Antepartum haemorrhage

Question 1

What is antepartum haemorrhage?

Answer 1

Defined as bleeding from genital tract after 24 weeks gestation and before end of 2nd stage of labour

Question 2

Commonest causes of antepartum haemorrhage?

Answer 2

Placental abruption

Placental praevia

Question 3

What is the cause of 20% of APH?

Answer 3

Placenta praevia

Question 4

Definition of placenta praevia?

Answer 4

When placenta lies directly over internal os, low lying placenta can also be assoc with bleeding

Question 5

Who is placenta praevia more common in?

Answer 5

Multiparous women

More than one c section

Question 6

Symptoms of placenta preavia?

Answer 6

Painless bleeding

Foetal movements present

Question 7

Signs of placenta praevia

Answer 7

Patients condition is directly proportional to amount of observed bleeding, may be malpresentation of foetus
Normal uterine tone

Question 8

Diagnosing PP and LLP?

Answer 8

Transvaginal US

MRI shoudl be done if placenta accreta is supected

Question 9

Management of placenta praevia?

Answer 9

Resus 
FBC, Crossmatch 
CTG 
Anti-D if Rh -ve 
Steroids if 24-36 weeks 
If bleeding stops, send home 
If bleeding continues may activate major haemorrhage protocol and deliver

Question 10

WHat is placental abruption?

Answer 10

Separation of a normally implanted placenta partially or totally before the birth of the fetus (it is a clinical diagnosis)

Question 11

Placental abruption is assoc with?

Answer 11

Hypertensive disease
Maternal thrombophilia
FGR
Trauma
Domestic violence

Question 12

Symptoms of placental abruption?

Answer 12

• Severe continuous abdominal pain (in contrast to labour intermittent pains)
• Backache
• Bleeding (may be concealed- amount of bleeding PV does not necessarily correlate to the amount of blood lost)
• Preterm labour
• Longitudinal lie of fetus
• May present with maternal collapse

Question 13

Signs of placental abruption?

Answer 13

• Unwell patient
• Tender uterus
• Woody hard uterus
• Fetal heart rate may be low or absent
• CTG shows an irritable uterus

Question 14

Management of placental abruption?

Answer 14

• Resus
• Admit
• Assess foetal growth
• Preterm: aim to prolong preg
• Alive and close to term or dead: IOL ASP
• Compromised: C section
• Both stable: stay in hospital until bleeding/pain stopped, then get IOL at 37-38 weeks

Question 15

Placenta acreta?

Answer 15

Placenta is abnormally adherent to uterine wall (5-10% of placenta praevia)

Question 16

Increased risk of placneta accreta with what?

Answer 16

C sections

Question 17

What is placenta accreta assoc with?

Answer 17

Severe bleeding
PPH
Hysterectomy

Question 18

Uterine rupture RFs?

Answer 18

Prev C section 
Uterine surgery 
Multiparity 
Prostaglandin use 
Obstructed labour

Question 19

Signs of uterine rupture?

Answer 19

Intrapartum: loss of ocntractions

• Presneting part rises
• Peritonism
• acute abdo pain
• Foetal distress
• Risk of IUD

Question 20

Symptoms of uterine rupture?

Answer 20

Severe abdo pain
Shoulder tip pain
Maternal collapse
PV bleeding