tailieunhanh - Phương pháp điều trị sản khoa - Tình huống số 5

Tham khảo tài liệu 'phương pháp điều trị sản khoa - tình huống số 5', y tế - sức khoẻ, y dược phục vụ nhu cầu học tập, nghiên cứu và làm việc hiệu quả | CASE 14 A 30-ycar-old 15 P4 woman at 32 weeks gestation complains of significant bright red vaginal bleeding. She denies uterine contractions leakage of fluid or trauma. The patient states that 4 weeks previously after she had engaged in sexual intercourse she experienced some vaginal spotting. On examination her blood pressure is 110 60 and HR is so min. Temperature is 99 F. The heart and lung examinations are normal. The abdomen is soft and uterus nontender. Fetal heart tones arc in the range of 140 to 150 bpm. What is your next step What is most likely diagnosis What will be the long-term management of this patient 12 8 s I Illis. OBSTETRICS AND i Y N I co I oil Y ANSWERS TO CASE 14 Placenta Previa SuniiiKirv A 30-year-old Ĩ5 P4 woman at 32 weeks gestation complains of painless vaginal bleeding. Pour weeks previously she experienced some postcoital vaginal spotting. The abdomen is soft and uterus nontender. I etal heart tones arc in the range of 140 to 150 bpm. Next step Ultrasound examination. Most likely diagnosis Placenta previa. Long-term management of this patient Expectant management as long as the bleeding is not excessive. Cesarean delivery at 36 to 37 weeks gestation. Analysis Objectives 1. Know the differential diagnosis of antepartum bleeding. 2. Understand that painless vaginal bleeding is consistent with placenta previa. 3. Understand that the ultrasound examination is a good method for assessing placental location. Considerations The patient experiences antepartum vaginal bleeding bleeding after 20 weeks gestation . Because of the painless nature of the bleeding and lack of risk factors for placental abruption this case is more likely to be placenta previa defined as the placenta overlying the internal OS of the cervix. Placenta abruption premature separation of the placenta usually is associated with painful uterine contractions or excess uterine lone rhe history of postcoital spotting earlier during the pregnancy is consistent with previa since .