Chapter 3: Late Pregnancy Bleeding

Diseases	Definition	Clinical Presentation	Risk Factor	Management
Abruptio Placenta (abrupt means sudden onset)	Normally implanted placenta separates from uterus	Painful late trimester vaginal bleeding. Complications: DIC		Emergency C-section Vaginal delivery Do if >36 pregnancy Conservative
Placenta Previa (previa means preview, so during cervical examination first thing u will see is placenta)	Placenta implanted in lower uterine segment	Painless late trimester vaginal bleeding Complications: intractable bleeding requiring hysterectomy	Previous Placenta Previa Multiple gestation Multiparity Advance gestational age	Emergency C-sec Conservative management Do vaginal delivery only if lower placental edge more than 2cm from internal OS
Placenta Accreta Placenta Increta Placenta Percepta	A for accrete, A for attaches to myometrium In for Increta, In for invades myometrium P for percepta, P for perforation
Vasa Previa	Fetal vessels traverse the fetal membrane at lower OS	Rupture of memb Painless bleeding Fetal bradycardia	Velamentous umbilical cord insertion Multiple gestation	Immediate C-section
Uterine Rupture	Separation of wall of uterus	Vaginal bleeding Loss of station of fetal head	Previous uterine incision, myomectomy, excessive oxytocin stimulatioin A vertical fundal uterine scar is 20 times more likely to rupture than a low segment incision	Immediate C-section Hysterectomy in patients who don’t want children