Antepartum Haemorrhage

Question 0

Causes of APH

X9

Answer 0

Placenta Previa
Placenta abruptio
Local lesions
Vasa previa
Infections
Coagulation defects
Polyps
Cancer

Question 1

Definition of APH

Answer 1

Vaginal bleeding from 24 weeks until delivery

Question 2

Placenta praevia

General explanation

Answer 2

Implantation in lower segment of uterus
Placenta lies in front of the presenting part
If placenta is less than 3cm from margin of internal os

Question 3

Risks for placenta praevia

Answer 3

Pre-term birth
IUGR
Cong. Malformations
Fetal malpresentations
Placenta accreta/increta/percreta
Multiple pregnancies
Tobacco/cocaine/amphetamine
Age>35
PPH
Previous C/S
Previous TOP
Previous placenta praevia

Question 4

Placenta praevia symptoms

Answer 4

Painless bleeding 
Bright red blood
Presence of fetal movements
Low HB
Head easily balotable above pelvis
Presence of abnormal presentation

Question 5

Type 1 placenta praevia

Answer 5

Lower margin dips into lower uterine segment.

Edge within 3cm of cervical os

Question 6

Type 2 Placenta Praevia

Answer 6

Marginal placenta

Within 2cm of the cervical os but doesn’t cover

Question 7

Type 3 placenta praevia

Answer 7

Covers os when closed but not when fully dialated

Question 8

Type 4 placenta praevia

Answer 8

Complete placenta

Covers internal so, completely and centrally even when fully dialated

Question 9

Definition of placenta praevia

Answer 9

Major - lying over cervical os

Minor - not lying over os but encroaching on lower segment

Question 10

Scans in asymptomatic placenta praevia

Answer 10

Major - follow up at 32-36

Minor - follow up at 30-32

Question 11

Diagnosis of PP

Answer 11

Transvaginal ultrasound

Question 12

When can you deliver vaginally?

Answer 12

Type I or II
Only slight bleeding 
Vertex presentation
Partially dialated cervix to allow amniotomy
Adequate pelvis

Question 13

Now what do you do?

General shit for obstetric emergencies and shock

Answer 13

Localize
Resuscitate and stabilize
IVI plasma ringers
Vital signs 
CTG
Refer to level 2-3 hospital
C/S
Cross match bloods

Question 14

Placental abruptions

Types of bleeding x3

Answer 14

Revealed bleeding - lower part of placenta where blood escapes from the vagina
Concealed bleeding - blood seeps between placenta and uterine wall
Mixed bleeding

Question 15

Risk factors of placental abruptions

X10

Answer 15

Pre-eclampsia 
Hypertension
PROM
Chorioamnionitis
Abdominal trauma
Cigarette smoking, cocaine and tik
History
Multiple pregnancy 
Polyhydramnios

Question 16

Abruption grade 1

Answer 16

Small retroplacental clot after delivery

Question 17

Grade 2 Abruption

Answer 17

Mild vaginal bleeding with uterine tenderness
With no shock, distress or coagulopaty
48%

Question 18

Grade 3 Abruption

Answer 18

Concealed bleed with persistent pain and atomic uterus, increased maternal pulse, decreased BP, abnormal FHR
May be a coagulopathy
27%

Question 19

Grade 4 Abruption

Answer 19

Can be concealed or revealed with tetanic uterus
Coagulopathy and fetal demise usually present
27%

Question 20

Signs and symptoms of placental Abruption

X11

Answer 20

CONTINUOUS bleeding
DARK blood
Sudden onset of severe and constant pain 
Back pain with posterior placenta
Tense, tender uterus
Onset of labour in 50%
⬇️ fetal movement
No fetal parts felt
Maternal tachy
Unlikely to hear FHR with concealed hemorrhage 
Uterus larger for dates due to blood