Supervisors info:
Παπαντωνίου Νικόλαος, Ομότιμος Καθηγητής ,Ιατρική, ΕΚΠΑ
Κασσάνος Δημήτριος, Ομότιμος Καθηγητής, Ιατρική, ΕΚΠΑ
Χρέλιας Χαράλαμπος, Αναπληρωτής Καθηγητής, Ιατρική, ΕΚΠΑ
Summary:
Introduction
The present postgraduate thesis focuses on third trimester bleeding in pregnancy, reviewing the current relevant literature. However, the topic is introduced by referring to the fetilization process, the implantation process due to the subsequent invasion and migration of fetal trophoblastcells into the maternal decidua, and finally the placental anatomy and development.
Material and Methods
The goal of this research project is to provide valuable up-to-date information to gynecologists-obstetricians, midwives, and other medical subspecialties, so as to successfully deal with a medical emergency regarding third trimester bleeding.
Results
Third trimester bleeding is a cause for concern for obstetricians,due to its strong association with increased maternal as well as perinatal morbidity and mortality.Placental implantation abnormalities account for the majority of cases of third trimester bleeding.These are referred to as placenta praevia,which is divided into four grades:Grade I(low lying placenta),Grade II(marginal praevia),Grade III(partial praevia) and Grade IV (complete praevia).Another leading cause of third trimester bleeding is placental abruption,which is defined as the premature seperation of the placenta from the uterus.It is classified into two types:Marginal and Central. Other causes of minor importance, are vasa previa, uterine rupture, parturition (cervical dilation), cervical polyps, vaginitis,as well as malignant tumors of the female reproductive system.These hemorrhages are rare,minor,and easily managed.
Conclusions
To summerise, third trimester bleeding is an emergency requiring early rapid ultrasound, close monitoring and hospital admission. Ultrasound may mislead the practitioner due to the high prevalence of false negative results.Thus it is critically important,one recognises the early signs of hypovolemic shock due to blood loss, so as to quickly intervene,minimizing the risk for serious cοmplications.
Furthermore,it is vital that obstetricians,as well as gynecologists,undergo continuous training and are kept up to date regarding new developments in ultrasound technology.Early detection of abnormal placental implantation is critical,due to the serious consequences of misdiagnosis.This in turn will result in effective management, beneficious to both the mother and her fetus.
Keywords:
Bleeding in pregnancy, Placenta previa, Placental abruption, Vasa previa Rupture uterus
