differential diagnosis of third trimester bleeding

Differential Diagnosis of Third Trimester Bleeding1. Blood Show2. A Bruntio placenta3. Placenta previa4. Visa previa5. Uterine rupture6. Cervical pathology

- Polyps- Carcinoma- varicositis

7. Maternal coagulopathy- Pre eclampsia- Intra uterine demise- other causes of coagulopathy

Placenta Previa Versus Abruptio Placentae

Placenta Previa Abruptio Placenta

Pain Painless Bleeding Pain Fula Bleeding

Blood Bright Red Portwne

Clotting Yes No

Blood loss Obvious Conceales behind the placenta

DIC Rare Possioility

Diagnosis Confirmed by Ultrasound Clinical and ultrasound

Diagnosis of Dessminated Intravascular coagulopathy

• Clinical Suspicions- Pregnancy- Non-Clotting Blood- In ability to control hemorrhage

• Laboratory- Prolonged PT / PTT- Low Fibrinogen level- low platelet count- Presence of fibrin degradation products

Coagulation Changes of Pregnancy• Increased factor level

- Fibrinogen- Faktor V,VII, VII, IX, X, XII- Fibrin split products Von Willebrand Factor

• No change- Factor XI- Antithrombin III- Platelet count

• Decrease- Factor XIII- Platelet count- PT- PTT