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Previa
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· RFs:
· Prior placenta previa
· Prior CS
· Multiple gestation
· Clx: Painless vaginal bleeding weeks gestation
· Dx: Transabdominal followed by transvaginal sonogram
· Tx:
· No intercourse
· No digital cervical examination
· Inpatient admission for bleeding episodes
· F/U w/ pt, as previa could resolve
· If not resolved -> CS at 36-37 weeks
Bed rest + nothing in vagina
(if husband is horny he can masturbate)
If preterm: tx as preterm
CS, if:
· Fetal distress
· Cx >4cm
· Unstoppable bleeding
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Abruption
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RFs:
· Maternal hypertension or preeclampsia/eclampsia
· Abdominal trauma
· Prior placental abruption
· Cocaine & tobacco use
Clx
· Sudden-onset vaginal bleeding (80%)
· Abdominal or back pain
· High-frequency, low-intensity contractions
· Hypertonic, tender uterus
Dx
· Clx Dx
· US (not required for dx) to rule out placenta previa; may show retroplacental hematoma
CS if:
· Uncontrollable maternal hemorrhage
· Rapidly expanding concealed hemorrhage
· Fetal distress
· Rapid placental separation
NVD are indicated if:
· Placental separation is limited
· Fetal heart tracing is assuring
· Separation is extensive and fetus is dead
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Accreta
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If placenta cannot detach from the uterine wall after delivery → catastrophic hemorrhage and shock.
Patients require hysterectomy.
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Uterine rupture
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 RF: multiple CS
Presentation (during labor):
· Sudden onset of extreme abdominal pain
· Abnormal bump in abdomen
· No uterine contractions
· Regression of fetus
IMMEDIATE Laparotomy 🚨
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Uterine Rupture
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RF
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· Prior uterine surgery (CS)
· IOL/ ⤴️⏰ Labor
· الطفل حجمه كبير
· تشوهات في الرحم
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Clx
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· Vaginal bleeding
· Intraabdominal bleeding (hypotension, tachycardia)
· Fetal heart decelerations
· Loss of fetal station
· Palpable fetal parts on abdominal examination
· Loss of intrauterine pressure
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Tx
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Laparotomy for delivery & uterine repair
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Uterine Inversion
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?
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· Excessive fundal pressure
· Excessive umbilical cord traction
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S/S
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· Lower abdominal pain
· Round mass protruding through cervix
· Uterine fundus not palable transabdominally
· Hemorrhage shock
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Tx
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· IVF aggressive
· Put uterus back (replacement)
· Remove Placeta
· Give uterotonic drugs
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Fast HY Review 