PERINEAL LACERATIONS

1st degreeExtends through vagina & perinea skin

2nd degreeExtends into soft tissue of perineum (bulbocavernous and perineal muscle)

3rd degreeThrough anal sphincter

4th degreeThrough rectal mucosa

TYPES OF SPONTANEOUS ABORTION

BLEEDINGABD. PAINCERVIXPOC

THREATENEDMinimalPossibleCloseNo POC expelled

INEVITABLEProfuseSevereOpenNo POC expelled

INCOMPLETEProfuseMinimal/severeOpenSome POC expelled

COMPLETEMinimalMinimalOpenAll POC expelled

MISSEDNoneNo painCloseNo POC expelled

SEPTICAbortion resulting in uterine infection. Presents with fever, chills and peritoneal signs

THIRD TRIMESTER BLEED

PAINLESS BLEEDING

PLACENTA PREVIAVASA PREVIA

MechanismAbnormal placental implantation in close proximity, extending or covering the cervixRupture of fetal vessel that cross placental membrane overlying the cervix

Risk factorsMultiparity, multiple gestation, advance maternal age, previous placenta previa, previous csMultiple gestation, velamentous cord insertion, accessory lobe of placenta

Source of bleedingMaternal bloodFetal blood

ManagementNo vaginal exam, stabilize patient with premature fetus, emergency CSEmergency CS

PAINFUL BLEEDING

ABRUPTIO PLACENTAUTERINE RUPTURE

MechanismPremature separation of placentaLaceration of uterine wall

Risk factorsHypertension, abdominal or pelvic trauma, premature rupture of membrane, previpus placenta abruptia, tobacco of cocaine usePrevious uterine scar, excessive oxyytocin, over distended uterus

Source of bleeding

ManagementStabilize patient and manage expectantly if with premature fetus, emergency CSEmergency CS

OB GYN HISTORYCC,HPI, PMHx, FHx and ROS plus:HPI: gravidity (# or pregnancies including the current one (tiwns =1/1)parity (# of births beyond 24 wks aog or