FIRST AND SECOND TRIMESTER BLEEDING Differential Diagnosis abortion (threatened, inevitable, incomplete, complete) < 5% of thre...
FIRST AND SECOND TRIMESTER BLEEDING
Differential Diagnosis
- abortion (threatened, inevitable, incomplete, complete)
- < 5% of threatened abortions go on to abort
- abnormal pregnancy (ectopic, molar)
- trauma (post-coital)
- physiologic bleeding (due to placental development)
- genital lesion (e.g. cervical polyp, neoplasms)
THIRD TRIMESTER BLEEDING
Differential Diagnosis
- placenta previa
- abruptio placentae
- vasa previa
- bloody show (shedding of cervical mucous plug)
- marginal sinus bleeding
- cervical lesion (cervicitis, polyp, ectropion, cervical cancer)
- uterine rupture
- other: bleeding from bowel or bladder, placenta accreta, abnormal
coagulation - NB - do NOT perform a vaginal exam until placenta previa has been ruled out by U/S
- incidence 1 in 5000
- occurs with velamentous insertion of cord into membranes of placenta; unprotected fetal vessels pass over the cervical os
- since bleeding is from fetus a small amount of blood loss can have catastrophic consequences
- presents with painless vaginal bleeding and fetal distress (tachy- to bradyarrhythmia)
- Apt test (NaOH mixed with the blood) can be done immediately to determine if the source of the bleeding is fetal (supernatant turns pink) or maternal (supernatant turns yellow)
- Wright stain on blood smear and look for nucleated red blood
cells (in cord not maternal blood) - management is STAT C-section
- 50% perinatal mortality, increasing to 75% if membranes rupture (most infants die of exsanguination)
