third trimester bleeding

Question 1

definition

Answer 1

• vaginal bleeding from 24 week to delivery of the baby

Question 2

causes

Answer 2

1. placental
   - placenta previa
   - placenta abruption : accidents, high parity uterine overdistension - entrons
   - vasa previa
2. local
   - cervicitis
   - cervical erosion
   - erosion
   - cervical carcinoma
   - vaginal trauma
   - vaginal infection

Question 3

risk factors

Answer 3

1. multiple gestation
2. previous C – section
3. uterine structural abN
4. assisted conception
5. abdominal trauma, accidents
6. hypertension
7. smoking, drug cocaine
8. anticoagulant therapy
9. polyhydramniosis
10. low socioeconomic
11. rupture of vasa in PPROM
12. trauma, infection, inflammation of cervix, vagina

Question 4

differential diagnosis between abruptio placentae and placenta previa

Answer 4

Placenta previa Placenta abruption
1. painless abdomen Painful abdomen

2. bright red colour of blood, small amount recurrent bleeding

Dark, non clotting, continuous large amount of blood visually at the onset of labour

3. non agitated, less distressed Agitated and distressed
4. abdomen is soft, relaxed Woody hard abdomen, tense, painful (tender)
5. abnormal lie, presentation Normal lie presentation
6. blood loss is proportional to the shock
   Blood loss is not proportional as 1/3 of abruption is concealed
7. abN CTG, hypoxia is less probable abN CTG, hypoxia is more probable
8. random association with PE Marked association with PE
9. coagulation defects are later Coagulation defects are early
10. fetus is normally alive Fetus is dead in 50 %

Question 5

clinical approach

Answer 5

1. history of vaginal bleeding, amount of blood loss triggering factors, associated with pain or not
   - L cervical smear character
2. condition of mother and / or fetus by external examination of mother
   - pale, tachycardia, decrease fetal movement, underwear soaked in blood
3. should check for other abdominal conditions, appendicitis, pyelitis

Examination
- pulse, BP
- uterine tenderness ( soft or firm / tense )
- fetal heart auscultation / CTG
- speculum vaginal examination
- ultrasound examination for finding the placental sight and diagnose PP, PA, fetal size, presentation
- cross matching of 6 units of blood depending on the degree of blood loss