Summary
Definition
History and exam
Key diagnostic factors
- sangramento vaginal
- dor abdominal
- contrações uterinas
- sensibilidade uterina
Other diagnostic factors
- lombalgia
- óbito fetal
Risk factors
- hipertensão crônica
- pré-eclâmpsia
- tabagismo
- uso de cocaína
- trauma
- parto cesáreo prévio
- ruptura prematura das membranas fetais pré-termo
- multiparidade
- idade materna avançada
- polidrâmnio
- corioamnionite
- malformações uterinas
- descolamento da placenta prévio
- gestações multifetais
- oligoidrâmnios
- leiomiomas uterinos
- trombofilias
Diagnostic investigations
1st investigations to order
- monitorização fetal
- Hb e hematócrito
- exames de coagulação
- teste de Kleihauer-Betke (K-B)
- ultrassonografia
Investigations to consider
- patologia placentária
Treatment algorithm
todos os pacientes
feto vivo: >34 semanas
feto vivo: ≤34 semanas
morte fetal
Contributors
Authors
Yinka Oyelese, MD, FACOG

Director, Obstetric Imaging
Beth Israel Deaconess Medical Center
Harvard Medical School
Boston
MA
Disclosures
YO is an author of a number of references cited in this topic.
Anthony M. Vintzileos, MD, FACOG

Chairman
Department of Obstetrics and Gynecology
Winthrop University Hospital
Mineola
Professor
Obstetrics, Gynecology, and Reproductive Medicine
Stony Brook School of Medicine
Stony Brook
NY
Disclosures
AMV declares that he has no competing interests.
Peer reviewers
Christopher Glantz, MD, MPH
Professor of Obstetrics and Gynecology
University of Rochester School of Medicine
Rochester
New York
NY
Disclosures
CG declares that he has no competing interests.
Austin Ugwumadu, PhD, FRCOG
Consultant/Senior Lecturer in Obstetrics and Gynaecology
St George's Hospital
London
UK
Disclosures
AU declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
American College of Radiology. ACR appropriateness criteria: second and third trimester bleeding. 2020 [internet publication].Full text
Society for Maternal-Fetal Medicine (SMFM), Gyamfi-Bannerman C. Society for Maternal-Fetal Medicine (SMFM) Consult Series #44: Management of bleeding in the late preterm period. Am J Obstet Gynecol. 2018 Jan;218(1):B2-8.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Trabalho de parto pré-termo
- Placenta prévia
- Corioamnionite
More DifferentialsGuidelines
- Intrapartum care
- ACR appropriateness criteria: second and third trimester vaginal bleeding
More GuidelinesPatient information
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