Antepartum Hemorrhage

Question 1

Antepartum hemorrhage?

Answer 1

vaginal bleeding occurring at >= 28 weeks gestation at any time prior to delivery

Question 2

Causes of APH?

Answer 2

1. placenta praevia
2. placental abruption
3. vasa previa
4. uterine rupture
5. stillbirth
6. bloody show
7. cervical trauma

Question 3

Management of APH?

Answer 3

ABCDE APPROACH and hemodynamic support
1. general condition + vital signs
2. IV access + 2 large bore cannulae
> 0.9% NS 1L
3. foley catheter + monitor input and output
> >30ml/hr
4. send blood for - FBC, U+Es, Cr, clotting time + grouping and cross match
5. Transfusion
> 2 units each- PRBC, FFP and platelets
> 2 units whole blood
6. USS
> fetal condition
> placenta previa/rupture
7. NO DIGITAL VAGINAL EXAM UNTIL PLACENTA PREIA IS EXCLUDED

Question 4

What is placental abruption?

Answer 4

The partial or complete separation of the placenta from the uterus prior to delivery; subsequent hemorrhage occurs from both maternal and fetal vessels