens before the cerclage is removed Some risks associated with general anesthesia include vomiting and nausea

Are there signs I should look for after the cerclage is placed that indicate a problem?
It is important to contact your doctor if you experience any of the following symptoms after your cerclage is placed:

Contractions or cramping Lower abdominal or back pain that comes and goes like labor pain Vaginal bleeding A fever over 100 F or 37.8 C, or chills Nausea and vomiting Foul-smelling vaginal discharge Your water breaking or leaking

What about future pregnancies?

Most women who need a cerclage in one pregnancy will need to have a cerclage placed in future pregnancies.
Kernicterus Kernicterus is a form of brain damage caused by excessive jaundice. The substance which causes jaundice, bilirubin, is so high that it can move out of the blood into brain tissue. When babies begin to be affected by excessive jaundice, when they begin to have brain damage, they become excessively lethargic. They are too sleepy, and they are difficult to arouse - either they don't wake up from sleep easily like a normal baby, or they don't wake up fully, or they can't be kept awake. They have a high-pitched cry, and decreased muscle tone, becoming hypotonic or floppy) with episodes of increased muscle tone (hypertonic) and arching of the head and back backwards. As the damage continues, they may develop fever, may arch their heads back into a very contorted position known as opisthotonus or retrocollis.

Kernicterus is a rare but serious disease that affects babies soon after they are born. It is especially tragic because it is easily prevented. The yellowing of your baby's skin (jaundice) that is seen before Kernicterus develops is a clue that there may be a problem. A doctor should know from this sign that the baby needs treatment. If jaundice is treated, Kernicterus can be prevented. Kernicterus only develops if jaundice is untreated. Children who develop Kernicterus likely are victims of medical malpractice. While some children who have Kernicterus can do well, others will have severe deficits that require a lifetime of care.
Jaundice in Newborns and its Treatment About 60% of newborn infants in the United States are jaundiced, that is they look yellow. Excessive jaundice in newborn infants may cause brain damage. Jaundice is caused by a high level of bilirubin in the blood (hyperbilirubinemia) and tissues. When bilirubin gets too high, it can be treated. Norms exist for bilirubin in term and nearly term babies based on the age in hours after birth. Other factors, such as prematurity, blood group incompatibilities between infant and mother including Rh and ABO blood types, and bruising, especially cephalohematomas and caputs (bleeding under the skin of the scalp), can increase bilirubin production and lead to excessive jaundice. Babies with high bilirubin levels can be effectively treated. Phototherapy (treatment with light) is usually very effective. It is the blue color in visible light that alters the bilirubin from a toxic form to a water soluble, non-toxic form that

can be eliminated. At higher, more dangerous levels of bilirubin, or in certain situations where the bilirubin is expected to rise very rapidly, such as Rh or other hemolytic diseases of the newborn, a more extreme treatment may be used, exchange transfusion, to rapidly remove toxic bilirubin from the blood.

HELLP syndrome is a life-threatening obstetric complication usually considered to be a variant of pre-eclampsia. Both conditions usually occur during the later stages of pregnancy, or sometimes after childbirth. HELLP is an abbreviation of the main findings:[1]

Hemolytic anemia Elevated Liver enzymes and Low Platelet count

Contents
[hide]

1 Signs and symptoms 2 Diagnosis 3 Classification 4 Pathophysiology 5 Treatment 6 Epidemiology 7 History 8 See also 9 References

[edit] Signs and symptoms

Often, a patient who develops HELLP syndrome has already been followed up for pregnancy-induced hypertension (gestational hypertension), or is suspected to develop pre-eclampsia (high blood pressure and proteinuria). Up to 8% of all cases present after delivery. There is gradual but marked onset of headaches (30%), blurred vision, malaise (90%), nausea/vomiting (30%), "band pain" around the upper abdomen (65%) and paresthesia (tingling in the extremities). Edema may occur but its absence does not exclude HELLP syndrome. Arterial hypertension is a diagnostic requirement, but may be mild. Rupture of the liver capsule and a resultant hematoma may occur. If the patient has a seizure or coma, the condition has progressed into full-blown eclampsia. Disseminated intravascular coagulation is also seen in about 20% of all women with HELLP syndrome,[2] and in 84% when HELLP is complicated by acute renal failure.[3] Patients who present symptoms of HELLP can be misdiagnosed in the early stages, increasing the risk of liver failure and morbidity.[4] Rarely, post caesarean patient may

present in shock condition mimicking either pulmonary embolism or reactionary haemorrhage.

[edit] Diagnosis
In a patient with possible HELLP syndrome, a batch of blood tests is performed: a full blood count, liver enzymes, renal function and electrolytes and coagulation studies. Often, fibrin degradation products (FDPs) are determined, which can be elevated. Lactate dehydrogenase is a marker of hemolysis and is elevated (>600 U/liter). Proteinuria is present but can be mild. A positive D-dimer test in the presence of preeclampsia has recently been reported to be predictive of patients who will develop HELLP syndrome.[4] D-dimer is a more sensitive indicator of subclinical coagulopathy and may be positive before coagulation studies are abnormal.[citation needed]

[edit] Classification
The platelet count has been found to be moderately predictive of severity: under 50,000/mm3 is class I (severe), between 50,000 and 100,000 is class II (moderately severe) and >100,000 is class III (mild). This system is termed the Mississippi classification.[5]

[edit] Pathophysiology
The exact cause of HELLP is unknown, but general activation of the coagulation cascade is considered the main underlying problem. Fibrin forms crosslinked networks in the small blood vessels. This leads to a microangiopathic hemolytic anemia: the mesh causes destruction of red blood cells as if they were being forced through a strainer. Additionally, platelets are consumed. As the liver appears to be the main site of this process, downstream liver cells suffer ischemia, leading to periportal necrosis. Other organs can be similarly affected. HELLP syndrome leads to a variant form of disseminated intravascular coagulation (DIC), leading to paradoxical bleeding, which can make emergency surgery a serious challenge.

[edit] Treatment
The only effective treatment is prompt delivery of the baby. Several medications have been investigated for the treatment of HELLP syndrome, but evidence is conflicting as to whether magnesium sulfate decreases the risk of seizures and progress to eclampsia. The DIC is treated with fresh frozen plasma to replenish the coagulation proteins, and the anemia may require blood transfusion. In mild cases, corticosteroids and antihypertensives (labetalol, hydralazine, nifedipine) may be sufficient. Intravenous fluids are generally required. Hepatic hemorrhage can be treated with embolization as well if life-threatening bleeding ensues.