ectopic/preg comp

• Placenta previa

  Placental tissue expansion over internal os
• Risk factors for placenta previa

  • Previous placenta previa
  • Maternal age
  • Previous c-section
  • Smoking/cocaine
  • Multiple gestation
  • Uterine procedure
  • Abortions
  • Increased parity
  • Male fetus
• Placenta previa treatment

  1. If asymptomatic/stable, monitor

  2. No sex/on pelvic rest

  3. No moderate/strenuous activity

  4. no Prolonged standing

  5. Repeat ultrasound at 32/36 weeks

  6. Schedule C-section
• Acute bleed in placenta previa


  Administer, stabilize, labs, fetal monitor, C-section if active labor, distressing fetal heart sounds, severe/persistent bleed, gestational age
• Stable bleed under 34 weeks

  1. 1-2 episodes= short observation period or continued hospitalization

  2. Want to prolong pregnancy for fetal growth

  3. Antenatal corticosteroids

  4. And all above
• Placental abruption

  Premature separation of placenta from uterine wall, over 20 weeks; rupture of maternal vessels in decidua basalis
• Risk factors for placental abruption

  • Hypertension
  • Abdominal trauma
  • Cocaine
  • Polyhydramnios
  • Preeclampsia
  • Eclampsia
  • Prelabor rupture of membranes
  • Chorioamnionitis
  • Short umbilical cord
  • Previous ischemic placental disease
  • Abortion history
  • Older age
  • Multiparity
  • Smoking while pregnant
  • PPROM
  • Fetal growth restriction
• Diagnosis of placental abruption

  • Subchorionic
  • Retroplacental
  • Preplacental
• Placental abruption treatment

  1. Fetal heart monitor

  2. Hemodynamic stability

  3. 1-2 large bore IVs

  4. Medications (Rhogam, GBS, corticosteroids, magnesium)
• Home if no labor

  No bleed for 48 hours, reassuring fetal heart tones/ultrasound, asymptomatic, antenatal corticosteroids, deliver between 37-38 weeks
• Postpartum care

  1. Oxytocin

  2. Maternal monitoring (vitals, labs, urine output, uterus size/tone)
• Postpartum hemorrhage is defined as over 1000 mL blood loss in the last 24 hours or signs of hypovolemia like weakness
• Postpartum hemorrhage

  OB emergency
• Risk factors for postpartum hemorrhage

  • Previous PPH
  • Previous c-section/uterine surgery
  • Family history
  • Obesity
  • High parity
  • Anemia
  • Uterine overdistention
  • Prolonged labor/induction
  • Intrapartum cesarean
• Etiologies of postpartum hemorrhage

  • Tone
  • Tissue
  • Trauma
  • Thrombin
• Postpartum hemorrhage treatment

  1. Monitor stability

  2. Quantify blood loss

  3. Maybe move to OR

  4. Labs

  5. 2 large bore IVs

  6. Transfusion

  7. PE, looking at uterine tone, retained products

  8. Administer TXA
• Postpartum hemorrhage interventions

  1. Repair lacerations

  2. Uterine massage

  3. Uterotonic medications

  4. Uterine tamponade
• If severe postpartum hemorrhage

  External aortic compression, laparotomy, hysterectomy
• Risk factors for ectopic pregnancy

  • Previous ectopic/tubal surgery
  • Tubal pathology
  • Sterilization
  • IUD
  • In vitro fertilization in current pregnancy
  • COC
  • STI history
  • PID history
  • In utero DES exposure
  • Smoking
  • Pelvic/abdominal surgery
  • Spontaneous abortion history
  • Medically induced abortion
  • Infertility
  • Over 40 years old
  • Vaginal douching
• History symptoms for ectopic pregnancy

  • Early pregnancy bleed
  • Current bleed
  • Abdominal pain
  • Dizziness/lightheadedness
  • Syncopal episode
• Clinical symptoms for ectopic pregnancy


  • Fatigue
  • Fever
  • Chills
  • Chest pain
  • Palpitations
  • Shortness of breath
  • Abdominal pain
  • Nausea/vomiting
  • Bowel changes
  • UTI symptoms
  • Vaginal discharge
  • Dizziness
  • Lightheadedness
  • Syncope
• Ruptured ectopic pregnancy has closed os and persistent urge to defecate
• TVUS ectopic


  Gestational sac + yolk sac or embryo outside uterus
• Most visible when bhCG is 1500-2000, so if over 1500 and no IUP, it's probably ectopic
• Treatment options for ectopic pregnancy


  • Methotrexate
  • Salpingectomy
  • Salpingostomy