3rd Trimester Bleeding (Placenta Previa :baby::skin-tone-2: (Vasa Previa …
3rd Trimester Bleeding
- 3rd Tri bleeding is mostly benign (normal), can be treated after the pregnancy
- There are 4 diseases tested against one another (dangerous).
- Introduce normal, decision to operate, & advanced organizer for names & presentation
- Cervical lesions (polyps, cervicitis), nbd unless mom has STI
- Cervix dilates
- Bloody show = rupture of membranes (could be clear/meconium/blood tinge [massive]) :warning:looks dangerous, and work it up
Act: Look @ mom's :pregnant_woman::skin-tone-2:vitals & Hgb
- continuous bleed: consider DIC (platelets & Coags), but not every time.
- Do a PEx (speculum/bimanual) to see source of bleeding
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)
- 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
Placenta Previa :baby::skin-tone-2:
Path: Placenta has grown across the Os
- Mom's "oil well" has dried up (multigravida, multi gestational :female_sign:)
- Placenta will migrate as uterine blood flow diminishes, search for nutrients
- If growth over the Os, the Os dilates and tears placenta = bleeding
Pt: Painless bleeding in 3rd Tri
- usually when contractions begin/ cervix dilates
- then Stress test (non or Contraction)
- See: Transverse Lie (baby wasn't able to engage head: placenta in the way)
- Fetal distress
- Marginal: minimal Os coverage
- Partial: placenta reaches Os midline
- Complete: covers all Os