can be complete, incomplete (partial expulsion), inevitable (no expulsion but bleeding), threatened (normal but bleeding), or missed (no expulsion and not bleeding) miscarriage - pregnancy that ends prior to 20 weeks gestation C-section prior to ROM (~35 weeks gestation) Apt test for fetal nucleated RBCs (determine fetal vs maternal hemorrhage) diagnose via color Doppler US (middle cerebral artery peak systolic velocity) Clinical - sinusoidal FHR (due to fetal anemia) –> fetus can exsanguinate on ROM (abrupt sustained fetal bradycardia) Risk factors - velamentous cord insertion, placenta with accessory lobes, IVF babies, or multisī. Vasa previa - umbilical vessels cross internal os in front of fetal presenting partĪ.C-section, unless there is fetal demise –> vaginal delivery Mgmt - clinical diagnosis, US to r/o previa blood clot adherent to placenta, can lead to coagulopathy (DIC) 2/2 hypofibrinogenemiaĬ. Clinical - painful vaginal bleeding, Couvelaire uterus (bleed into myometrium), firm tender uterus Risk factors - HTN, prior abruption, short cord, trauma (eg MVA), cocaine use, submucosal leiomyomata, hydramnios, smoking, PPROMī. ![]()
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