This document discusses various causes of obstetric hemorrhage that can occur in the third trimester or postpartum, including placenta previa, placental abruption, uterine rupture, and uterine atony. It provides details on the presentation, risk factors, diagnosis, and management of these conditions. Potential treatments covered include IV fluids, blood transfusions, uterotonic medications, and in severe cases surgical interventions like uterine artery ligation or hysterectomy.
This document discusses various causes of obstetric hemorrhage that can occur in the third trimester or postpartum, including placenta previa, placental abruption, uterine rupture, and uterine atony. It provides details on the presentation, risk factors, diagnosis, and management of these conditions. Potential treatments covered include IV fluids, blood transfusions, uterotonic medications, and in severe cases surgical interventions like uterine artery ligation or hysterectomy.
This document discusses various causes of obstetric hemorrhage that can occur in the third trimester or postpartum, including placenta previa, placental abruption, uterine rupture, and uterine atony. It provides details on the presentation, risk factors, diagnosis, and management of these conditions. Potential treatments covered include IV fluids, blood transfusions, uterotonic medications, and in severe cases surgical interventions like uterine artery ligation or hysterectomy.
Obstetrics and Gynecology Pelabuhan Ratu General Hospital Third Trimester Bleeding A 32 yo G2P1 presents at 36 weeks complaining of bright red vaginal bleeding. Upon further questioning she does admit to having had some light bleeding on 1 to 2 occasions last week. Her previous pregnancy was delivered at term by a Classical Cesarean Section for footling breech presentation. Differential Diagnosis? Placenta Previa Uterine Rupture Placental Abruption Vasa Previa Laceration Vaginal mass Placenta Previa Painless third-trimester bleeding Complicates 4-6% pregnancies between 10 and 20 wks, 0.5% pregnancies >20 weeks Risk factors Increasing parity, maternal age, prior c/s, curettages for sabs/tabs Placental tissue overlying the internal os. Types? Complete previa (20-30%) Partial previa (does not completely cover) Marginal (proximate to os) Management: pelvic rest, u/s, IV, T+S, C/S Associated Conditions Placenta accreta, increta, percreta Risk inc w/ inc no. of prior c/s (50% risk in pt w/ previa and 2 prior c/s) Vasa Previa Vessels traverse the membranes in the lower uterine segment in advance of the fetal head. Rupture can lead to fetal exsanguination Uterine Rupture Associated with Prior c/s Rates of uterine rupture? Spontaneous rupture (no c/s history): 1/2000 (0.05%) Low Transverse: 0.5%-1%risk rupture, VBAC 80% success rate Classical C/s: 10% risk rupture, schedule amnio/c/s ~37 weeks. Placental Abruption Premature separation of placenta Painful third-trimester bleeding Risk Factors smoking, trauma, HTN cocaine, pprom, polyhydramnios, multiples Trauma evaluation bleeding, contractions, abdominal pain and NRFHT in 4hrs U/s misses up to 50% of abruptions Management: IV, T+X, Continuous monitoring, c/s vs. vag delivery Case Contd U/s reveals active, vertex fetus. Placenta anterior and free of os. Pt having contractions q 2-3 minuters. Bleeding increases. BP drops from 110/60 to palpable systolic pressure of 70. FHT drops from 120 to 90 bpm.
What do you do???
Post Partum Hemorrhage A 34yo G6P6 patient at term has just delivered a 4000gm infant after second stage of labor lasting 3 hours. The placenta delivered spontaneously and the patient is bleeding briskly. What is average EBL w/ SVD? 500cc What is average EBL w/ C/S? 1000cc Classes of Hemorrhage Class 1 <900cc Minimal symptoms Class 2 1200-1500cc Tachycardia, tachypnea Class 3 1800-2100cc Overt Hypotension, cold, clammy skin Class 4 2400cc Shock, absent BP Management Fluids Crystalloid, open wide/bolus Labs Cbc, coags, fibrinogen Transfuse PRPCs FFP Larger vol (250cc/unit, all coagulation factors) Cryopercipitate Smaller volume (20cc/unit, many coagulation factors) Differential Diagnosis Atony Uterine inversion Laceration (cervical, vaginal) Retained Placenta Uterine Atony Risk factors multiparity, multiple gestation, macrosomia, abruption, retained POCs, placenta previa, induction (prolonged pitocin) Management Bimanual exam/massage IV acess/fluids Oxytocin, methergine 0.2mg IM, Hemabate 250mcg IM, misoprostol 800 to 1000mcg rectally Laparotomy Uterine artery ligation B Lynch Hysterectomy UAE Uterine Inversion Inverted fundus extends beyond cervix (looks beefy red) Stop pitocin if infusing Replace uterus Relaxants if necessary (terbutaline, MgSo4, Nitrogylcerin) Anesthesia Laparotomy
Summary: Fast Like a Girl: A Woman’s Guide to Using the Healing Power of Fasting to Burn Fat, Boost Energy, and Balance Hormones: Key Takeaways, Summary and Analysis