Under the topic of (APH) I talked about the most common causes of (APH) which are placental causes, including Placental Abruption, Placenta Previa and Vasa previa and I depended on the most famous obstetric and gynecological books, Like:
1-An evidence-based text for MRCOG, THIRD EDITION. 2016
2-Bedside Obstetrics and Gynecology (2010)
3-Differential_Diagnosis_in_Obstetrics and gynecology
And other books
Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.
Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.
Placenta previa (pluh-SEN-tuh PREH-vee-uh) occurs when a baby's placenta partially or totally covers the mother's cervix — the outlet for the uterus. Placenta previa can cause severe bleeding during pregnancy and delivery. If you have placenta previa, you might bleed throughout your pregnancy and during your delivery
Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.
Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.
Placenta previa (pluh-SEN-tuh PREH-vee-uh) occurs when a baby's placenta partially or totally covers the mother's cervix — the outlet for the uterus. Placenta previa can cause severe bleeding during pregnancy and delivery. If you have placenta previa, you might bleed throughout your pregnancy and during your delivery
A comprehensive overview of hypertensive disorders in pregnancy with its complications and management. Mainly focused on gestational hypertension, preeclampsia and eclampsia.
physiology of labor includes the contraction and retraction of the muscles of uterus. I hope this presentation will help the persons of concerned subject.
Adherent placenta occurs when there is a defect in the decidua basalis, Resulting in an abnormal invasion of the placenta directly into the substance of the uterus
A comprehensive overview of hypertensive disorders in pregnancy with its complications and management. Mainly focused on gestational hypertension, preeclampsia and eclampsia.
physiology of labor includes the contraction and retraction of the muscles of uterus. I hope this presentation will help the persons of concerned subject.
Adherent placenta occurs when there is a defect in the decidua basalis, Resulting in an abnormal invasion of the placenta directly into the substance of the uterus
Bleeding from the genital tract in the late pregnancy, after 20th weeks of gestation and before the onset of labor.
This may place the life of the mother and fetus at risk.
Antepartum haemorrhage (APH) is defined as bleeding from or in to the genital tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the baby. The most important causes of APH are placenta praevia and placental abruption, although these are not the most common.
Types 1 and 2 are classified as minor placental praevia as these typically result in minor antepartum haemorrhaging. Types 3 and 4 are referred to as major placental praevia due to the risk of heavy haemorrhaging in the case of a rupture due to the location of placental attachment.
Antepartum hemorrhage (APH) is defined as bleeding from or into the genital tract, occurring from 24+0 weeks of pregnancy and before the birth of the baby. The most important causes of APH are placenta praevia and placental abruption
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
2. Definition:
• Vaginal bleeding after 24weeks and before the delivery of the fetus.
• It complicates (3-4%) of all pregnancies.
• It is an obstetric emergency because it endanger the life of both the
mother and fetus.
• Hemorrhage remain the most frequent cause of maternal deaths.
• Mild= <50 mL loss of blood, Major= 50-1000mL loss, Massive=
>1000mL loss.
• Bleeding >1 occasion regarded as recurrent APH.
3. • Erosion
• Polyps
• Cancer
• Varicosities
• Lacerations
Placental
causes
Etiology
Placenta P.
Abruptio P.
Vasa Previa
Local Causes
4. • In 30% of cases no cause can be found.
• Placenta previa and abruptio placenta are the main
causes of APH and will be discusses in details
Etiology:
5. • How much bleeding?
• What is the nature and duration of bleeding?
• What are the patients Vital Signs?
• Are fetal Heart Rates Present?
• What is fetal status?
• Is there pain or contraction?
• Last cervical smear (date/normal or abnormal)?
• What is the location of placental implantation?
Initial Evaluation
6. • Pulse, blood pressure.
• Is the uterus soft or tender and firm?
• Fetal heart / CTG.
• Speculum vaginal examination, with particular importance
placed on visualizing the cervix (having established that
placenta is not a previa, preferably using a portable
ultrasound).
Examination
7. Initial Investigations
• CBC
• DIC Workup
• (Platelets, PT, PTT (partial), Fibrinogen, D-Dimer).
• Type and Crossmatch
• US (location of Placenta)
Never Perform PV or Speculum exam Until you exclude
Placenta previa by U/S.
8. Initial Management
• IV line with a large bore needle
• If maternal signs are unstable, run Isotonic Fluid 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
10. • Third trimester bleeding due to premature separation of a normally
sited placenta.
• It complicates 0.5-2% of pregnancies.
• It could be of two types:
1. Revealed (Overt) and External Bleeding: there is obvious
external vaginal bleeding (2/3 of cases)
2. Concealed or Internal Bleeding: bleeding in the uterus with no
external bleeding. (1/3 of cases).
Placental Abruption:
11. A. MAJOR
• This is clinically obvious and may result in the death of the fetus.
• It is also life-threatening to the mother and usually involves
separation of more than one-third of the placenta.
B. MINOR
• Premature separation of small areas of the placenta may result in
placental infarcts.
• Several small abruptions may precede a large abruption.
Classification of Abruptio Placenta:
12. Percentage of placenta separated
50 % 100 %0 %
Placental abruption is a continuous process
MILD
Abruption
Normal FHR
Moderate
abruption
Tachy., Variability
Mild late
decelerations
Severe
Abruption
Severe late
deceleration, brady,
death!
22. Most common cause of
Late
pregnancy bleeding
PainfulLate
pregnancy bleeding
ObstetricDIC
Abruptio
placentaAbruptio
placenta
Abruptio
placenta
23. Ob-Gyn key TRIADS
Late trimester painful bleeding
Normal placental implantation
DIC
Abruptio placenta
24. Risk factors
1. Idiopathic: (Majority).
2. There is an association with defective trophoblastic invasion, as with pre-
eclampsia and intrauterine growth restriction.
3. Direct trauma e.g. RTA and external cephalic version.
4. High parity.
5. Uterine over distention (as in polyhydramnios and multiple pregnancy).
6. Sudden decompression of the uterus e.g. after delivery of 1st twin or release
of polyhydramnios.
7. Hypertension.
8. Smoking.
9. Folic acid deficiency.
25. Diagnosis
• This is based on the presence of Painful, late trimester vaginal
bleeding with a normal Fundal or Lateral uterine wall placental
implantation not over the lower Uterine segment.
• U/S can be helpful in some cases, demonstrating retro placental
clot and excluding placenta previa.
• However as the bleeding may be concealed ,it’s absence does not
exclude the diagnosis.
• Abruptio placenta usually occurs near term and frequently during
labor.
26. Clinical Presentation:
A. MAJOR
• Women present with abdominal pain and varying degrees of shock.
• The blood loss that is visible (revealed haemorrhage) is often less
than the degree of shock.
• On examination:
1.The uterus is woody hard; due to a tonic contraction.
2.The fetal parts cannot be felt.
3.The fetus may be dead.
27. B. MINOR
• Minor abruptions are often not diagnosed until after
delivery.
• They may present with:
Mild abdominal pain associated with threatened preterm
labour.
Unexplained APH.
Tenderness over one area of the uterus only.
Clinical Presentation:
28. The management depends on:
1. The severity of bleeding.
2. The gestational age.
3. The fetal and maternal condition.
Management of Placental Abruption:
29. Management of Abruptio placenta
Emergency
C/S
Vaginal
delivery
Conservative
In-Hospital
Maternal or Fetal
jeopardy
Preterm, UC subsides,
Mom and fetus stable
Term, in labour, Mom and
fetus is stable
30. • Acute Tubular Necrosis
• DIC.
• Couvelaire uterus: refers to blood extravasating between the myometrial fibers.
• Postpartum Hemorrhage
• Feto-maternal haemorrhage.
• Maternal mortality
• Recurrence: 10% After 1st attck, 25% After 2nd attck
Complications of placental abruption:
Maternal complications:
Fetal complications:
• Impaired fetal growth and/or hypoxic ischaemic encephalopathy (HIE)……C.P
34. Placenta previa (P.P.)
Means implantation of the placenta in the lower uterine segment (28 wks).
• Usually the lower implanted placenta atrophies and the upper placenta
hypertrophies, resulting in migration of the placenta.
• At term placenta previa is found in only (0.4-0.8%) of pregnancies.
• Symptomatic placenta previa occurs when painless vaginal bleeding
develops through avulsion of the anchoring villi of an abnormally
implanted placenta as lower uterine segment stretching occurs in the
latter part of pregnancy.
• Bleeding from placenta previa account for about 30% of all cases of APH.
37. Prevalence of Placenta PREVIA
At 16 Weeks 20 %
At 40 Weeks 0.5 %
Why the difference?
TROPHO TROPISM
Placental movement
38.
39.
40.
41.
42.
43.
44.
45. 1. The placenta covers the internal os with an overlap
of more than 1.5 cm.
2. The leading edge of the placenta is thick .
3. The placenta is posterior.
4. There is a uterine scar.
Factors on 2nd trimester ultrasound are associated
with the persistence of a placenta previa in the 3rd
trimester:
46. Diagnosis
• This is based on the presence of recurrent painless late-trimester
vaginal bleeding (small bleed or no. of small bleeds precede a larger one)
• The uterus is non-tender and non-irritable and fetal heart is
normal.
• Per vaginal (PV) examination is contraindicated
• Persistent malpresentation or high head in late pregnancy
• An ultrasound scan will show the position of the placenta.
• If the placenta lies in the anterior part of the uterus and reaches
into the area covered by the bladder, it is known as a low-lying
placenta (before 24 weeks) and placenta previa after 24 weeks.
51. Grading of placenta previa:
Grade .1 (lateral placenta):
The placenta implanted in the lower uterine segment but not reach the internal os.
Grade .2.(marginal placenta):
The edge of the placenta reaches the internal os but not cover it.
Grade.3.(partial placenta previa):
The placenta partially covering the internal os.
Grade.4.(complete placenta previa):
The placenta completely cover the internal os completely.
Grade (1&2) called minor P.P. grade (3&4) major P.P.
62. Management:
A. ASYMPTOMATIC LOW-LYING PLACENTA
• All women with a low-lying placenta diagnosed in early pregnancy
should be rescanned at 34weeks’ gestation.
• There is no need to restrict work activities or sexual intercourse in
women with a low-lying placenta on ultrasound unless they bleed.
• If the placenta previa is still present at 34 weeks’ Gestation and is Grade
I or II, the woman should be Rescanned on a fortnightly basis but
doesn’t need to be admitted unless they bleed.
• Clinically, a high presenting part or abnormal lie at 37 weeks implies that
the placenta is covering the cervix and a Caesarean section should be
performed electively.
63. • Admit to hospital.
• Insert a wide-bore i.v. cannula with i.v. fluid
• Take blood for cross-matching and Hb. estimation.
• If the woman is anaemic, she is no longer bleeding and the baby is <37
weeks then she should be transfused aiming for a haemoglobin of
>10.5g/dl.
• Avoid all digital vaginal examinations. (Just speculum examination)
• Perform ultrasound as soon as possible because this is more precise.
• Cross-matched blood should be kept permanently available.
• Placental position and fetal growth should be monitored.
B. PLACENTA PRAEVIA WITH BLEEDING
Management:
64. Management of Placenta PREVIA
Emergency C/S
Vaginal
delivery
Conservative
In-Hospital
Maternal or Fetal jeopardy
Term, stable Mom and fetus
Preterm, stable Mom and
fetus
Scheduled C/S
Marginal placenta previa
>2cm from os
65. At 36–37 weeks’ presentation, a final ultrasound should be performed
and acted upon:
A. Grades III and IV placenta praevia should have a C/S between 37
and 38weeks’ gestation by an experienced obstetrician particularly if
the placenta is on the anterior wall of the uterus.
B. If the presenting part is below the lower edge of the placenta in
Grade I, then it is safe to wait until labour and these women can be
expected to deliver vaginally.
66. A- Maternal complications:
• There is increased maternal mortality and morbidity.
• Profound hypotension can cause anterior pituitary necrosis
(Sheehan syndrome) or acute tubular necrosis.
• If placenta previa occurs over a previous uterine scar, the villi may
invade into the deeper layers of the decidua basalis and
myometrium, This can result in intractable bleeding requiring
cesarean hysterectomy.
Complications of placenta previa
67. Complications of placenta previa:
B- Fetal complications:
The perinatal mortality of patients with placenta previa is higher than the
general population and this is related to:
1. Prematurity (which is the main cause).
2. Higher incidence of IUGR (about 20% of pregnancies with placenta
previa) Malpresentation (in 30% of cases).
3. Higher risk of preterm premature rupture of membranes.
4. The presence of vasa previa which carry a perinatal mortality of 75%.
68. • After several days without bleeding, she may be ambulate and even
discharged if she lives nearby.
• Instruct the patient to return at the first sign of further bleeding.
• Her hematocrit should be followed her haemoglobin should be not less
than 11gm.
• Blood should always be available for the patient.
Advice for the patient
70. • This is a rare condition
• Velamentous insertion of the umbilical cord in the
membranes.
• At the time of rupture of membranes (whether
spontaneous or artificial) the umbilical vessels will
rupture causing massive bleeding which is of fetal
origin.
• It is suspected when fetal heart shows sever
bradycardia after rupture of membranes.
• Treatment is by immediate C/S.
Vasa Previa:
75. A 32-year-old multigravida at 31 weeks’ gestation is admitted to the
birthing unit after a motor-vehicle accident.
She complains of sudden onset of moderate vaginal bleeding for the
past hour.
She has intense, constant uterine pain and frequent contractions.
Fetal heart tones are regular at 145 beats/min.
On inspection her perineum is grossly bloody.
Placental Abruption
What is the diagnosisWhat is the diagnosis & Why?
76. A 34-year-old multigravida at 31 weeks’ gestation comes to the birthing
unit stating she woke up in the middle of the night in a pool of blood.
She denies pain or uterine contractions.
Examination of the uterus shows the fetus to be in transverse lie.
Fetal heart tones are regular at 145 beats/min.
On inspection her perineum is grossly bloody.
What is the diagnosis
Placenta previa
What is the diagnosis & Why?
77. A 21-year-old primigravida at 38 weeks’ gestation is admitted to the
birthing unit at 6-cm dilation with contractions occurring every 3 min.
Amniotomy (artificial rupture of membranes) is performed, resulting in
sudden onset of bright red vaginal bleeding.
The electronic fetal monitor tracing, which had showed a baseline fetal
heart rate (FHR) of 135 beats/min with accelerations, now shows a
bradycardia at 70 beats/min.
The mother’s vital signs are stable with normal blood pressure and
pulse.
Vasa previa
What is the diagnosis & Why?