[24] Antepartum Haemorrhage

Question 1

What is the importance of antepartum haemorrhage?

Answer 1

It is a significant cause of perinatal and maternal morbidity and mortality

Question 2

What is the UK accepted definition of antepartum haemorrhage?

Answer 2

Haemorrhage from the vagina after the 24th week of gestation

Question 3

When might factors causing antepartum haemorrhage be present from?

Answer 3

Before 20 weeks

Question 4

What is the distinction between threatened miscarriage and antepartum haemorrhage based on?

Answer 4

If the fetus is considered potentially viable

Question 5

What are the categories of causes of antepartum haemorrhage?

Answer 5

• Haemorrhage from placental site and uterus
• Lesions of the lower genital tract
• Bleeding for fetal vessels

Question 6

What can cause haemorrhage from the placenta site and uterus?

Answer 6

• Placenta praevia
• Placental abruption
• Uterine rupture

Question 7

What % of cases of antepartum haemorrhage are due to placental praevia?

Answer 7

30%

Question 8

What % of cases of antepartum haemorrhage are due to placental abruption?

Answer 8

20%

Question 9

What lesions of the genital tract can cause antepartum haemorrhage?

Answer 9

• Bloody show associated with labour
• Cervical ectropion or carcinoma
• Cervicitis
• Polyps
• Vulval varices
• Trauma
• Infection

Question 10

What is bloody show?

Answer 10

When there is bleeding from the vagina caused by ruptured of small vessels in the cervix

Question 11

What can cause bleeding from fetal vessels?

Answer 11

Vasa praevia

Question 12

What % of cases of antepartum haemorrhage are of unclassified/unknown cause?

Answer 12

50%

Question 13

What are the risk factors for antepartum haemorrhage?

Answer 13

• Smoking

- Lower socioeconomic class

Question 14

What is the rate of antepartum haemorrhage?

Answer 14

2-5%

Question 15

What can antepartum haemorrhage be classified into?

Answer 15

• Spotting
• Minor haemorrhage
• Major haemorrhage
• Massive haemorrhage

Question 16

What is spotting?

Answer 16

Stains, streaking, or spots of blood

Question 17

What is minor haemorrhage?

Answer 17

Less than 500ml

Question 18

What is major haemorrhage?

Answer 18

500-1000ml, without signs of circulatory shock

Question 19

What is massive haemorrhage?

Answer 19

Greater than 1000ml, with or without signs of circulatory shock

Question 20

What might the patient present with in cases of severe haemorrhage?

Answer 20

Signs of hypovolaemic shock

Question 21

What are the fetal symptoms of antenatal haemorrhage?

Answer 21

Signs of fetal stress, such as decelerations on heart monitoring and decreased fetal movements

Question 22

How is the diagnosis of antepartum haemorrhage made?

Answer 22

Primarily clinical, and confirmed with trans-abdominal or trans-vaginal ultrasound

Question 23

What does the treatment approach in antepartum haemorrhage depend on?

Answer 23

• Maternal symptoms

- Fetal viability

Question 24

What is the conservative approach to antepartum haemorrhage?

Answer 24

Continuous monitoring

Question 25

When is conservative management of antepartum haemorrhage recommended?

Answer 25

For asymptomatic patients carrying a healthy fetus

Question 26

When is an emergency C-section indicated in antepartum haemorrhage?

Answer 26

In patients with acute symptoms and a live, distressed fetus

Question 27

What should be done if fetal death is diagnosed in antepartum haemorrhage?

Answer 27

Vaginal birth is recommended for most women provided the maternal condition is satisfactory, but C-section will need to be considered for some