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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
Abdominal pregnancy
Incidence: 1/7,000 deliveries, 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