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10-19-2013, 03:27 AM
The clinical approach depends on the clinical situation. For example:

1-A 3rd trimester patient who is actively hemorrhaging bright red blood should go directly to the operating room for a cesarean section to deliver her from the placental abruption or placenta previa. While en route to the OR, call for blood transfusions and labs to determine coagulopathy.
2-A patient at term with regular contractions and a small amount of bloody mucous can be examined vaginally after confirming (through ultrasound or clinical exam of the abdomen) that there is no placenta previa.
3-Patients with bright red vaginal bleeding that is less than hemorrhage should be carefully evaluated prior to performing a pelvic exam. Ultrasound can be helpful in locating the placenta and looking for retroplacental blood clot. 4-Laboratory tests for coagulopathy can be helpful. Hgb is useful, not to determine whether to transfuse or not (that is a clinical, not laboratory decision), but to indicate the margin of safety available to the clinician in caring for this patient. Continuous electronic fetal monitoring is important to determine the degree of tolerance the fetus has for this bleeding and the extent to which uteroplacental circulation has been disrupted. After ruling out a placenta previa, examine the patient with a speculum to determine the source of the bleeding (from the cervical os? from the surface of the cervix? from a laceration of the vaginal wall? etc.)

This video discusses Third Trimester Bleeding:
Topic Covered:

-Vasa Previa
-Placenta Previa
-Abrupto Placenta
-Uterine Rupture

This clip will help you distinguish the difference between 3rd Trimester Bleeding causes in a way where you will never get these questions wrong again.