473:. Only when the site of detachment occurs on the side facing the cervical opening can the total amount of haemorrhaging be measured by vaginal bleeding. Using vaginal bleeding as a measurement of the severity of the placental abruption is therefore ineffective. The scale of haemorrhaging depends on the degree to which the placenta has separated from the uterine wall. In the case of partial placental separation, haemorrhaging can be minor. However, in the case of total placental separation haemorrhaging will be major and emergency delivery will typically be the course of action. Placental abruption causes blood loss from the mother and loss of oxygen and nutrients to the placenta occasionally leading to
149:
1996:
441:. Placenta percreta results in the most intense haemorrhaging that can be expected caused by abnormal placentation. In the event of placental detachment from the uterine wall, the depth of chorionic villi attachment dictates the amount of haemorrhaging that can be expected. The chance of abnormal placentation increases in subsequent pregnancies, if there is scar tissue present from previous pregnancies. For example, previously undergoing a
22:
350:
trimester of pregnancy, thinning of the lower uterine segment or contractions caused by cervical dilation can increase the amount of stress placed on the placental attachment to the uterine wall. In patients with placenta praevia, these stresses can cause detachment of the placenta from the uterine wall causing haemorrhaging. To prevent further haemorrhaging patients with major placental praevia are recommended to have a
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349:
Types 1 and 2 are classified as minor placental praevia as these typically result in minor antepartum haemorrhaging. Types 3 and 4 are referred to as major placental praevia due to the risk of heavy haemorrhaging in the case of a rupture due to the location of placental attachment. During the third
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exposing some columnar glandular cells on the external cervical orifice. Unlike stratified squamous epithelial cells, glandular cells are columnar and not used to external stresses such as abrasion. The translocation of these cells causes bleeding and mucus secretion. Cervical ectropion can be
585:
When a placenta has multiple lobes which are distal and not of equal size this is referred to as a succenturiate placenta. Distal lobes are connected by a placental artery and vein extending from the main placenta, which tends to be centrally located and is the largest in mass. At the time of
739:
Estimates of the frequency of endometriosis in women range between 6-15% across several sources. In a 30-year reproductive and pregnancy outcome study of 14,000+ women, those with endometriosis had a significantly increased risk of antepartum haemorrhage during pregnancy.
460:
occurs when the placenta detaches from the endometrium. Detachment causes antepartum haemorrhaging at the location of abruption. Depending on the site of detachment, haemorrhaging may or may not be apparent. If abruption occurs behind the
1098:
Ruiter, L., Kok, N., Limpens, J., Derks, J., de Graaf, I., Mol, B. and Pajkrt, E. (2015). Incidence of and risk indicators for vasa praevia: a systematic review. BJOG: An
International Journal of Obstetrics & Gynaecology, 123(8),
567:. Bilobing of the placenta can be caused by placental implantation occurring over areas of uterine fibroid scarring, previous surgery, decreased blood supply or implantation occurring over the internal cervical orifice. Chances of
558:
A bilobed placenta has a cleavage in the middle dividing it into two lobes with membranous vessels branching in between. The exposed connecting membranous vessels present risk of rupturing due to limited protection from
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or delivery the connecting placental arteries and veins may rupture resulting in significant haemorrhaging. Incidences of vasa previa and haemorrhaging in the presence of a succenturiate placenta are highly increased.
516:
of the placenta. In the event of foetal vessel rupture, antepartum haemorrhaging occurs however blood is lost from the foetal blood supply. If the foetus is developed enough caesarean sections are often recommended.
504:. Vasa praevia is a very rare, presenting only 4:10,000 cases from the largest study of the condition. Risks of antepartum bleeding due to vasa praevia greatly increase during the third trimester of pregnancy during
1304:
1250:
1235:
544:. This is to compensate for an undersized chorionic plate resulting in a decreased nutritional supply to the foetus. Thickening of the placental edge due to a circumvallate placenta can lead to
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Royal
College of Obstetricians & Gynaecologists. (2018). Placenta Praevia, Placenta Praevia Accreta and Vasa Praevia: Diagnosis and Management (Green-top Guideline No. 27). Available at:
932:
Love, C. and
Wallace, E. (1996). Pregnancies complicated by placenta praevia: what is appropriate management?. BJOG: An International Journal of Obstetrics and Gynaecology, 103(9), pp.864-867.
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287:. Intermittent antepartum haemorrhaging occurs in 72% of women living with placenta praevia. The severity of a patient's placenta praevia depends on the location of placental attachment;
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Nielsen, T., Hagberg, H. and
Ljungblad, U. (1989). Placenta previa and Antepartum Hemorrhage after Previous Cesarean Section. Gynecologic and Obstetric Investigation, 27(2), pp.88-90.
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The total amount of blood loss and signs of circulatory shock due to blood determine the severity of the antepartum haemorrhaging. There are 4 degrees of antepartum haemorrhaging:
1290:
2001:
881:
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Suzuki, S. and
Igarashi, M. (2007). Clinical significance of pregnancies with succenturiate lobes of placenta. Archives of Gynecology and Obstetrics, 277(4), pp.299-301.
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Hermann, Z. (1963). Circumvallate
Placenta, a Cause of Antepartum Bleeding, Premature Delivery, and Perinatal Mortality. Obstetrics & Gynecology, 22(6), pp.798-802.
1154:
837:
Lam CM, Wong SF, Chow KM, Ho LC (2000). "Women with placenta praevia and antepartum haemorrhage have a worse outcome than those who do not bleed before delivery".
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attributed to rises in oestrogen levels during foetal development. Antepartum haemorrhage caused by cervical ectropion can be expected and is typically harmless.
1012:
Smith, Z., Sehgal, S., Van
Arsdalen, K. and Goldstein, I. (2014). Placenta Percreta With Invasion into the Urinary Bladder. Urology Case Reports, 2(1), pp.31-32.
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1080:
TIKKANEN, M. (2010). Placental abruption: epidemiology, risk factors and consequences. Acta
Obstetricia et Gynecologica Scandinavica, 90(2), pp.140-149.
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increase in the presence of a bilobed placenta due to decreased surface area for attachment to the uterine wall and the exposure of membranous vessels.
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or other infections are all irritants to the vaginal and cervical lining, causing bleeding from those surfaces where the infection is severe.
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cells on the developing blastocyst form an abnormally deep attachment to the uterine wall, this is known as abnormal placentation. Abnormal
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The presence of severe vaginal infections at the time of pregnancy may cause minor antepartum haemorrhaging. For example, the presence of
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the epithelial transitional zone (also called the squamo-columnar junction) migrates from the endocervical canal towards the
882:"Meta-analysis on the effect of aspirin use for prevention of preeclampsia on placental abruption and antepartum hemorrhage"
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2028:
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512:. Vessel rupture is very likely in the event of a membranous rupture as foetal blood vessels aren't protected by the
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can categorised into 3 types, depending on the depth of infiltration of the chorionic villi into the uterine wall:
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increases the likelihood of abnormal placentation, therefore increasing the chances of antepartum haemorrhaging.
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may cause lesions in the cervix leading to minor haemorrhaging or spotting. Abrasion or slight trauma caused by
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677:. The amount of bleeding in these areas are typically limited to spotting or minor antepartum haemorrhaging.
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Antepartum
Haemorrhage. (2015). Perth, Western Australia: Department of Health Western Australia, pp.3-6.
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In regard to treatment, it should be considered a medical emergency (regardless of whether there is
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Cervical ectropion (cervical erosion). (2015). Guy's and St Rhomas' NHS Foundation Trust, pp.1-2.
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Derbala, Y., Grochal, F. and Jeanty, P. (2007). Vasa
Praevia. Journal of Prenatal Medicine.
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Silver, R. (2015). Abnormal Placentation. Obstetrics & Gynecology, 126(3), pp.654-668.
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1191:"ESHRE2015: Endometriosis associated with a greater risk of complications in pregnancy"
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refers to when the placenta of a growing foetus is attached abnormally low within the
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Antepartum haemorrhage or bleeding in the second half of pregnancy. (2013). p.11.
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Antepartum haemorrhage or bleeding in the second half of pregnancy. (2013). p.14.
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485:, however it is not uncommon for the cause of placental abruption to be unknown.
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can often be mistaken for antepartum haemorrhaging and are typically harmless.
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can cause minor antepartum haemorrhaging. Non genital tract bleeding caused by
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During pregnancy the layer of endometrium that attaches directly to developing
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https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg27/
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Most cases of Antepartum haemorrhaging originate from within the
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Rathburn, K. and Hildebrand, J. (2017). Placenta, Abnormalities.
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may also cause spotting from the cervix. Vaginal bleeding from
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wraps twice around, over the foetal side around the edge of the
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Greater than 1000mL with or without signs of circulatory shock
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Touching but not covering the internal orifice of the cervix
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It can be associated with reduced fetal birth weight. Use of
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Pruritic urticarial papules and plaques of pregnancy (PUPPP)
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the epithelia is columnar glandular which transitions into
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also appears effective at preventing antepartum bleeding.
1155:"Antepartum haemorrhage - Patient Information Brochures"
1197:. European Society of Human Reproduction and Embryology
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Completely covering the internal orifice of the cervix
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The Royal Women's Hospital > antepartum haemorrhage
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Partially covering the internal orifice of the cervix
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Antepartum haemorrhage (APH), prepartum haemorrhage
46:. Unsourced material may be challenged and removed.
880:Roberge, S; Bujold, E; Nicolaides, KH (May 2018).
705:also attribute to minor haemorrhaging. Similarly,
423:Invading past the myometrium into the perimetrium
1898:Childbirth-related post-traumatic stress disorder
500:running along the placenta and over the internal
2015:
403:Attached to outermost portion of the myometrium
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889:American Journal of Obstetrics and Gynecology
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477:. Other causes of placental abruption can be
254:50-1000mL without signs of circulatory shock
199:), as if it is left untreated it can lead to
1056:Services, Department of Health & Human.
955:Services, Department of Health & Human.
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469:, blood will pool and form a retroplacental
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106:Learn how and when to remove this message
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234:Stains, streaking, or spotting of blood
188:before 16 weeks of pregnancy to prevent
981:"Placenta and Extraembryonic Membranes"
665:Cervical canal and distal genital tract
595:Fetal blood (can be distinguished with
374:. In the absence of a decidua basalis,
2016:
636:and external cervical orifice. During
496:is the presence of unprotected foetal
465:where blood cannot escape through the
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1536:Intrahepatic cholestasis of pregnancy
1503:Intrahepatic cholestasis of pregnancy
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839:Journal of Obstetrics and Gynaecology
1602:Pregnancy-induced hypercoagulability
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954:
580:Multilobed or Succenturiate Placenta
548:, causing antepartum haemorrhaging.
366:becomes the maternal portion of the
44:adding citations to reliable sources
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13:
1551:Pruritic folliculitis of pregnancy
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1809:Pain management during childbirth
1736:Twin-to-twin transfusion syndrome
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296:Location of Placental Attachment
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1981:Sexual activity during pregnancy
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433:have grow entirely through the
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1036:American Pregnancy Association
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1:
1685:Prelabor rupture of membranes
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173:, is genital bleeding during
1964:Systemic lupus erythematosus
1615:Maternal care related to the
1597:Gestational thrombocytopenia
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689:, clinical examinations and
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1765:Cephalopelvic disproportion
1062:www.betterhealth.vic.gov.au
961:www.betterhealth.vic.gov.au
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481:or sudden decompression of
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2029:Health issues in pregnancy
1876:Breastfeeding difficulties
1675:Constriction ring syndrome
1649:Braxton Hicks contractions
902:10.1016/j.ajog.2017.12.238
763:inflammatory bowel disease
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429:In placenta percreta, the
391:Depth of Chorionic Villus
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1913:Peripartum cardiomyopathy
1903:Pubic symphysis diastasis
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1439:Gestational hypertension
1189:Saraswat, Lucky (2015).
795:"Antepartum haemorrhage"
521:Abnormal placental shape
413:Invading the myometrium
1838:Umbilical cord prolapse
1760:Amniotic fluid embolism
1518:dermatoses of pregnancy
775:Obstetrical haemorrhage
713:or inflammation in the
681:, dysplasia, polyps or
310:, no attachment to the
1954:Concomitant conditions
1933:Postpartum thyroiditis
1711:Circumvallate placenta
1531:Impetigo herpetiformis
1526:Gestational pemphigoid
1498:Hyperemesis gravidarum
1431:hypertensive disorders
851:10.1080/01443610063417
749:Differential diagnosis
534:circumvallate placenta
527:Circumvallate placenta
163:antepartum haemorrhage
2024:Obstetric haemorrhage
1923:Postpartum infections
1918:Postpartum depression
1058:"Placental abruption"
1032:"Placental Abruption"
613:There are 2 types of
358:Abnormal placentation
224:Amount of Blood Loss
55:"Antepartum bleeding"
1928:Postpartum psychosis
1797:Obstetrical bleeding
1692:Obstetrical bleeding
1513:Integumentary system
1488:Gestational diabetes
1467:related to pregnancy
1465:Other, predominantly
437:and invade into the
370:, also known as the
177:after the 28th week
171:prepartum hemorrhage
40:improve this article
1908:Postpartum bleeding
1731:Placental abruption
1716:Monochorionic twins
1546:Prurigo gestationis
1161:on 30 December 2017
630:stratified squamous
620:present within the
573:placental abruption
546:placental abruption
536:refers to when the
458:Placental abruption
453:Placental abruption
260:Massive Haemorrhage
159:Antepartum bleeding
124:Antepartum bleeding
1938:Puerperal mastitis
1893:Breast engorgement
1680:Monoamniotic twins
1670:Chorionic hematoma
957:"Placenta praevia"
823:2010-01-08 at the
683:cervical carcinoma
679:Cervical ectropion
638:cervical ectropion
609:Cervical ectropion
2011:
2010:
1969:Thyroid disorders
1959:Diabetes mellitus
1843:Uterine inversion
1775:Shoulder dystocia
1770:Obstructed labour
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1610:
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1579:Chorea gravidarum
1355:Ectopic pregnancy
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1195:endometriosis.org
985:www.med.umich.edu
649:Vaginal infection
506:cervical dilation
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419:Placenta Percreta
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306:Lower segment of
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250:Major Haemorrhage
240:Minor Haemorrhage
203:of the mother or
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118:Medical condition
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1833:Postmature birth
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1726:Placenta praevia
1721:Placenta accreta
1665:Chorioamnionitis
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510:placenta praevia
502:cervical opening
479:abdominal trauma
409:Placenta Increta
398:Placenta Accreta
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276:Placenta praevia
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1881:Low milk supply
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1848:Uterine rupture
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895:(5): 483–489.
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733:Main article:
671:cervical canal
622:cervical canal
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514:umbilical cord
490:
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475:preterm labour
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1858:Uterine atony
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1444:Pre-eclampsia
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1313:Pathology of
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57: –
56:
52:
51:Find sources:
45:
41:
35:
34:
29:This article
27:
23:
18:
17:
2000:
1993:
1853:Vasa praevia
1813:
1787:Locked twins
1703:
1696:
1653:
1629:
1375:Interstitial
1264:
1249:
1234:
1199:. Retrieved
1194:
1184:
1175:
1163:. Retrieved
1159:the original
1149:
1140:
1131:
1122:
1113:
1104:
1094:
1085:
1076:
1065:. Retrieved
1061:
1051:
1040:. Retrieved
1038:. 2017-04-27
1035:
1026:
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1008:
999:
988:. Retrieved
984:
975:
964:. Retrieved
960:
950:
937:
928:
919:
892:
888:
875:
845:(1): 27–31.
842:
838:
832:
813:
802:. Retrieved
799:patient.info
798:
789:
759:haemorrhoids
738:
728:
727:
723:haemorrhoids
707:varicosities
668:
664:
663:
652:
648:
647:
632:towards the
612:
608:
607:
604:Minor causes
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557:
552:
531:
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494:Vasa praevia
492:
489:Vasa praevia
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380:placentation
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179:of pregnancy
170:
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158:
157:
102:
93:
83:
76:
69:
62:
50:
38:Please help
33:verification
30:
1792:Nuchal cord
1541:Linea nigra
1493:Hepatitis E
1426:proteinuria
1407:Miscarriage
1392:Embryo loss
1370:Heterotopic
1201:14 February
687:intercourse
588:contraction
569:vasa previa
439:perimetrium
376:trophoblast
129:Other names
2018:Categories
1802:Postpartum
1697:Antepartum
1412:Stillbirth
1323:puerperium
1321:, and the
1319:childbirth
1266:DiseasesDB
1067:2024-08-29
1042:2024-08-29
990:2024-08-29
966:2024-08-29
804:2024-08-29
781:References
719:haematuria
659:cervicitis
657:, thrush,
642:ectocervix
634:ectocervix
626:endocervix
615:epithelial
561:thrombosis
435:myometrium
364:blastocyst
354:delivery.
143:Obstetrics
66:newspapers
1868:Puerperal
1456:Eclampsia
1360:Abdominal
1331:Pregnancy
1315:pregnancy
1165:29 August
867:218855273
744:Diagnosis
699:vaginitis
691:pap smear
655:chlamydia
624:. In the
443:caesarean
352:caesarean
175:pregnancy
138:Specialty
2002:Category
1815:placenta
1705:placenta
1365:Cervical
1350:Abortion
911:29305829
859:15512459
821:Archived
769:See also
755:GI bleed
597:Apt test
542:placenta
463:placenta
368:placenta
230:Spotting
1655:chorion
1380:Ovarian
711:tumours
695:atrophy
186:aspirin
80:scholar
1659:amnion
909:
865:
857:
703:ulcers
701:, and
675:vagina
565:trauma
467:cervix
339:Type 4
329:Type 3
319:Type 2
312:cervix
308:uterus
302:Type 1
285:uterus
271:Causes
145:
82:
75:
68:
61:
53:
1947:Other
1752:Labor
1618:fetus
1589:Blood
1428:, and
1422:Edema
1271:30077
885:(PDF)
863:S2CID
715:vulva
618:cells
221:Stage
201:death
169:) or
87:JSTOR
73:books
1620:and
1255:9-CM
1203:2024
1167:2024
907:PMID
855:PMID
571:and
563:and
471:clot
388:Type
293:Type
205:baby
197:pain
59:news
1260:641
1251:ICD
1245:O46
1236:ICD
897:doi
893:218
847:doi
721:or
673:or
508:or
445:or
167:APH
42:by
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