Antepartum bleeding Flashcards
(40 cards)
antepartum haemorrhage (APH) definition
bleeding from the genital tract after 24 weeks gestation and before the end of the second stage of labour
i.e. >24/40 and before the baby is delivered
what are the commonest causes of antepartum haemorrhage?
placental abruption and placenta praevia
minor APH
<50ml
settled
major APH
50-1000ml
no shock
massive APH
> 1000ml
and/or shock
what is placental abruption?
separation of a normally implanted placenta - partially or completely before birth of the fetus
what percentage of APHs does placental abruption make up?
40% of APH
what tests should we do if we think there is placental abruption?
NO TIME FOR TESTS !
Clinical diagnosis
when is placental abruption most likely to occur?
the last trimester, particularly during the last few weeks prior to birth
what percentage of cases of placental abruption occur in low-risk pregnancies?
70%
placental abruption risk factors
- unknown (low risk pregnancies!)
- pre-eclampsia/hypertension
- trauma
-smoking/cocaine/ amphetamine
-thrombophilias/renal diseases/diabetes/hypothyroidism
-polyhydramnios - multiple pregnancy
- preterm-PROM
-Placenta insufficiency
-previous abruption
placental abruption symptoms
- CONTINUOUS severe abdominal pain
- backache with posterior placenta
- bleeding (may be concealed)
- preterm labour
- may present with maternal collapse
placental abruption overall signs
- unwell distressed patient
- signs may be inconsistent with revealed blood
placental abruption signs on abdominal examination
- uterus large for date or normal
- uterine tenderness
- woody hard uterus
- fetal parts difficult to identify
- may be in preterm labour
“woody hard uterus”
placental abruption
placental abruption fetal condition
- bradycardia
- absent HR (intrauterine death)
- CTG shows irritable uterus
placental abruption management
- ABCDE approach
- RESUSCITATE MOTHER
- Assess and deliver baby
- Manage complications
- Debrief the parents
how do we assess fetal heart in placental abruption management?
CTG
USS if no fetal heart
fetal complications of placental abruption
- intrauterine death (14%)
- hypoxia
- prematurity
- small for gestation age and fetal growth restriction
what is placenta praevia
when the placenta lies directly over the internal os
when should the term “low-lying placenta” be used?
after 16/40 when the placental edge is less than 20mm from the internal os on TA or TV scanning
Risk factors for placenta praevia
- previous c section
- previous termination of pregnancy
- maternal age >40
- multiparity
- assisted conception
- multiple pregnancy
- smoking
- deficient endometrium due to presence or history of: uterine scar, endometritis, manual removal of placenta, D+C, submucous fibroid
placenta praevia symptoms
- painless bleeding >24 weeks
- usually unprovoked but coitus can trigger bleeding
- bleeding can be minor e.g. spotting, or severe
- fetal movements usually present
do not perform vaginal examination until you exclude ______ ________
placenta praevia
