6 - Antepartum Hemorrhage

Question 1

Antepartum hemorrhage:

Answer 1

Bleeding after the age of viability

Question 2

Main causes:

Answer 2

1– Placenta previa [PP]

2– Placenta abruption

Question 3

Minor causes:

Answer 3

1– Premature separation of the placenta
2– Polyps, cancer, trauma, erosion
3– Vasa previa

Question 4

Placenta previa and its criteria:

Answer 4

— Placenta is inserted in the lower uterine segment OR Any placenta 2 cm or less from the cervical os and needs a CS [Identified by US]

— Diagnosed after 28 weeks, painless and a risk factor for preterm labor

Question 5

Predisposing factors for placenta previa:

Answer 5

1– Multiple gestation
2– Multiparity
3– Previous CS
4– Previous previas
5– Uterine anomalies [Fibroid in fundus]
6– Increased maternal age

Question 6

Placental changes in the placental previa:

Answer 6

The upper uterine segment has higher blood supply, so when the placenta goes to the lower uterine segment, it compensates by getting wider and thinner and needs a digital try to deliver it

Question 7

PP classes:

Answer 7

1– Minor = Grade 1 and 2 Anterior [Low lying] and a margin of the placenta covers the lower uterine segment
2– Major includes grade 2 posterior, grade 3 [Partially covers the internal os] and grade 4 AKA CENTRALIS [Totally covering the internal os]

Question 8

PP presentation:

Answer 8

1– Painless vaginal bleeding [About 1 L/min]
2– Recurrent bouts early in pregnancy
3– Malpresentations [Like breech or transverse presentation]
4– Soft uterus

Question 9

PP maternal complications:

Answer 9

1– Hemorrhage 
2– PPH
3– CS risk and complications 
4– Sepsis [From CS]
5– Air embolism

Question 10

PP fetal complications:

Answer 10

1– Malpresentation
2– IUGR
3– Malformations
4– Umbilical cord complications

Question 11

Why shouldn’t the suspense of PP be examined by DVE?

Answer 11

Because palpation can cause placental separation —> More hemorrhage

Question 12

PP management:

Answer 12

Crystalloid solution, FFP to avoid hemodilution and blood transfusion by packed RBCs

Question 13

Management in severe bleeding VS mild:

Answer 13

— CS irrespective of GA

— Try to reach maturity without risking mother’s health and apply expectant management

Question 14

Expectant management:

Answer 14

Keep in hospital, corticosteroids and correct the anemia with routine checking of fetal growth and CTG

Question 15

PP conditions:

Answer 15

1– P Accreta [Attaches to myometrium w/o penetration]
2– P Increta [Penetrates the myometrium]
3– P Percreta [Penetrates the myometrium to the serosa and attach to organs like rectum and bladder]

Question 16

Placental abruption [PA]:

Answer 16

Placental separation before delivery

Question 17

PA complications:

Answer 17

1– Fetal hypoxia

2– Nutrients deprivation

Question 18

PA R/F:

Answer 18

1– HTN, thrombophelia 
2– Previous PA
3– Short cord 
4– High parity and low social class
5– PROM/ROM
6– Trauma 
7– Polyhydramnios 
8– Chorioamnionitis

Question 19

PA C/P:

Answer 19

1– Bleeding
2– Abdominal pain [Backache]
3– Uterine tetany and tenderness
4– Normal lie and presentation 
5– Fetal distress
6– BP normal 
7– DIC evidence + Skin ecchymosis

Question 20

Fucking bored with this lecture

Answer 20

See ya later biatch