[24] Antepartum Haemorrhage Flashcards
What is the importance of antepartum haemorrhage?
It is a significant cause of perinatal and maternal morbidity and mortality
What is the UK accepted definition of antepartum haemorrhage?
Haemorrhage from the vagina after the 24th week of gestation
When might factors causing antepartum haemorrhage be present from?
Before 20 weeks
What is the distinction between threatened miscarriage and antepartum haemorrhage based on?
If the fetus is considered potentially viable
What are the categories of causes of antepartum haemorrhage?
- Haemorrhage from placental site and uterus
- Lesions of the lower genital tract
- Bleeding for fetal vessels
What can cause haemorrhage from the placenta site and uterus?
- Placenta praevia
- Placental abruption
- Uterine rupture
What % of cases of antepartum haemorrhage are due to placental praevia?
30%
What % of cases of antepartum haemorrhage are due to placental abruption?
20%
What lesions of the genital tract can cause antepartum haemorrhage?
- Bloody show associated with labour
- Cervical ectropion or carcinoma
- Cervicitis
- Polyps
- Vulval varices
- Trauma
- Infection
What is bloody show?
When there is bleeding from the vagina caused by ruptured of small vessels in the cervix
What can cause bleeding from fetal vessels?
Vasa praevia
What % of cases of antepartum haemorrhage are of unclassified/unknown cause?
50%
What are the risk factors for antepartum haemorrhage?
- Smoking
- Lower socioeconomic class
What is the rate of antepartum haemorrhage?
2-5%
What can antepartum haemorrhage be classified into?
- Spotting
- Minor haemorrhage
- Major haemorrhage
- Massive haemorrhage
What is spotting?
Stains, streaking, or spots of blood
What is minor haemorrhage?
Less than 500ml
What is major haemorrhage?
500-1000ml, without signs of circulatory shock
What is massive haemorrhage?
Greater than 1000ml, with or without signs of circulatory shock
What might the patient present with in cases of severe haemorrhage?
Signs of hypovolaemic shock
What are the fetal symptoms of antenatal haemorrhage?
Signs of fetal stress, such as decelerations on heart monitoring and decreased fetal movements
How is the diagnosis of antepartum haemorrhage made?
Primarily clinical, and confirmed with trans-abdominal or trans-vaginal ultrasound
What does the treatment approach in antepartum haemorrhage depend on?
- Maternal symptoms
- Fetal viability
What is the conservative approach to antepartum haemorrhage?
Continuous monitoring
When is conservative management of antepartum haemorrhage recommended?
For asymptomatic patients carrying a healthy fetus
When is an emergency C-section indicated in antepartum haemorrhage?
In patients with acute symptoms and a live, distressed fetus
What should be done if fetal death is diagnosed in antepartum haemorrhage?
Vaginal birth is recommended for most women provided the maternal condition is satisfactory, but C-section will need to be considered for some
