Antepartum Haemorrhage Flashcards
(21 cards)
Causes of APH
X9
Placenta Previa Placenta abruptio Local lesions Vasa previa Infections Coagulation defects Polyps Cancer
Definition of APH
Vaginal bleeding from 24 weeks until delivery
Placenta praevia
General explanation
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
Risks for placenta praevia
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
Placenta praevia symptoms
Painless bleeding Bright red blood Presence of fetal movements Low HB Head easily balotable above pelvis Presence of abnormal presentation
Type 1 placenta praevia
Lower margin dips into lower uterine segment.
Edge within 3cm of cervical os
Type 2 Placenta Praevia
Marginal placenta
Within 2cm of the cervical os but doesn’t cover
Type 3 placenta praevia
Covers os when closed but not when fully dialated
Type 4 placenta praevia
Complete placenta
Covers internal so, completely and centrally even when fully dialated
Definition of placenta praevia
Major - lying over cervical os
Minor - not lying over os but encroaching on lower segment
Scans in asymptomatic placenta praevia
Major - follow up at 32-36
Minor - follow up at 30-32
Diagnosis of PP
Transvaginal ultrasound
When can you deliver vaginally?
Type I or II Only slight bleeding Vertex presentation Partially dialated cervix to allow amniotomy Adequate pelvis
Now what do you do?
General shit for obstetric emergencies and shock
Localize Resuscitate and stabilize IVI plasma ringers Vital signs CTG Refer to level 2-3 hospital C/S Cross match bloods
Placental abruptions
Types of bleeding x3
Revealed bleeding - lower part of placenta where blood escapes from the vagina
Concealed bleeding - blood seeps between placenta and uterine wall
Mixed bleeding
Risk factors of placental abruptions
X10
Pre-eclampsia Hypertension PROM Chorioamnionitis Abdominal trauma Cigarette smoking, cocaine and tik History Multiple pregnancy Polyhydramnios
Abruption grade 1
Small retroplacental clot after delivery
Grade 2 Abruption
Mild vaginal bleeding with uterine tenderness
With no shock, distress or coagulopaty
48%
Grade 3 Abruption
Concealed bleed with persistent pain and atomic uterus, increased maternal pulse, decreased BP, abnormal FHR
May be a coagulopathy
27%
Grade 4 Abruption
Can be concealed or revealed with tetanic uterus
Coagulopathy and fetal demise usually present
27%
Signs and symptoms of placental Abruption
X11
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
