Bleeding in Second Half (Late) of Pregnancy
Bleeding in Second Half (Late) of Pregnancy
Bleeding in Second Half (Late) of Pregnancy
PREGNANCY
DR DOHBIT SAMA
DEPT. OBS/GYN
FMBS, UY I.
INTRODUCTION
PLAN
1. Introduction
2. Classification
3. Management principles
4. Hypovolemic shock
5. The unstable and the stable patient
6. Ultrasound and vaginal examination
7. Management
8. Conclusion
INTRODUCTION 2
Almost
CLASSIFICATION
Obstetric
CLASSIFICATION 2
Less
CLASSIFICATION 3
Bloody
CLASSIFICATION 4
Obstetric causes
Non obstetric
Bloody show
Ca cervix or dysplasia
Placenta praevia
Cervicitis(trichom,gonococcu
s, HSV, chlamydia)
Abruptio placentae
Cervical polyps
Vasa praevia
Cervical eversion
DIC
Vaginal laceration
Uterine rupture
Vaginitis
MANAGEMENT PRINCIPLES
Patient
HYPOVOLEMIC SHOCK
Pallor,
airway
Trendelenburg with left tilt
Patent IV lines
The D is continuous foetal monitoring using
the Doppler ultrasound
IV filling and prepare for blood transfusion
At times invasive hemodynamic monitoring
may be necessary
ABCDs
Team
VAGINAL EXAM
Placenta
ECHOGRAPHY
Transvaginal
MANAGEMENT OPTIONS
Immediate
delivery
Continued
labour
Expectant
PLACENTA ABRUPTIO
PLACENTA ABRUPTIO 2
Visible
or external in 80%
Concealed (20%) bleeding
Foetal distress may be present
10% with DIC
Other complications related to blood loss and
shock
Revisit placenta praevia and uterine rupture
CONCLUSION
Third
THANK YOU
MERCI