102. Management of APH

Question 1

When should those with APH be admitted

Answer 1

Any bleeding may indicate danger

Question 2

What should be investigated on history

Answer 2

Time frame of bleeding
Quantity of blood loss
Relevant risk factors
Gynae factors
Fetal movements still present

Question 3

What signs should be elicited on investigation

Answer 3

Pallor
Hypotension
External bleeding
Tachycardia
Maternal pain

Question 4

What investigations should be undertaken?

Answer 4

Abdominal examination- uterine tone, presenting fetal part,

Vitals

CTG

Obstetric USS

DO NOT DO SPECULUM OR VAGINAL SCAN UNTIL USS DONE (to exclude placenta preavia)

Question 5

Who gets anti-D injections?

Answer 5

Woman who are rhesus negative?

Question 6

What classifies an obstetric emergency in APH?

Answer 6

Shock
Fetal compromise
Severe bleeding

Question 7

How do you deal with obstetric emergencies?

Answer 7

ABCDE!

Get help/experts

Resuscitation

Question 8

What is involved in resuscitation?

Answer 8

Insert two large bore cannulae
Set up IV infusion

Take blood- Cross match, FBC, LFT, U&E, Clotting screen

High flow mask oxygen at 50l per minute- reservoir mask

ABO rhesus compatible blood

Catheterise and monitor urine output, aim for 30ml/min

Question 9

What are the complications of APH?

Answer 9

Maternal- Anaemia, infection, maternal shock, renal tubular necrosis, DIC, PPH,

Fetal complications- Fetal hypoxia, fetal growth
restriction, prematurity, fetal death

Question 10

What is involved in post natal management

Answer 10

Thromboprophalxis
Clinical incident reporting
Debriefing