Early pregnancy bleeding Flashcards
What are some of the causes of APH?
- Placenta praevia
- Placental abruption
- Unclassified
- — Trauma
- — Cervicitis
- — vulval/vaginal varicosities
- — genital tumours
- — genital infections
- — Haematuria
- — Vasa praevia
What information do you gather when someone presents with antenatal bleeding?
- Get vitals
- History (recent sex, cancer, infections, clotting disorder)
- Ask how much loss and ask for them to take a photo or show a pad.
- Ask if they know the difference between a show and bleeding
What is placenta praevia?
When the placenta grows over the OS. Bleeding from separation can be life threatening.
What are the classifications of PP?
Type I - placenta mainly in upper segment but encroaches on lower segment.
Type II - Placenta reaches to, but does not cover internal OS.
Type III - Placenta located over internal OS but not centrally.
Type IV - Placenta completely covers OS.
Do all PP have to have caecareans?
Not necessarily, only type III and IV must.
What are the risk factors for PP?
- multiparity
- multiple pregnancy
- age
- scarred uterus
- hx of myomectomy
- smoking
- placental abnormality
- associated conditions (Placenta accreta and IUGR)
What is placenta accreta?
A rare condition where the placenta embeds into the 2nd and maybe 3rd layer of the uterus. Requires manual removal.
What are the S&S of PP?
- painless recurrent vaginal bleeding
- malpresentation of fetus
- non-engagement of presenting part
- difficulty palpating fetal parts
- loud maternal pulse below umbilicus (if placenta is anterior)
- bleeding around 24-28 weeks
- Severe haemorrhage occurs mostly around 34 weeks.
Why can bleeding occur with PP?
- lower segment completing development
- Increase in BH
- Cervical effacement
- Detachment of placenta due to:
- —— being unable to adapt to uterine changes.
- —— blood escapes easily as the placenta is in the lower segment.
- —— recurrent episodes indicate further placenta detachment.
- Fetal bleeding may occur if placenta tears
- There is a likelihood of torrential bleeding
What is the conservative management for slight bleeding <38 weeks?
- admission
- Speculum examination
- USS to locate placenta
- Placental function tests
- Monitor fetal growth
- NO VE
- if settles send home
What is the conservative management for bleeding at birth?
- vaginal birth if the placenta site is known and bleeding is not severe.
- If placenta unclear: prepare for C/S, IV therapy and cross match blood (group and hold).
- Risk of PPH as LUS may not contract effectively because of where placenta is attached.
What is the active management of AN bleeding?
- Gather hx.
- Gentle abdominal palp
- IVT/Transfusion
- OBS - FHR every 15mins, vitals every 15mins while bleeding.
- Take bloods - cross match, Fetal-maternal Haemorrhage test.
- Woman RIB until bleeding stops.
- strict FBC.
What is the active management when PP has been diagnosed?
- Remain in hospital until baby’s delivery
- Elective C/S or vaginal birth
- full fetal assessment
- management of Rh - women
- Corticosteroids if <34 weeks
- paediatric consultation
What is the active management of severe blood loss?
- admission
- resuscitation
- frequent observations (pulse, BP, vaginal loss, FHR)
- Blood loss (total loss, colour, consistency)
- uterine activity
What does resuscitation involve for active management of sever blood loss?
- IV access 16g
- Blood taken (FBE, Group and cross match, coagulation studies, FMH test for Rh-)
- fluid/blood replacement
- 02 therapy
- IDC
- maternal monitoring (vital signs, blood loss)
- Prepare for urgent birth
