Abnormal Ob
BLEEDING DISORDERS OF LATE PREGNANCY
PLACENTA PREVIA * placenta develops in the lower part of uterus versus the upper part * There are 3 degrees of previa: * Marginal – reaches within 3cm of cervical opening * Partial – placenta partially covers the cervical opening * Complete/ Total – completely covers opening * Observe bleeding during contraction
Manifestations:
* bright red, painless vaginal bleeding * risk of hemorrhage increases with nearing of labor * fetus often in abnormal presentation because uterine segment is covered, therefore, there is no descent * fetus may have anemia because of chronic bleeding * Mother may be more at risk postpartum for infection and hemorrhage * Vaginal organisms can easily reach placenta site * Lower portion of uterus has fewer muscles resulting to weaker contractions
Diagnosis:
* serial monitoring through ULTRASOUND! (Abdominal) * can confirm diagnosis * full bladder can create false appearance of anterior previa * presenting part may overshadow posterior previa * transvaginal scan can locate placental edge and internal os * transvaginal and internal examinations – discouraged because it may lead to early pregnancy bleeding
Treatment:
* depends on AOG and amount of bleeding * Goal is to maintain pregnancy as long as safety possible (at least until 37 weeks AOG) * Mother encouraged to lie on side or with pelvic tilt to avoid supine hypotension * Delivery by C-section if total or partial * May deliver vaginally if low-lying or marginal double set-up * With no active bleeding * Expectant management * No intercourse and digital exams * With late pregnancy bleeding * Assess overall status, circulatory stability * Full dose Rhogam if Rh- * Consider maternal transfer to tertiary hospital if premature * May need corticosteroids, tocolysis, amniocentesis * Rhogam – to prevent antibody production
PLACENTA PREVIA * placenta develops in the lower part of uterus versus the upper part * There are 3 degrees of previa: * Marginal – reaches within 3cm of cervical opening * Partial – placenta partially covers the cervical opening * Complete/ Total – completely covers opening * Observe bleeding during contraction
Manifestations:
* bright red, painless vaginal bleeding * risk of hemorrhage increases with nearing of labor * fetus often in abnormal presentation because uterine segment is covered, therefore, there is no descent * fetus may have anemia because of chronic bleeding * Mother may be more at risk postpartum for infection and hemorrhage * Vaginal organisms can easily reach placenta site * Lower portion of uterus has fewer muscles resulting to weaker contractions
Diagnosis:
* serial monitoring through ULTRASOUND! (Abdominal) * can confirm diagnosis * full bladder can create false appearance of anterior previa * presenting part may overshadow posterior previa * transvaginal scan can locate placental edge and internal os * transvaginal and internal examinations – discouraged because it may lead to early pregnancy bleeding
Treatment:
* depends on AOG and amount of bleeding * Goal is to maintain pregnancy as long as safety possible (at least until 37 weeks AOG) * Mother encouraged to lie on side or with pelvic tilt to avoid supine hypotension * Delivery by C-section if total or partial * May deliver vaginally if low-lying or marginal double set-up * With no active bleeding * Expectant management * No intercourse and digital exams * With late pregnancy bleeding * Assess overall status, circulatory stability * Full dose Rhogam if Rh- * Consider maternal transfer to tertiary hospital if premature * May need corticosteroids, tocolysis, amniocentesis * Rhogam – to prevent antibody production