Antepartum Haemorrhage Flashcards
What is antepartum haemorrhage?
Antepartum haemorrhage is vaginal bleeding occurring between 24 weeks of pregnancy and birth.
Give differentials for antepartum haemorrhage
Differentials for antepartum haemorrhage include:
- Placental abruption
- Placenta praevia
- Vasa praevia
- Malignancy or trauma of the genital tract
- Infection of the genital tract
- Uterine rupture
- Inherited bleeding disorder
- Gestational trophoblastic disease
- Cervical ectropion
What questions need to be asked in the history of antepartum haemorrhage?
- How much blood is there?
- When did the bleeding start?
- What colour is it? (fresh red, brown, mixed in with mucus?)
- Is there any abdominal pain?
- Could the waters have broken?
- Any trauma? (post-coital)?
- Are the fetal movements normal?
- Risk factors?
Briefly describe the management of antepartum haemorrhage
The first step in management of antepartum haemorrhage is always to assess the haemodynamic status. If haemodynamic compromise is present due to major haemorrhage resuscitation should be commenced. If there is no haemodynamic compromise a thorough clinical history, abdominal examination and speculum examination should be performed.
Note that digital vaginal examination should be avoided if there is a possibility of placenta praevia.
What bloods should be taken during antepartum haemorrhage?
Intravenous access should be obtained and the following bloods should be obtained:
- Group and save, crossmatch
- Full blood count
- Coagulation screen
- Urea and electrolytes
- LFTs
- Kleihauer test should be taken in rhesus negative women to determine the dose of anti-D immunoglobulin required
What imaging is used to assess placenta praevia?
Ultrasound may be required to exclude placenta praevia.
What imaging is used to assess the foetus?
Cardiotocography should be used to assess and monitor the foetus.
