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Women's health > Antepartum haemorrhage > Flashcards

Antepartum haemorrhage Flashcards

1
Q

Causes of of APH

A
  1. Placenta praevia
  2. Abruptio placentae
  3. Unexplained antepartum bleeding
  4. Vasa praevia
  5. Local lesion in the lower genital tract
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2
Q

Placenta praevia

A

• Defined as partial or complete implantation of the placenta in the lower uterine segment.

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3
Q

Risk factors of Placenta praevia

A
  1. High parity
  2. History of caesarean section (or any myometrium damage)
  3. Cigarette smoking
  4. Multiple pregnancy
  5. Advanced maternal age
  6. History of placenta praevia
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4
Q

Classification of Placenta praevia

A

• Type 1
Placenta lies mostly on the body of uterus but small portion of placenta lies in the lower segment of the uterus.

• Type 2
Placenta lies partly on the body and also partly on the lower segment. Lower edge of the placenta touches the cervix.

• Type 3
Lies mainly on the lower segment and covers the internal cervical OS.

• Type 4
Placenta lies only on the lower segment and completely covers the internal cervical OS.

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5
Q

Assessment of Placenta praevia

A 
1. HISTORY 
• Warning bleeds 
• Usually painless but can be accompanied by uterine contractions 
•Risk factors 
• DDX
  1. EXAM
    • ABC (Screen for any signs of anemia and hypovolemic shock)
    • Speculum (for ddx)
  2. INVESTIGATIONS
    • Ultrasound (diagnostic of placenta praevia)
    • CTG (to assess the fetal being)
    • FBC, HB, Platelet count, PTT/PT, or coagulopathies
    • Blood type and cross match
  3. Monitor vital signs
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6
Q

Antepartum management Placenta praevia < 37 weeks?

A

• Start IV therapy, normal saline 0,9%.

  1. Admit, do not discharge if major placenta praevia.
  2. Blood test and transfuse if indicated.
  3. If <34 weeks, give betamethasone and tocolytic agents.
  4. Perform CTG for foetal being .
  5. Treat iron deficiency if present and maintain HB in normal range.
  6. Plan elective caesarean section at 35-37 weeks.
  7. Preform emergency caesarean section if blood transfusion becomes necessary or if the bleeding is severe or if there is fetal distress.
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7
Q

Antepartum management Placenta praevia >37 weeks?

A
  1. If an ultrasound indicates placenta praevia that covers the cervix, perform caesarean section.
  2. If placenta does not cover the cervix, perform vaginal exam in theatre, and proceed immediately with c-section if the placenta can be felt next to or near the cervix.
  3. If placenta cannot be felt, and cervix is adequately opened, induce labour.
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8
Q

Maternal complications

A
  1. Haemorrhagic shock
  2. Placenta accrete
  3. Postpartum haemorrhage
  4. Recurrent placenta praevia
  5. Infection secondary to anaemia
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9
Q

Perinatal complications

A
  1. Premature rapture of membrane
  2. Intrauterine restrictions
  3. Preterm labour
  4. Foetal distress
  5. Perinatal death
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10
Q

Post operative (c-section) assessment

A
  1. Close up monitoring of vital signs during the first 4-6 hrs for evidence of bleeding.
  2. 40 units of oxytocin in 1L of normal saline for 4-6 hrs to prevent PPH, thereafter continue with normal saline every 6-8 hrs for 24-48hrs.
  3. Prophylactic antibiotics
  4. Monitor for postoperative complications.
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11
Q

Definition of Abruptio Placentae

A

Placenta abruption is the premature separation of a placenta which is normally situated in the upper segment of the uterus.

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12
Q

Etiology and Risk Factors

A
  1. Pre-eclampsia
  2. Pre-term rupture of the membranes and chorioamnionitis.
  3. Blunt abdominal trauma to the mother.
  4. Cigarette smoking
  5. Poor socio-economic status
  6. Previous placenta abruption
  7. A very short umbilical cord.
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13
Q

TYPES of Abruptio of placenta

A
  1. Revealed accidental hemorrhage
  2. Concealed accidental hemorrhage
  3. Combined accidental hemorrhage
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14
Q
  1. Revealed accidental hemorrhage
A

?

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15
Q
  1. Concealed accidental hemorrhage
A

?

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16
Q
  1. Combined accidental hemorrhage
A

?

17
Q

Clinical Manifestations

A
  • Vaginal bleeding (dark blood with clots)
  • Uterine tenderness
•Back pain
• Fetal movements absent or reduced 
• Fetal distress
  1. Possible diminished or 
    absent fetal movements
2. Decelerations seen on fetal heart monitor

• May be signs of shock- tachycardia, hypotension

• Physical Exam
↪Uterus may be hard, tender and large for expected dates

18
Q

Diagnosis

A

• Clinically with history and physical examination

  1. Painful, with mild to severe bleeding
  2. The uterus is woody hard and tender in severe abruptio placentae
  3. Pelvic examination: Do a speculum exam gently to inspect the cervix and visualize where the bleeding is coming from.
  4. Digital vaginal examination is contraindicated in antepartum haemorrhage until placenta praevia is excluded.
  • Ultrasound
  • Full blood count
  • Coagulation profiles: PT, Hb, PTT, fibrinogen levels
  • Urine dipstick
  • Fetal heart monitoring
19
Q

DDX

A
  1. Placenta previa
  2. Ruptured uterus
  3. Labour with heavy bleeding
20
Q

Maternal complications of Placenta abruptio

A
  1. Severe haemorrhagic shock, and death.
  2. Disseminated intravascular coagulopathy with multiple organ failure.
  3. Acute renal failure
  4. Postpartum haemorrhage
21
Q

FOETAL COMPLICATIONS of Placenta abruptio

A
  1. Preterm birth
  2. Fetal distress
  3. Intrauterine fetal death in severe cases.
22
Q

General measures for Abruptio of placenta

A

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Women's health (7 decks)

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