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Third Trimester Bleeding:
- Estimated to occur in 4% of Pregnancy
- 50% will have a benign cause, the other 50% will have a life threatening cause
- Life Threatening Causes:
- Benign or Non-OB Causes
- Contact Bleeding (local trauma)
- Cervical Inflammation (i.e. infection)
- Cervical effacement and dilation
- Cervical cancer
- Other sites:
- rectal bleeding
- urinary bleeding
- Evaluation:
- ABC's: Stablilize mother, consider 2 large bore IVs
- Consult OB/GYN early (most centers with OB/Gyn will have these patients evaluate and treated in Labor and Delivery), if not readily available complete evaluation as listed below:
- Initially avoid bimanual exam
- Obtain baseline labs (CBC, Coags, Chemistries, Consider LFTs if suspecting eclampsia or HELLP syndromes). If not known obtain Rh status
- Fetal Monitioring ideally with continous fetal heart rate and tocometry
- Sterile Speculum exam for culture and check for active bleeding.
- Obtain ultrasound.