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ANTENATAL HEMORRHAGE : 1st 2nd and 3rd TRIMESTER BLEEDING

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FIRST AND SECOND TRIMESTER BLEEDING

Differential Diagnosis

  1. abortion (threatened, inevitable, incomplete, complete)
  2. < 5% of threatened abortions go on to abort
  3. abnormal pregnancy (ectopic, molar)
  4. trauma (post-coital)
  5. physiologic bleeding (due to placental development)
  6. genital lesion (e.g. cervical polyp, neoplasms)

THIRD TRIMESTER BLEEDING

Differential Diagnosis

  1. placenta previa 
  2. abruptio placentae
  3. vasa previa 
  4. bloody show (shedding of cervical mucous plug) 
  5. marginal sinus bleeding 
  6. cervical lesion (cervicitis, polyp, ectropion, cervical cancer)
  7. uterine rupture 
  8. other: bleeding from bowel or bladder, placenta accreta, abnormal
    coagulation
  9. NB - do NOT perform a vaginal exam until placenta previa has been ruled out by U/S

    VASA PREVIA

    1. incidence 1 in 5000
    2. occurs with velamentous insertion of cord into membranes of placenta; unprotected fetal vessels pass over the cervical os
    3. since bleeding is from fetus a small amount of blood loss can have catastrophic consequences
    4. presents with painless vaginal bleeding and fetal distress (tachy- to bradyarrhythmia)
    5. Apt test (NaOH mixed with the blood) can be done immediately to determine if the source of the bleeding is fetal (supernatant turns pink) or maternal (supernatant turns yellow)
    6. Wright stain on blood smear and look for nucleated red blood
      cells (in cord not maternal blood)
    7. management is STAT C-section
    8. 50% perinatal mortality, increasing to 75% if membranes rupture (most infants die of exsanguination)

    ANTENATAL HEMORRHAGE : 1st 2nd and 3rd TRIMESTER BLEEDING ANTENATAL HEMORRHAGE : 1st 2nd and 3rd TRIMESTER BLEEDING Reviewed by Radiology Madeeasy on September 09, 2010 Rating: 5
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