Bleeding disorders 2nd trimester

1st trimester 1. H-mole

- fertilized egg develops into a mass of cysts,
1. Abortion
rather than a fetus
- less than 500 grams
- H-moles high hCG, mgmt. is hysterectomy
- if less than 20 weeks it is called abortus (removal of uterus and cervix)

Types of abortion - Gestational Trophoblastic disease (group of

- missed (fetus dies in the womb but is not
expelled)
- threatened (vaginal bleeding occurs before 20
weeks of gestation but the cervix is still closed
and the fetus is still viable)
- complete (all the products of conception are
expelled from the uterus)
- Incomplete (some but not all the products of
conception are expelled)
rare tumors that develop in the cells that would
normally form the placenta during pregnancy)
- Choriocarcinoma (develops from the cells that
would normally form the placenta and produce
the hCG, malignant and can quickly spread to
other organs, may occur years after h-mole,
cancerous)
- Invasive moles (abnormal cells grow into the
muscle layer of the uterus)

2. Incompetent Cervix
2. Ectopic - 4 – 5.2 cm is the normal ± 2 cm
- cervix is dilated/open
- ampulla is the most common site (80-90%) - no mucus plug (barrier to prevent bacteria
- ovarian - fimbriae - cervical from entering the uterus)
- 3cm up no cerclage
- isthmus - interstitial - must check for infection before doing cerclage
- indomethacin therapy
- Cullen’s sign (bluish tinge in the umbilicus)
- avoid sex for 2 weeks
- abdominal pain radiating to the shoulder (phrenic Types of cerclages
nerve) - Shirodkar (permanent)
- McDonalds (temporary)
- rigid/stiff abdomen

- Assisted reproduction
3rd trimester
- GIFT (Gamete Intrafallopian Transfer)
1. Placenta Previa (Abnormal implantation)
- sperm cell is added to meet/fertilize - 34 weeks
the egg - development of lower uterine segment
- resolution of placenta previa
- IVF (in Vitro Fertilization) - tocolytics given
- egg is already fertilized Types
- complete - partial
- salpingostomy – di tinatahi for healing/repairing - marginal - low lying
- salpingectomy – tinatahi *Deliver the baby is the mother has severe
bleeding regardless of gestation

* If the mother has minimal bleeding but the

baby is premature promote bed rest
 * If the mother has minimal bleeding but the
baby is full term, deliver the baby

2. Abruptio Placenta (Normal implantation)

- happens in endometrium
- prone to hypovolemic shock
- covert (concealed, dark red bleeding), middle
is detached
- overt (bright red bleeding) sides are detached
- tocolytics given
- uterine apoplexy (Couvelaire)
- blood in myometrium (thick middle
muscular layer of the uterus wall
responsible for the movements of the
uterus during childbirth. Its main
function is to induce uterine
contractions to help during labor and
delivery)
- purple uterus
- ischemia (blood flow (and thus
oxygen) is restricted or reduced in a
part of the body)