Antepartum haemorrhage Flashcards
(51 cards)
Definition of antepartum haemorrhage
Bleeding from the genital tract after 24 weeks gestation until the end of the 2nd stage of labour
What percentage of pregnancies are affected by APH?
3-5%
5 Main causes of APH
Placental problems
Local causes
Uterine problems
Vasa praevia
Indeterminate
Placental causes of APH
Placental abruption
Placenta praevia
Local causes of APH
Ectropion
Polyp
Infection
Carcinoma
Uterine cause of APH
Rupture
What are the 4 classifications of APH bleeding?
- Spotting - Staining, streaking, wiping
- Minor - <50ml
- Major - 50-1000ml
- Massive - >1000ml +/- Shock
Minor APH volume
<50ml
Major APH volume
50-1000ml
Massive APH volume
> 1000ml + shock
Management of APH
- ABCDE approach, resuscitating mother first, then assessing baby
- Deliver (Emergency or planned)
- Steroids and MgSO4
- Cell salvage
- MDT
- Tranexamic acid, IV crystalloid and calcium replacement may all also be given
Maternal complications of APH
- Hypovolaemic shock
- Anaemia
- PPH (25%)
- Renal failure
- Coagulopathy/DIC
- Infection
- Psychological issues (Mother and partner)
Foetal complications of APH
- Foetal death (14%)
- Hypoxia
- Prematurity
- Small for gestational age and foetal growth restriction
What is placental abruption?
the placenta separates from the wall of the uterus during pregnancy. The site of attachment can bleed extensively after the placenta separates.
Risk factors for placental abruption
- Previous placental abruption
- Pre-eclampsia
- Bleeding early in pregnancy
- Trauma (consider domestic violence)
- Multiple pregnancy
- Fetal growth restriction
- Multigravida
- Increased maternal age
- Smoking
- Cocaine or amphetamine use
Describe th pathophysiology of placental abruption
Vasospasm followed by arteriole rupture into the decidua
Blood therefore escapes into the amniotic sac or further under the placenta and into the myometrium
This causes tonic contraction and interrupts placental circulation which causes hypoxia
This results in Couvelaire uterus (Blood penetrates into the peritoneal cavity, uterus becomes tense and rigid and myometrium becomes weakened
Presentation of placental abruption
- Sudden onset severe abdominal pain that iscontinuous
- Vaginal bleeding (antepartum haemorrhage)
- Shock (hypotension and tachycardia)
- Abnormalities on the CTG indicating fetal distress
- Characteristic “woody” abdomen on palpation, suggesting a large haemorrhage
What is a concealed abruption
where thecervical osremains closed, and any bleeding that occurs remains within the uterine cavity. The severity of bleeding can be significantly underestimated with concealed haemorrhage.
Management of placental abruption
Obstetric emergency
- Urgent involvement of a senior obstetrician, midwife and anaesthetist
- 2 x grey cannula
- Bloods include FBC, UE, LFT and coagulation studies
- Crossmatch 4 units of blood
- Fluid and blood resuscitation as required
- CTG monitoring of the fetus
- Close monitoring of the mother
What is the use of antenatal steroids?
Causes acceleration of maturation of the lungs
When are antenatal steroids offered?
24 - 34+6 weeks in anticipation of pre-term delivery
What is placenta praevia?
where the placenta is attached in the lower portion of the uterus, lower than the presenting part of the fetus.Praeviadirectly translates from Latin as “going before”.
Definition of low-lying placenta
Placenta within 20mm of the internal cervical os
Definition of placenta praevia
Placenta covering the internal cervical os
