Please enable JavaScript.

Coggle requires JavaScript to display documents.

3rd Trimester Bleeding (Placenta Previa :baby::skin-tone-2: (Vasa Previa …

- - - - Act: Look @ Baby :baby::skin-tone-3:
        
        NST or Contraction stress test (if mom's contracting), checking for fetal heart rate :<3:
        
        Look for variability, accelerations, absence of bradycardia or late decelerations. (evaluation of fetal distress)
        
        Dx: US
        
        Fetal HR determines if need to have surgery
        
        Reassurance (continue pregnancy)?
        
        or Induce labor?
        
        or C section?
        
        or (super emergent) Crash Section?
        
        :pencil2:Decision for surgery is based on :pregnant_woman::skin-tone-2: or :baby::skin-tone-2: stability, not on the Dx.
        
        for the sake of this lecture, we're linking Dx to a treatment
        
        :pencil2:3rd Tri bleeding can be
        
        Painful: Uterine origin, :pregnant_woman::skin-tone-2:, uterus is tearing, mom hemorrhages. These are not "Previa" diseases
        
        Painless: placental origin, :baby::skin-tone-2:Baby's blood (mom doesn't feel px from fetal structures) :pencil2:baby's blood origin = "previa" diseases
- - - - Dx: US
        
        then Stress test (non or Contraction)
        
        See: Transverse Lie (baby wasn't able to engage head: placenta in the way)
        
        Fetal distress
        
        Tx: C Section (urgent)
        
        ~~Crash Section~~
        
        Nomenclature (LY):
        
        Marginal: minimal Os coverage
        
        Partial: placenta reaches Os midline
        
        Complete: covers all Os
  - - - 1 way that blood vessels can run to the edge of the placenta
        
        (placenta accrete: always evaluate placenta b/c bv's don't run to the edge)
        
        Vasa Previa: connection btw accessory lobes & tear looks like bv's that run to the edge.
        
        How the appearance of placenta is different than Placenta Previa?
        
        Vasa Previa: can't look at the placenta; it hasn't been birthed yet
        
        Pt: Painless bleeding
        
        Dx: US
        
        unlikely to show anything
        
        then Stress test = Fetal distress
        
        Tx: C section (urgent)
        
        Logic: Labor & dilation but far from delivery; get :baby::skin-tone-4: out!
    - - Path: Uterus previously scarred. Prior C section. Attempting vaginal birth
        
        VBAC attempted & uterine scar
        
        Augmenting power of contraction w/ OCT
        
        Force of contraction is down&out, but scar causes uterus to tear.
        
        Baby birthed into peritoneum
        
        :baby::skin-tone-3: may be contained by uterine membrane, if lucky. (still pretty bad)
        
        :pencil2: must happen with contractions
        
        Pt: :pregnant_woman: already experiencing px.
        
        painful 3rd Tri bleed, significantly increased during contractions (the tearing)
        
        :warning: Loss of fetal station (lose :baby::skin-tone-3: location)
        
        Dx: Clinical
        
        Tx: :warning:Crash section
        
        Seconds to get baby out!
      - Placental Abruption :pregnant_woman::skin-tone-2:
        
        Path: Placenta tears off endometrial lining
        
        some insult (large) causes placenta to rip off.
        
        Placenta loses its connection, and mom's blood leaks out
        
        Dangerous form, one that can't be seen (placenta contains blood in a pocket)
        
        Nomenclature:
        
        Complete: placental tear = blood seen
        
        Concealed: placental tear ≠ blood seen (hidden)
        
        looking for some large force that blows the placenta off
        
        Path: HTN or cocaine
        
        or Deceleration injury (MVA :car:)
        
        Pt: Painful bleeding
        
        mom notices since it's her blood
        
        Dx: US
        
        then C/NST contraction or non stress test
        
        1 more item...