LOGO Bleeding in the second half pregnancy Facilitator

LOGO Bleeding in the second half pregnancy Facilitator: Pawin Puapornpong

Cause Obstetric causes 1. 2. 3. 4. 5. 6. 7. Placenta previa Abruptio placentae Rupture of the uterus ������ vasa previa ����� marginal sinus Excessive bloody show Placenta circumvallate Non-obstetrics causes 1. 2. 3. 4. 5. 6. 7. Polyp ���� eversion ������ Vaginitis or cervicitis �������������� �������������

2. ������ n n n Vital signs: ������������ Sign of shock: restlessness, perfusion ������ Anemia, petechial, ecchymosis ������������ HEENT : pale conjunctiva, anicteric sclera Abdomen : soft, tendet, hepatosplenomegaly, mass

. 2������ Abdomen: - �������� - Leopold maneuver - ������� uterine contraction: Duration, Interval, Intensity, tone ������ n FHR Monitoring : NST, CST n Vagina examination ���� ultrasound ������ presenta previa n

3. �������� n n n n Complete blood count(CBC) Grouping and matching for whole blood/PRC Prothrombin time(PT), Partial thromboplastin time(PTT) Fibrinogen , D-dimer Venous clotting time BUN/Cr Electrolytes

Differential diagnosis n Analysis from history, physical examination and investigation

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