3.4 Diagnosis of bleeding during the second half of pregnancy (summary)
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Table 3.1 - Aetiological diagnosis
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Placenta praevia
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Abruptio placenta
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Uterine rupture
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History |
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- Twin pregnancy
- Caesarean section
- Bleeding during a previous pregnancy
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- Pre-eclampsia
- Primipara
- Trauma
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- Long labour
- Primipara
- Dystocia
- Grand multipara (≥ 5)
- Caesarean section
- Overuse of uterotonic
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Clinical signs |
Bleeding
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- Bright red blood
- Painless bleeding, spontaneous or after vaginal exam or sexual intercourse
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- Bleeding without warning sign
- Light flow of blackish blood, or sudden bright red bleeding
- Bleeding with severe, constant uterine and lower back pain
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Variable
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Haemorrhagic shock
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- Blood loss visible
- Shock proportional to amount of bleeding
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- Blood loss not always visible
- Shock out of proportion to the amount of visible bleeding (intra-abdominal or retroplacental bleeding)
- Diffuse haemorrhage
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- Blood loss not always visible
- Shock out of proportion to the amount of visible bleeding (intra-abdominal bleeding)
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Uterus
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- Soft uterus
- Contractions, if present, are intermittent
- Foetus high and mobile
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- Painful, continuous contraction ("woody uterus")
- Foetal position hard to determine (hard uterus and haematoma)
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Foetus sometimes expelled into the abdominal cavity: uterus is retracted into a ball, the foetus felt under the skin
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Vaginal exam
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Soft, spongy placenta
Perform only one, very cautious, vaginal exam if ultrasound is not available.
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Cervix often closed
Vaginal exam not helpful in diagnosis of abruptio placenta.
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Foetal heart tones
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Normal in the absence of maternal shock
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Absent or weak
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Absent or weak
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