Bleeding in Pregnancy

What is placenta previa?

the placenta covers the cervical os (opening)

What is a major complication of placenta previa?

hemorrhage

What is the key sign for placenta previa?

bright red, painless bleeding

How is placenta previa diagnosed?

ultrasound

When is placenta previa most common?

patients with a hx of previous c-sections (since the placenta needs a highly vascular space and can’t use the scar tissue created by c-section)

How is placenta previa managed?

delivery (usually via c-section) between 36-37 weeks

What should you educate patients with placenta previa about?

seek urgent care if bleeding or contractions occur

What is vasa previa?

fetal blood vessels cover the cervical os

Is placenta previa or vasa previa rarer?

vasa previa

What should you educate patients with vasa previa about?

any bleeding (even a tiny amount) is an emergency and can be a sign of hemorrhage; go to the hospital!

What is placental abruption?

the placenta prematurely separates from the uterine wall

What is the most common cause of placental abruption?

abdominal trauma (from a car wreck, domestic abuse, etc.)

How is placental abruption treated?

rhogam for Rh- patients and emergency c-section

What are signs and symptoms of placental abruption?

dark red bleeding, knife-like pain, severe/unrelenting uterine contractions, + prolonged/variable FHR decels

Which labwork should be used in placental abruption and why?

kleihauer-betke; it detects fetal RBCs in maternal circulation (determining whether baby and mom’s blood are mixing)

What is disseminated intravascular coagulopathy (DIC)?

uncontrolled clotting

What are some causes of DIC?

placental abruption, PP hemorrhage, HELLP syndrome, prolonged fetal demise, + maternal sepsis (anything using up a large amount of mom’s platelets!)

What is usually the first sign of DIC?

bleeding at the IV site

What is the primary goal when treating DIC?

find + stop the underlying cause