Antepartum Haemorrhage (APH) Flashcards
(27 cards)
What is the definition of antepartum haemorrhage (APH)?
Bleeding from the genital tract after 28 weeks of gestation and before delivery of the baby.
From which gestational age is bleeding considered APH in developing countries?
From 28 weeks, due to viability and stillbirth registration standards.
What are the four major causes of APH?
Placenta praevia, placental abruption, local causes, vasa praevia.
What are the minor or local causes of APH?
Cervical cancer, polyps, cervicitis, friable condylomata acuminata.
What is placenta praevia?
Placenta implanted wholly or partly in the lower uterine segment.
What are the types of placenta praevia?
Type 1: does not reach internal os, Type 2: reaches but does not cross internal os, Type 3: crosses internal os but does not completely cover it, Type 4: completely covers internal os
Which types of placenta praevia are considered minor?
Types 1 and 2 (placenta praevia minor).
What are the types of abnormal placentation?
Accreta: attaches to outer myometrium, Increta: invades myometrium, Percreta: penetrates through myometrium into perimetrium
List five predisposing factors to placenta praevia.
Advanced maternal age, high parity, prior uterine surgery, intrauterine synechiae, multiple gestations.
What is the typical clinical presentation of placenta praevia?
Painless, bright red vaginal bleeding, recurrent and unprovoked, more severe closer to term.
What is the diagnostic approach to placenta praevia?
USS (preferred), MRI; vaginal exam contraindicated.
Why is vaginal examination contraindicated in suspected placenta praevia?
Risk of provoking massive haemorrhage.
What are the principles of management of placenta praevia?
Conservative for remote gestation, Surgical for major praevia, repeated/severe bleeding, or malpresentation, May need blood transfusion, Double setup technique for evaluation
What are the complications of placenta praevia?
Haemorrhage, anaemia, shock, maternal death.
What is abruptio placentae?
Premature separation of a normally situated placenta before delivery.
What is Couvelaire uterus?
When bleeding infiltrates into the myometrium, causing a bluish discolouration.
What are the aetiological factors of placental abruption?
Unknown primary cause; others include hypertension, trauma, polyhydramnios, advanced parity, rapid uterine decompression.
What is the hallmark clinical presentation of placental abruption?
Painful uterine contractions with bleeding in the third trimester.
What investigations are essential in placental abruption?
FBC, coagulation studies, blood grouping and crossmatch, USS (retroplacental haematoma).
Outline the management of placental abruption.
Conservative if mild, no fetal distress, fetus preterm, Blood transfusion and monitoring, Vaginal delivery if stable, Surgery if severe bleeding or fetal distress
What are maternal complications of placental abruption?
Life-threatening haemorrhage, DIC, PPH, renal failure, shock, maternal death.
What are fetal complications of placental abruption?
Fetal hypoxia, anaemia, IUGR, and death.
What is vasa praevia?
Bleeding from fetal vessels that cross the membranes unprotected over the cervix.
What test is used to diagnose vasa praevia?
APT test.
