[24] Antepartum Haemorrhage Flashcards

1
Q

What is the importance of antepartum haemorrhage?

A

It is a significant cause of perinatal and maternal morbidity and mortality

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2
Q

What is the UK accepted definition of antepartum haemorrhage?

A

Haemorrhage from the vagina after the 24th week of gestation

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3
Q

When might factors causing antepartum haemorrhage be present from?

A

Before 20 weeks

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4
Q

What is the distinction between threatened miscarriage and antepartum haemorrhage based on?

A

If the fetus is considered potentially viable

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5
Q

What are the categories of causes of antepartum haemorrhage?

A
  • Haemorrhage from placental site and uterus
  • Lesions of the lower genital tract
  • Bleeding for fetal vessels
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6
Q

What can cause haemorrhage from the placenta site and uterus?

A
  • Placenta praevia
  • Placental abruption
  • Uterine rupture
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7
Q

What % of cases of antepartum haemorrhage are due to placental praevia?

A

30%

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8
Q

What % of cases of antepartum haemorrhage are due to placental abruption?

A

20%

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9
Q

What lesions of the genital tract can cause antepartum haemorrhage?

A
  • Bloody show associated with labour
  • Cervical ectropion or carcinoma
  • Cervicitis
  • Polyps
  • Vulval varices
  • Trauma
  • Infection
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10
Q

What is bloody show?

A

When there is bleeding from the vagina caused by ruptured of small vessels in the cervix

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11
Q

What can cause bleeding from fetal vessels?

A

Vasa praevia

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12
Q

What % of cases of antepartum haemorrhage are of unclassified/unknown cause?

A

50%

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13
Q

What are the risk factors for antepartum haemorrhage?

A
  • Smoking

- Lower socioeconomic class

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14
Q

What is the rate of antepartum haemorrhage?

A

2-5%

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15
Q

What can antepartum haemorrhage be classified into?

A
  • Spotting
  • Minor haemorrhage
  • Major haemorrhage
  • Massive haemorrhage
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16
Q

What is spotting?

A

Stains, streaking, or spots of blood

17
Q

What is minor haemorrhage?

A

Less than 500ml

18
Q

What is major haemorrhage?

A

500-1000ml, without signs of circulatory shock

19
Q

What is massive haemorrhage?

A

Greater than 1000ml, with or without signs of circulatory shock

20
Q

What might the patient present with in cases of severe haemorrhage?

A

Signs of hypovolaemic shock

21
Q

What are the fetal symptoms of antenatal haemorrhage?

A

Signs of fetal stress, such as decelerations on heart monitoring and decreased fetal movements

22
Q

How is the diagnosis of antepartum haemorrhage made?

A

Primarily clinical, and confirmed with trans-abdominal or trans-vaginal ultrasound

23
Q

What does the treatment approach in antepartum haemorrhage depend on?

A
  • Maternal symptoms

- Fetal viability

24
Q

What is the conservative approach to antepartum haemorrhage?

A

Continuous monitoring

25
Q

When is conservative management of antepartum haemorrhage recommended?

A

For asymptomatic patients carrying a healthy fetus

26
Q

When is an emergency C-section indicated in antepartum haemorrhage?

A

In patients with acute symptoms and a live, distressed fetus

27
Q

What should be done if fetal death is diagnosed in antepartum haemorrhage?

A

Vaginal birth is recommended for most women provided the maternal condition is satisfactory, but C-section will need to be considered for some