6: APH

Question 1

Define APH

Answer 1

Bleeding in pregnancy after 24 weeks gestation

Question 2

Causes of APH

Answer 2

Placental: placenta praevia, abruption, edge bleeding, vasa praevia, uterine rupture
Cervical: polyp, ectropion
Vaginal: vaginitis, STI

Question 3

Risk factors for placenta praevia

Answer 3

Personal: advanced age, high parity
This pregnancy: multiple pregnancy
Obs hx: previous PP, prev SOTP
Gynae: fibroids
PMHx
SHx: smoking

Question 4

Risk factors for abruption

Answer 4

Personal: advanced age
This pregnancy: assisted reproduction, PET
Obs hx: prev abruption, prev caeserean, high parity
PMHx: autoimmune disease, HTN
SHx: smoking, illicit drug use

Question 5

Mx of APH

Answer 5

1. ABCDE: resuscitate with fluids, oxygen as appropriate. Ensure IV access.
2. Bloods: Group and hold, FBC, U&E, coags, LFTs
3. CTG for foetal monitoring

Insert IDC and measure urine output if resuscitating/haemodynamically unstable.

Question 6

Outcomes/sequelae of abruption?

Answer 6

Maternal: massive haemorrhage, shock, DIC, renal failure, liver failure, inc. risk PPH

Foetal: demise, distress

Question 7

Outcomes/sequelae of placenta praevia?

Answer 7

Maternal: anaemia, blood loss, placenta accreta, inc. risk PPH
Foetal: growth restriction, SGA, distress