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Third Trimester Bleeding

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to placental abruption . Incidence: 0.5% - 2.5% pregnancies ... Previous abruption. Illicit drugs, especially Cocaine. Trauma. Cocaine, Cigarette, Ethanol ... – PowerPoint PPT presentation

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Title: Third Trimester Bleeding


1
Third Trimester Bleeding
  • Ahmad Behrooz, M.D.
  • Ahwaz University of Medical Sciences

2
Occurring in 5 of all pregnancies , obstetric
hemorrhage is a major cause of maternal
mortality morbidity.
Hemorrhage most commonly occurs in the third
trimester or immediately postpartum.
3
Causes of T.T.Bleeding
  • Bloody show
  • Cervical neoplam
  • Cervicitis
  • Circumvallate placenta
  • Genital tract trauma
  • Placenta previa
  • Placental abruption
  • Vaginal neoplasm
  • Vasaprevia

4
Which one is better ?
Abruption
Previa
Previa
Previa
Abruption
Abruption
Previa
Previa
Abruption
Previa
Abruption
Previa
5
Placenta previa
  • Complete
  • Partial
  • Marginal
  • Low-lying

6
Placenta previa Risk factors
  • Multiparity
  • Maternal age
  • Previous C/Section
  • Smoking
  • Cocaine
  • Erythroblastosis fetalis
  • Multiple fetuses

7
Placenta previa Diagnosis
  • Painless vaginal bleeding
  • Blood is bright red with or without clots
  • Incidence peaks at the 30th to 34th weeks
  • Malpresentation
  • Ultrasonography

8
Placenta previa Management
  • Double set-up
  • Trial labor
  • Vaginal delivery
  • Cesarean Section
  • Expectant management

9
Placenta previa Expectant
Management
  • The mother is stable
  • Vaginal bleeding has stopped
  • The fetus has normal heart rate
  • Cesarean can be performed immediately at any time

10
Indication for discontinuing expectant
management
Placenta previa
  • Fetal indications
    Anomalies incompatible with
    life Distress

    Death

    Pulmonary maturity
  • Maternal indications
    Labor that fails
    tocolysis
    Excessive bleeding
    Other obstetric
    Indication(e.g.,preeclampsia)

11
Placenta previa in a pregnancy of viable
gestational age
Management
-

Bleeding
-
Expectant management
Torrential and/or Fetal distress


C/Section
Fetal lung maturity
-
-
Sono assessment q 3-4 weeks
-

Placental migration
Bleeding
Trial of labor
-

Complete resolution

Trial of labor (low-lying only)
Double set-up
12
Abruptio placenta
Among all episodes of third trimester
hemorrhage, approximately 30 are due to
placental abruption .
Incidence 0.5 - 2.5 pregnancies
13
Abruptio placenta Risk factors
  • Maternal hypertension
  • Maternal age, Multiparity
  • Previous abruption
  • Illicit drugs, especially Cocaine
  • Trauma
  • Cocaine, Cigarette, Ethanol
  • Uterine leiomyoma

14
Abruptio placenta Diagnosis
  • History Physical examination
  • Painful uterine contraction
  • Bloody amniotic fluid
  • Sonography

15
Abruptio Placenta Management
  • Hospitalized
  • Type Cross-match blood
  • Large-bore IVs
  • Bed rest
  • Tocolysis as needed
  • Hb, HCT monitoring
  • Clotting studies
  • Urine output

16
Management
Abruption in a pregnancy of viable gestational
age
-

Unstable patient
-

Stabilize and deliver
Fetal distress
C/Section

Expectant management
Fetal lung maturity
Deliver
17
Differentiating Placental abruption from
Placenta previa
Abruption
Previa
Risks
Hypertension,Trauma prior abruption,Smoking Advanc
e maternal age, Fibroids
High parity Prior Cesarean delivery
Diagnosis
Clinical
Sonographic
Pain
Yes
No
Cont...
18
Differentiating Placental abruption from
Placenta previa
...Cont
Abruption
Previa
Bleeding
Dark, nonclotting (may be occult)
Bright Red , Clotting
Sequelae
DIC, Postpartum hemorrhage
Placenta accreta P.P.Hemorrhage
19
Which one is better ?
Abruption
Previa
Previa
Previa
Abruption
Abruption
Previa
Previa
Abruption
Previa
Abruption
Previa
20
Thank you

Goodbye
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