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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

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