Third trimester Bleeding

Third Trimester Bleeding Placenta Previa Presenter:Dr.T.Kiak: Xianya 2 nd Hospital of Central South University, China

Content ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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1. Zlatnik MG, Cheng YW, Norton ME, Thiet MP, Caughey AB. Placenta previa and the risk of preterm delivery. J Matern Fetal Neonatal Med . Oct 2007;20(10):719-23 2. http://emedicine.medscape.com/article/262063-overview 6.6 Endometrosis 5 Thrombophletitis Aged > 40years=2% 5.5 Septicemia Aged 30-39years=1% 10 Blood Transfusion Aged 20-29years= 0.33% 33 Need for Hysterectomy Aged 12- 19years= 1% 10 Antepartum Hemorrhage Age Relative Risks Morbidities

Classification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Figure 1. Types of Placenta Previa ( http:// www.google.com /images )

Etiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Clinical ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Differential Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],Pelvic ,Vaginal and PR Examination Don’t Provoke Hemorrhage, both vaginal and Rectal should be avoided

Pelvic ,Vaginal and PR Examination ????????? ,[object Object]

Workup ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Imaging Studies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

A. Expectant Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

medication Acts directly on beta2-receptors to relax uterine contractions. Terbutaline (Brethine) tocolytics to promote the time for expectant management of symptomatic placenta previa Loading dose: 6 g IV over 20 min; then 2-4 g/h continuous infusion; adjust to lessen contractions; not to exceed 4 g/h Tocolytics Magnesium sulfate Steroids may be administered after consultation with a gynecologist, if vaginal bleeding is mild and intermittent, if the patient is not in labor, and if gestation is less than 37 weeks. Corticosteroids Betamethasone (Celestone) Side Effect Dosage Drug

B. Delivery ,[object Object],[object Object],[object Object],[object Object],[object Object]

B. Delivery ,[object Object],A. Cesarean section: METHOD OF CHOICE B. Vaginal Delivery C. Assisted Deliverly: Vacuum & Forceps REF: http:// www.google.com /images

Complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Remarks ,[object Object],Patients with placenta previa should decrease activity to avoid rebleeding. intercourse should be avoided Patients with complete placenta previa tend to have poorer pregnancy outcomes. They tend to deliver more prematurely and may require hysterectomies at the time of delivery.

Third trimester Bleeding

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Third trimester Bleeding