- 2-5% of all pregnancies
- 10% maternal mortality
- Can be hemodynamically stable due to ability to compensate (increased blood volume, third spacing)
Etiology:
- Bloody show ( shedding of cervical mucous plug)
- Placental previa
- Abruptio placenta
- Vasa previa
- Marginal sinus bleeding
- Cervical lesion (cervicitis, polyp, ectropion, cancer)
- Uterine rupture
- Other
Placental abruption
* Normally placenta separates 5-30 minutes after delivery. In 1-2% of pregnancies it separates early (5-16% if history of abruption).
* Predisposing factors include:
- HTN
- Trauma
- Smoking
- Multiparity
- Short cord
- Rapid uterine decompression
- Previous abruption
- Alcohol consumption
- Cocaine use
- Maternal age >35yo
- Uterine distension (polyhydramnios or multiple gestation)
* Classification:
Total (inevitable fetal death) vs. partial
External/revealed/apparent: blood dissects towards cervix
Internal/concealed: blood dissects towards fetus
Mixed
* Presentation
- Pain (sudden onset, constant, localized to back and uterus)
- Bleeding
- Uterine tenderness
- Uterine contractions
- Fetal distress/demise
- Bloody amniotic fluid
* Treatment
ABC’s, stabilize and monitor (mother and fetus)
Prepare for OR if necessary (fetus mature, haemorrhage dictates)
Observe – await fetal lung maturity (Dx via amniocentesis)
Rhogam
Placenta Previa
* Abnormal location of placenta over, or in close proximity to the internal cervical os
* Predisposing factors include:
- Increasing maternal age
- Multiiparity
- Multiple gestations
- Previous C-section, D&C, myotomy
- Previous placenta previa
- Uterine tumor or abnormal shape
* Classification:
Total: completely covers os
Partial: partially covers os
Marginal: within 2 cm of os
Low lying: in low segment but clear of os
* Presentation
- Painless
- Bleeding (@~30wks)
* Diagnosis by ultrasound
* Treatment
ABC’s, stabilize and monitor (mother and fetus)
Prepare for OR if necessary (fetus mature, haemorrhage dictates)
Observe – await fetal lung maturity (Dx via amniocentesis at 36-37weeks)
Rhogam
Vasa Previa
* Velamentous insertion of cord into membranes of placenta, unprotected fetal vessels pass over cervical os
* Presentation
- Painless
- Bleeding
- Fetal distress
* Investigate bleeding wit Apt test (NaOH/KOH mixed with blood, if fetal no lysis supernatant turns pink)
* Treatment
- Emergency C-section
- Rhogam