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Hemorrhagic Catastrophes
Antepartum
Placenta previa
Incidence: 1/200 live births
Risk factors (1) Age (2) Parity
Multiple gestation
Ultrasound
Management based on prolonging pregnancy to lung maturity
Vasa previa
Definition: fetal vessels cross cervical os
May result in fetal hemorrhage
Diagnosed by clinical suspicion
Immediate delivery third trimester bleeding, placenta previa, placental abruption, abruptio placentae
Abdominal pregnancy
Incidence: 1/7,000 deliveries third trimester bleeding, placenta previa, placental abruption, abruptio placentae, birth trauma, brain injury
Amenorrhea
Abdominal pain
Fetal malpresentation
Poor response to oxytocin
Cornerstone of management is surgery
Intrapartum
Abruptio placentae
Incidence: between 1/50 and 1/200 live births b. Risk factors include
Hypertension
Increasing parity
Previous abruption
Smoking
Trauma
Vascular disease
Signs
Uterine irritability
Tenderness
Bleeding
Absence of uterine relaxation
Essentials of treatment