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Bleeding in Pregnancy (Late Preg (signs (confused, decreased urine output,…
Bleeding in Pregnancy
Early Preg
Miscarriage (14-19% of preg)
Threatened
inevitable
incomplete
complete
missed
septic
Managment
Conservative
incomplete - 79% complete evac in 3 days
missed
Medical
Mifeoristone + misprolol (prostaglandin)
13-93% success
Anti D (Rh -ve M) witihn 72 H
Surgical
Anti- D
ergometrine (if excess bleed)
Ectopic
Molar
Choriocarcinoma
Thyrotoxic
HCG mimics TSH
Late Preg
Severity
Minor <50ml, settled
Major 50-1000ml, no signs of shock
Spotting
massive >1000ml +/- signs of shock
Recurrent?
Unexplained?
Serial growth
Anti-D
signs
confused
decreased urine output
PAle
increased HR (mum#)
BP- may be NORMAL
Investigations
blood tests
coagulation is increased in preg - check
CTG (+/- steroids)
until 34 wks ( steroids)
Placental abruption
could be a concealed abruption
vag bleeding
abdo pain
woody hard uterus, tender
disproportionate shock
foetal distress
previous (>2 =25%), smoking,drugs( cocaine), 1st trimester bleeding, pre-eclampsia, multiparity, blunt force trauma, assisted conception, low BMI
Placenta previa
bright red
painless bleeding
C - Section if going to deliver
Previous one, LSCS, smoking, older mum, defective endometrium, previous TOP, assisted conception
Vasa Praevia
placenta percreta
placenta increta
placenta accreta
Post- Partum
Trauma
Tissue
Tone
most common
Thrombin
500ml loss
primary < 24H
RF: previous, APH, placenta praevia (x15), twins (x5) nulliparity, Pre eclampsia, PIH, BMI>35, >40yo. emergency deliver, repear LSCS, operative vag birth(forceps), induced labour, labour >12H, baby> 4kg
Secondary >24H
Laparotomy - B lynch (dissoluble suture)