From the Guidelines
The management of a scant bloody show in the third trimester should prioritize prompt evaluation and monitoring to rule out serious complications, with an initial assessment including vital signs, fetal monitoring, speculum examination, and possibly ultrasound to evaluate placental location and integrity, as recommended by the American College of Radiology 1. The patient should be assessed immediately by a healthcare provider, as this could represent the normal onset of labor or potentially concerning conditions like placental abruption or placenta previa. Key considerations in the management plan include:
- Gestational age
- Amount of bleeding
- Maternal and fetal status Initial steps may involve:
- Laboratory tests including complete blood count, coagulation studies, and blood typing
- Administration of corticosteroids (such as betamethasone 12mg IM, two doses 24 hours apart) to accelerate fetal lung maturity if delivery seems imminent and the patient is preterm 1. It is crucial to determine the underlying cause of the bleeding to guide further management, with close monitoring being essential regardless of the etiology to ensure maternal and fetal wellbeing, and transvaginal US has been shown to be both accurate and safe for the diagnosis of placenta previa 1.
From the Research
Management Plan for Scant Bloody Show in the 3rd Trimester
The management plan for a scant bloody show in the 3rd trimester involves prompt evaluation and treatment to prevent maternal and fetal morbidity and mortality.
- The two most common causes of third-trimester bleeding are placental abruption and placenta previa, which account for about half of all cases 2.
- Expectant management is among the current treatment options for pregnancies complicated by third-trimester bleeding at <36 weeks' gestation, and the use of tocolytic agents to stop associated contractions may be considered 3.
- Ultrasound can aid in creating a treatment plan by assessing the type of polyp and source of symptomatology, and can help localize the source of symptomatology to polyps versus placental pathology 4.
Diagnostic Approaches
- Transvaginal ultrasonography (TVUS) should be the imaging modality of choice for the detection of endometrial polyps in women of fertile age 5.
- Colposcopy may be used to evaluate vaginal bleeding of undetermined obstetric origin during pregnancy, and can diagnose the origin of bleeding in some cases 6.
- Dilation and Curettage (D&C) should be avoided for the diagnosis and management of polyps, and in-office hysteroscopy has the highest diagnostic accuracy in infertile patients with suspected endometrial polyps 5.
Treatment Options
- Hysteroscopic polypectomy is feasible and safe with negligible risk of intrauterine adhesion formation, and does not compromise reproductive outcomes from subsequent IVF procedures 5.
- Polypectomy does not appear to have any increased morbidity or mortality associated with its use in a controlled tertiary setting 3.
- The removal of asymptomatic polyps in premenopausal women should be considered in patients with risk factors for endometrial cancer 5.