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Trimester Bleeding and Obstetric Catastrophes

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