How to Deal with Gestational Bleeding Problems for the Physician Assistant Exam - dummies

How to Deal with Gestational Bleeding Problems for the Physician Assistant Exam

By Barry Schoenborn, Richard Snyder

You will need to know about problems with gestational bleeding for the Physician Assistant Exam. Three bleeding-related complications that can occur during pregnancy include placenta previa, abruptio placentae, and post-partum hemorrhage.

Placenta previa

Placenta previa is an uncommon cause of bleeding that’s potentially life-threatening to both mom and baby. In this condition, the placenta is located at the lowest part of the uterus and covers much of the cervix. The initial presentation is painless bleeding late in the second trimester and is diagnosed by a pelvic ultrasound.

Sometimes placenta previa can simply be watched to see whether the affected placenta migrates up the uterine wall. Cesarean section is the preferred method of delivering the infant before the onset of labor in cases of placenta previa. In emergent cases where you see evidence of fetal distress, a C-section is done.

This condition increases the risk of sepsis and bleeding post-partum.

Abruptio placentae

Abruptio placentae is a life-threatening medical condition for both mother and fetus. Here, the placenta detaches from the uterus before delivery. This condition presents with acute abdominal and back pain, as well as vaginal bleeding. There are different grades of abruptio placentae, but its most severe form involves significant hemorrhage or significant uterine contractions, which can harm the fetus.

Aggressive volume resuscitation and transfusion of blood and/or blood products is vital. If the fetus is still viable, a C-section may be done.

Postpartum hemorrhage

Postpartum hemorrhage, which occurs after delivery, is defined as more than 0.5 L of blood loss following a spontaneous vaginal delivery. If the mother had a C-section, then double that amount, 1.0 L, is considered to be significant blood loss. Postpartum bleeding has many causes, but the most common one is uterine atony: The uterus fails to fully contract after delivery of the baby.

If the uterus isn’t contracting, you first massage the uterus to enable it to contract. Treatment then includes volume and blood resuscitation, as well as correcting any underlying coagulopathy. If this doesn’t help, then emergent surgical intervention, including hysterectomy, is warranted.