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Management of Severe Painless Vaginal Bleeding in a 33-Week Pregnant Woman: A Case Study

A 32-year-old woman, 33 weeks pregnant, experienced severe painless vaginal bleeding during sleep, which resolved spontaneously after 15 minutes. Her current vitals are concerning, with blood pressure at 90/60 mmHg and pulse at 98 bpm. This case highlights the potential risk of placenta previa and the necessary steps for diagnosis and management. Key considerations include ultrasound examination, monitoring maternal and fetal conditions, and deciding between cesarean section or vaginal delivery based on bleeding severity and fetal presentation.

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Management of Severe Painless Vaginal Bleeding in a 33-Week Pregnant Woman: A Case Study

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  1. Case A 32 years old woman,now pregnancy for 33 weeks.Last night during sleeping she suffered from severe painlessvaginal bleeding without any cause ,and the blee- ding stopped spontaneously 15 minutes later.Now the patient’s Bp is 90/60mmHg, P is 98 bpm.

  2. Questions • What is the possible disease the patient suffered from? • What accessory examination should be done? • How to manage the patient and what is the treating principle for this disease?

  3. Key words placenta previa 前置胎盘 fetal presentation 胎先露 Trophoblastic 滋养叶的 succenturiate placenta 副胎盘 Engagement 衔接 placental murmur 胎盘血管鸣 Postpartum 产后 Anticipating therapy 期待疗法 cesarean section 剖宫产 vaginal delivery 阴式分娩 Placenta abruption 胎盘早剥

  4. Placenta previa 前置胎盘

  5. Contents of the lecture • Definition • Etiology ★ Classification ★Clinical manifestation • Diagnosis ★Management

  6. Definition If the placenta is attached to the low segment of uterus,its low edge reaches or covers the internal OS of cervix and is below the fetal presentation,it is called placenta previa.

  7. Etiology Ⅰ. Trophoblastic development retardation Ⅱ. Over large placenta Ⅲ. Endometrial lesion and damage Ⅳ. Abnormal placenta:such as succenturiate placenta

  8. 1 2 6

  9. Classification • complete placenta previa • partial placenta previa • marginal placenta previa

  10. Complete placenta previa

  11. Partial placenta previa

  12. Marginal placenta previa

  13. Clinical manifestation • Symptoms • signs

  14. Symptoms vaginal bleeding: Painless recurrent without any cause

  15. signs • General condition :Anemia shock • Abdominal examination : uterine size engagement of fetal presentation placental murmur

  16. uterine size

  17. engagement of fetal presentation

  18. Diagnosis • Symptoms • Body signs • Vaginal examination • Ultrasound examination • Postpartum examination of placenta and fetal membrane

  19. Vaginal examination

  20. Ultrasound examination

  21. rupture

  22. Management • Anticipating therapy • Termination of pregnancy 1.the indication of the termination of pregnancy 2.cesarean section 3.vaginal delivery

  23. cesarean section

  24. vaginal delivery

  25. Summary of the lecture • Definition • Etiology • ★ Classification • ★ Clinical manifestation • Diagnosis • ★ Management

  26. Next lecture… • Differentiation diagnosis • Placenta abruption

  27. Case A 32 years old woman,now pregnancy for 33 weeks.Last night during sleeping she suffered from severe painlessvaginal bleeding without any cause ,and the blee- ding stopped spontaneously 15 minutes later.Now the patient’s Bp is 90/60mmHg, P is 98 bpm.

  28. Questions • What is the possible disease the patient suffered from? • How to manage the patient and what is the treating principle for this disease? • How to manage the patient and what is the treating principle for this disease?

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