1) Placental abruption:
The patient presents with severe abdominal pain with (revealed PA) or without (concealed PA) vaginal hemorrhage. The uterus is typically HYPERTONIC. Do an US. usually think about DIC and Hemorrhagic shock as complications. risk factors include: maternal hypertension, cocaine abuse, trauma, folate deficiency, short cord, sudden amnios decompression. If the mother and fetus are stable and fetus is at term, deliver immediately usually C.section. If not, stabilize the patient, if not stabilized, terminate.
2) Uterine rupture:
The patient presents with severe abdominal pain after which she feels reliefed. The most important risks are trauma and vertical uterine scar. The patients feels giving way. The fetal parts can no longer be felt. vaginal hemorrhage may be present. The treatment is according the patient's need for further fertility. If she doesn't seek fertility, TAH is indicated. If she needs to preserve her uterus, surgical repair is the treatment of choice.
3) Ectopic pregnancy:
The patients has abdominal pain, hemorrhage, amenorrhoea, adnexal mass, BhCH fail to double after 24 hr, do a TVUS and BhCG.
Patient is unstable: laparotomy.
Stable and no containdication for methotrexate (see later), give IM methotrexate.
Stable and there are contraindication for mthx: laparoscopic procedures involving the tube
Indication for methotrexate use:
nonviable nonruptured sac <>
contraindication for methotrexate use:
viable ruptured bleeding sac > 3cm, B-hCG >3000.
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