Hemorrhage of the third quarters

The genital hemorrhages of the third quarters of Grossesse represent an event little running (5% of the pregnancies) and potentially severe: they constitute a maternal vital risk and fetal. In a close past, they were responsible for important a Mortalité (women “died in layers”). The objective of their assumption of responsibility rests on three main roads:

To determine the gravity of the situation and the vital risk
To seek the cause of the bleeding
To treat the bleeding (see in the specific chapters, by cause of hemorrhage)

Causes

By order of frequency:

Hématome rétroplacentaire
Placenta praevia
marginal Hématome décidual
Hemorrhage of Benckiser
uterine Rupture

Action to be taken in urgency

First gestures

Station of two peripheral venous ways
Perfusion of crystalloids
Taken vital constants
urgent biological Assessment: NFS, Blood group, Group Rhesus, coagulation, SPOKE
Order of globular bases (hematomas) of the same blood group Iso-rhesus
measurements of Reanimation if need be (shock, disorders of the Conscience, respiratory Insufficiency)

With the interrogation

Previous medical, surgical, Obstetric S, term of the Pregnancy, followed pregnancy (in particular echographic), concept of arterial Hypertension, anomaly of coagulation,
Blood group and rhesus of the patient, if it has a chart,
Évaluer the blood loss, while keeping in mind which the volume of exteriorized blood is often much lower than lost blood,
Mode of beginning of the bleeding, circumstances of beginning (spontaneous or caused)

With the examination

Mother: Pouls, blood Pressure (search for a Choc hypovolemic), saturation in Oxygène, palpation of the abdomen, Examination vaginal careful after echography eliminated a placenta praevia (and against formal indication of the TV in the contrary case)
Fœtus: measure fetal cardiac rhythm by external cardiotocometer, echography (with the research of the cause of the bleeding, and evaluation of the good fetal being by the Score of Manning).

At the end of this assessment, one must be able to specify the etiology of the métrorragies and their repercussion on the mother and the fetus. The assumption of responsibility of these various causes is detailed in the corresponding chapters.

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