Late pregnancy bleeding can occur after 20 weeks of gestation and has several potential causes. Placental abruption occurs when the placenta separates from the uterine wall before delivery, presenting with abdominal pain, vaginal bleeding, and contractions. Uterine rupture is a complete separation of the uterine wall that endangers the mother and fetus, often occurring in those with prior uterine surgery. Placenta previa is when the placenta implants in the lower uterine segment, presenting with painless vaginal bleeding. Vasa previa occurs when fetal vessels traverse the membranes over the cervical os, presenting with bleeding upon rupture of membranes or contractions and fetal bradycardia. Abnormal placenta attachment like accreta,
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
Haemorrhage is a major cause of maternal morbidity and mortality throughout the world. Antepartum haemorrhage is defined as the bleeding from or within the genital tract after 28th week of pregnancy but before the birth of the baby. Causes may be placental, extra placental or unexplained Major causes of APH are two: placenta previa and abruptio placenta. h Placenta previa is 4 types. Placentography (USG) confirms the diagnosis .Abruptio placenta should be differentiated placenta previa Placenta previa can be diagnosed by—(i) Ultrasonography (preferred), (ii) Clinically. Transvaginal ultrasound classify placenta previa: (a) within 2 cm or (b) > 2 cm from the undilated internal cervical os. Vaginal examination for the diagnosis of placenta previa should not be done as it provokes severe hemorrhageImaging modalities (Doppler USG, MRI) have reduced the need of double set up examination and the risk of bleeding thereof as they can make the improved diagnosis of placenta previa, accreta and abruption. h Placental abruption is diagnosed mainly clinically and supported by laboratory, USG or MRI. h Complications of placenta previa and abruptio placenta affect both the mother and the fetus. Management of placenta previa and abruptio placenta depends upon the severity of the problem and also on the duration of pregnancy.
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
Haemorrhage is a major cause of maternal morbidity and mortality throughout the world. Antepartum haemorrhage is defined as the bleeding from or within the genital tract after 28th week of pregnancy but before the birth of the baby. Causes may be placental, extra placental or unexplained Major causes of APH are two: placenta previa and abruptio placenta. h Placenta previa is 4 types. Placentography (USG) confirms the diagnosis .Abruptio placenta should be differentiated placenta previa Placenta previa can be diagnosed by—(i) Ultrasonography (preferred), (ii) Clinically. Transvaginal ultrasound classify placenta previa: (a) within 2 cm or (b) > 2 cm from the undilated internal cervical os. Vaginal examination for the diagnosis of placenta previa should not be done as it provokes severe hemorrhageImaging modalities (Doppler USG, MRI) have reduced the need of double set up examination and the risk of bleeding thereof as they can make the improved diagnosis of placenta previa, accreta and abruption. h Placental abruption is diagnosed mainly clinically and supported by laboratory, USG or MRI. h Complications of placenta previa and abruptio placenta affect both the mother and the fetus. Management of placenta previa and abruptio placenta depends upon the severity of the problem and also on the duration of pregnancy.
What to Expect if You’ve Been Diagnosed with Placenta PreviaMiami ObGyns
www.miamiobgyns.com/blog/diagnosed-placenta-previa/
If you’ve been diagnosed with Placenta Previa you are sure to have many questions about the causes, risks and treatments. Here’s what to expect...
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
What is the normal placenta
what is the Placental Abnormalities and
Hemorrhagic Complications during pregnancy
What is APH
How to manage The Hemorrhage
Ectopic pregnancy by dr aishwarya, a4 fertility centre, chennai
#ectopicpregnancy #ectopy #fertilitytips #pregnancycare #pregnancytreatment #ivfcentre #pregnancytips #a4hospital #a4fertilitycentre #chennai
This topic contains definition, incidence, varieties, causes, risk factors, dangers, diagnosis, prognosis, prevention and management of inversion of uterus.
Subject: Midwifery and Obstetrical Nursing. Topic: Ectopic pregnancy, Its types, various Implantation sites, Pathophysiology, Risk factors, Diagnosis, Various Managements and Recent Advancements.
What to Expect if You’ve Been Diagnosed with Placenta PreviaMiami ObGyns
www.miamiobgyns.com/blog/diagnosed-placenta-previa/
If you’ve been diagnosed with Placenta Previa you are sure to have many questions about the causes, risks and treatments. Here’s what to expect...
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
What is the normal placenta
what is the Placental Abnormalities and
Hemorrhagic Complications during pregnancy
What is APH
How to manage The Hemorrhage
Ectopic pregnancy by dr aishwarya, a4 fertility centre, chennai
#ectopicpregnancy #ectopy #fertilitytips #pregnancycare #pregnancytreatment #ivfcentre #pregnancytips #a4hospital #a4fertilitycentre #chennai
This topic contains definition, incidence, varieties, causes, risk factors, dangers, diagnosis, prognosis, prevention and management of inversion of uterus.
Subject: Midwifery and Obstetrical Nursing. Topic: Ectopic pregnancy, Its types, various Implantation sites, Pathophysiology, Risk factors, Diagnosis, Various Managements and Recent Advancements.
This PPT describes the common obstetrical emergency and its nursing management in a simple way. Content will be helpful to all healthcare professionals to revise, refresh and to update.
To understand the principles of taking an obstetric history.
To understand the key components of an obstetric examination
The patient is normally a healthy woman undergoing a normal life event.
The type of questions asked during the history change with gestation, as does the purpose and nature of the examination.
The history will often cover physiology, pathology and psychology
Globally, over 600,000 new cases and 300,000 deaths were estimated for cervical cancer in 2020 .
Third most common gynecological cancer in Palestine.
Palestine has a higher age-standardized mortality rate than other countries in the region
A five-year-old boy is now at the 95th percentile for weight and 50th percentile for height whereas previously he had been at the 50th percentile for both height and weight
he term myeloproliferative neoplasms (MPN) describes a
group of conditions arising from marrow stem cells and characterized by clonal proliferation of one or more haemopoietic
components in the bone marrow and, in many cases, the liver
and spleen. They are often called the myeloproliferative diseases. The three major non‐leukaemic disorders included in
this classification are:
1 Polycythaemia vera (PV);
2 Essential thrombocythaemia (ET); and
3 Primary myelofibrosis.
Malta Fever , Brucellosis , is one of the most prevalent zoonotic infection globally. It’s a
bacterial infection caused by Brucella , a Gram-Negative bacteria1
. Brucella melitensis
(transmitted from sheep and goats), B. abortus (transmitted from cattle and bovina), and B.
suis (transmitted to humans from pigs) are the most common species causing human
brucellosis
Gastroparesis is a syndrome of objectively delayed gastric emptying in the absence of a mechanical obstruction and cardinal symptoms of nausea, vomiting, early satiety, bloating, and/or upper abdominal pain
Common disorder with an annual incidence of 0.1% to 0.5%.
The peak age at onset is 20 to 30 years
Men > Women ( until 50s )
Wide geographic variations exist, due to differences in diet and water composition, as well as ambient and sunlight exposure. 5-9% in Europe 20% in Saudi Arabia
It is an inflammation of the middle ear cleft (( not middle ear cavity)).
Account for almost 1/3 of the office visit to pediatricians
Peak incidence 6-24 month of life
More common in boys and in low socioeconomic persons
Incidence increased in children with: HIV , cleft palate, trisomy 21
Many systemic diseases are reflected in the oral mucosa, maxilla, and mandible.
Mucosal changes may include ulceration or mucosal bleeding.
Immunodeficiency can lead to opportunistic diseases such as infection and neoplasia.
Bone disease can affect the maxilla and mandible.
Systemic disease can cause dental and periodontal changes.
Drugs prescribed for a systemic disease can affect oral tissue.
The facial nerve is the seventh (VII) of twelve paired cranial nerves.
It emerges from the brainstem between the Pons and the Medulla.
Facial nerve is a mixed nerve, having 2 roots:
1. Medial motor root.
2. Lateral sensory root (nervous intermedius),which contains sensory & parasympathetic fibers.
Waardenburg syndrome
this ppt presents pancreatitis and tumors of the pancreas
The fourth leading cause of cancer-related death in the United States and has a mean age of 55 at diagnosis.
I GET SMASHED
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!
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
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.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
3. Generally !
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.
8. Placental abruption
• A normally implanted placenta (not in the lower uterine segment)
separates from the uterine wall before delivery of the fetusas a result
of rupture of maternal decidual vessels.
• Separation can be partial or complete.
9.
10. Clinical Presentation
• Sudden-onset vaginal bleeding (80%)
• Abdominal or back pain
• High-frequency, low-intensity contractions
• Hypertonic, tender uterus
• DIC
severe abdominal pain and a tender, hypertonic uterus !
12. Classification : mild abruption
• vaginal bleeding is minimal
• with no fetal monitor abnormality.
• Localized uterine pain and
tenderness
13. Classification : Moderate and Sever abruption
With moderate abruption,
symptoms of uterine pain and
moderate vaginal bleeding can be
gradual or abrupt in onset. From
25–50% of placental surface is
separated. Fetal monitoring may
show tachycardia, decreased
variability, or mild late
decelerations.
With severe abruption, symptoms
are usually abrupt with a continuous
knife-like uterine pain. More than
50% of placental separation occurs.
Fetal monitor shows severe late
decelerations, bradycardia, or
even fetal death.
14. Diagnosis and Management :
• Primarily by clinical presentation
• Ultrasound (not required for diagnosis) to rule out placenta
previa; may show retroplacental hematoma
Complications: ATN & ARF ,DIC
15. Couvelaire uterus: refers to blood extravagating between the
Myometrial fibers, appearing like bruises on the serosal surface.
18. Uterine Rupture
• A complete separation of the wall of the pregnant uterus
with or without expulsion of the fetus that endangers the life
of the mother or the fetus, or both.
• The rupture may be:
– incomplete (not including the peritoneum)
– or complete (including the visceral peritoneum).
Uterine rupture typically occurs in patients with prior
uterine surgery (eg, prior cesarean delivery regardless of
subsequent vaginal delivery) because inelastic uterine scar
tissue can separate with contractions
19. Risk Factors
• The most common risk factors are :
– previous classic uterine incision,
– myomectomy,
– and excessive oxytocin stimulation.
– grand multiparity and marked uterine distention.
21. • If the placenta is involved, fetal perfusion is disrupted, leading to
fetal hypoxia (ie, late decelerations, prolonged bradycardia).
• If the umbilical cord prolapses into the maternal abdomen, cord
compression may increase (ie, variable decelerations). Because either
or both are likely to occur, an abrupt fetal heart rate tracing
abnormality is the most common finding of uterine rupture.
Clinical Presentation
22. • Disordered contractions occur because ruptured myometrial
fibers cannot contract in unison. This is often evidenced by
progressively decreasing contraction amplitude (ie, staircase
sign on tocodynamometry).
• Partial fetal delivery into the maternal abdomen can cause
fetal head retraction (eg, +1 to - 2 station) and loss of fetal
station.
• Myometrial tearing causes severe abdominal pain and
massive intraabdominal bleeding, which may result in
hemodynamic instability.
Clinical Presentation
23. Management :
• Treatment is surgical. Immediate delivery of the fetus is imperative.
• Uterine repair is indicated in a stable young woman to conserve
fertility.
• Hysterectomy is performed in the unstable patient or one who
does not desire further childbearing
27. Placenta Previa
• Occurs when the placenta is implanted in the lower uterine
segment. This is common early in the pregnancy, but is not
typically associated with bleeding.
• painless late-pregnancy bleeding, which can occur:
during rest or activity, suddenly and without warning.
• It may be preceded by trauma, coitus, or pelvic
examination.
• The uterus is nontender and nonirritable.
28. Grading
This is the most
dangerous location
because of its potential for
hemorrhage.
Massive Maternal Hemorrhage.
Heavy and Persistent
30. Digital cervical examination is contraindicated in patients with placenta
previa as digital examination enters the cervical canal,disrupting the previa
and leading to severe hemorrhage.
In contrast, speculum examination can be used in patients with known
or suspected placenta previa to verify and quantify vaginal bleeding as it
does not enter the cervical canal.
32. If placenta previa occurs over a previous uterine
scar, the villi may invade into the deeper layers of the
decidua basalis and myometrium, resulting in
intractable bleeding requiring cesarean
hysterectomy.
34. Vasa Previa
• Vasa previa is present when fetal vessels traverse the fetal
membranes over the internal cervical os.
• Either a velamentous insertion of the umbilical cord
• Or may be joining an accessory (succenturiate) placental lobe
to the main disk of the placenta
36. Vasa Previa
• Normal fetal vessels travel in the umbilical cord surrounded by
thick, gelatinous tissue (ie, Wharton jelly) that protects the
vessels.
• Vasa previa is The fetal vessels overlie the cervix surrounded
only by thin fetal membranes.
• Their location over the cervix and lack of protection by Wharton
jelly make these vessels prone to tear with rupture of
membranes or contractions.
38. Vasa Previa
• If these fetal vessels rupture the bleeding is from the
fetoplacental circulation, and fetal exsanguination will
• rapidly occur, leading to fetal death
39. Clinical Presentation
• The classic triad is rupture of membranes and painless
vaginal bleeding, followed by fetal bradycardia
• Painless vaginal bleeding with ROM or contractions
• FHR abnormalities (eg, bradycardia, sinusoidal pattern)
• Fetal exsanguination & demise Vaginal bleeding is minimal
because total fetal blood
volume is low (250 ml, or 1
cup)
Minimal and Transient
44. Abnormal Attachment
• • Normal placenta attaches to decidua
• • Abnormal decidua → abnormal attachment
• • Placenta attaches directly to myometrium
• • Leads to bleeding after delivery
• • Three forms
– • Placenta accreta (most common)
– • Placenta increta
– • Placenta percreta
Approximately 1 in 2,500 pregnancies
experience placenta accreta, increta,
or percreta
45. Abnormal Attachment
• Caused by defective uterine decidualization
• • Most important risk factor: prior C-section
• • Especially with placenta previa
• • Other risk factors:
– • Prior uterine surgery or D&C
46. Abnormal Attachment
• Placenta accreta
– • Placenta attached to myometrium
– • No penetration into myometrium
• • Placenta increta
– • Placenta penetrates myometrium
• • Placenta percreta
– • Placenta penetrates through myometrium
– • Invades uterine serosa (outer layer)
– • Can attach to bladder/rectum
47. Abnormal Attachment
• Clinical Presentation
– • Usually diagnosed by prenatal ultrasound
• • Undetected: placenta fails to detach after birth
– • Part/all of placenta remains attached to uterus
– • Breaks into pieces
• • Massive bleeding
• • Maternal hemorrhage
• • Shock, DIC, ARDS
• • Delivery usually by C-section
• • Often requires hysterectomy