Any Bleeding from genital tract after 24 to 28 weeks of pregnancy and Before delivery of the fetus
4% of all pregnancy
Causes:
Placental causes ( 50-70%) (obstetric causes)
_Placental previa
-Placental abruption
-Velamentous insertion of cord
-Marginal sinus rupture
-Circumvellate placenta
-Rarely rupture uterus
Excessive show
Non Obstetric Causes
_Cervical polyp
-Cervical ectopy (erosion)
_Carcinoma cervix
_Vaginal/ vulval Varicositis
_Cervicitis/vaginitis
Indeterminate Bleeding
Abruptio Placentae / accidental hemorrhage
Types:
Revealed / External hemorrhage
Concealed hemorrhage- carries worse risk , increased risk of consumptive coagulopathy / extent of hemorrhage not appreciated
Mixed
Total / partial
Incidence : 0.5%
Etiology
Advancing Maternal age
Race- more common among african american as compared to asians
main etiology is Hypertension such as chronic HTN : pre eclampsia
Uterine over distention e.g multiple pregnancy
Trauma
Cigarette smoking / cocaine
acquired thrombophilias
previous abruption
Pathophysiology:
Vascular injury
Rise in Uterine venous pressure
also separation of placenta
Clinical feature
Symptoms:
Bleeding (may be altered / fresh blood
Abdominal pain- Continuos pain
Too frequent contraction
Back pain
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mbbs in Philippines
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