LATE PREGNANCY BLEEDING
Late pregnancy bleeding is vaginal bleeding that occurs after 20 weeks’
gestation. Prevalence is <5%, but when it does occur, prematurity and perinatal
mortality quadruple.
Initial Evaluation. What are patient’s vital signs? Are fetal heart tones present?
What is fetal status? What is the nature and duration of the bleeding? Is there
pain or contractions? What is the location of placental implantation?
Initial Investigation. Complete blood count, disseminated intravascular
coagulation (DIC) workup (platelets, prothrombin time, partial thromboplastin
time, fibrinogen, D-dimer), type and cross-match, and sonogram for placental
location. Never perform a digital or speculum examination until ultrasound
study rules out placenta previa.
Initial Management. Start an IV line with a large-bore needle; if maternal vital
signs are unstable, run isotonic fluids without dextrose wide open and place a
urinary catheter to monitor urine output. If fetal jeopardy is present or
gestational age is ±36 weeks, the goal is delivery.
Cervical causes include erosion, polyps, and, rarely, carcinoma.
Vaginal causes include varicosities and lacerations.
Placental causes include abruptio placentae, placenta previa, and vasa previa.http://ebookobgyne.net