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This Concept Map, created with IHMC CmapTools, has information related to: Third Trimester Bleeding, Third Trimester Bleeding Uterine Rupture PAINFUL Incomplete-still has visceral peritoneum Complete-laceration through wall Rupture C/S scar -50% mort to fetus -5% mort to mom, Third Trimester Bleeding Placenta Previa-0.5% TA U/S FOR DX -uterus soft, nontender Painless bleeding, gradual -bright red blood -esp after intercourse Total-unlikely migration -vaginal delivery improbable Partial-likely will migrate -vag delivery possible Low-lying placenta -vag delivery likely, Third Trimester Bleeding Abruptio Placentae-1% CLINICAL DX -uterus tender, firm PAINFUL, abrupt -dark blood -bleed into decidua basalis -may be concealed -if into myometrium -COUVELAIRE UTERUS, Third Trimester Bleeding Mom complications Hemorrhagic Shock DIC PP Hemorrhage Renal Failure Sheehan Syndrome, Third Trimester Bleeding Vasa Previa Tx: EMERGENCY C/S, Third Trimester Bleeding Work Up Apt Test -mom or baby blood? -NaOH+blood -brown if mom, pink if baby -if pink->vasa previa U/S to r/o previa BEFORE speculum CBC, periph smear, DIC panel -type and cross 4 U PRBC, Third Trimester Bleeding Uterine Rupture Tx: EMERGENCY C/S, Third Trimester Bleeding Abruptio Placentae-1% CLINICAL DX -uterus tender, firm Tx: Delivery -Vaginal: if stable and will be rapid -Emergency C/S: if unstable -Conservative: if fetus immature, bleeding stopped, stable, no DIC (bed rest, tocolytics, steroids), Third Trimester Bleeding Vasa Previa Velamentous cord insertion ->vessels shear near os ->blood per os after ROM