7.3. Complications of Pregnancy - Antepartum Haemorrhage

Question 1

What is an Antepartum Haemorrhage?

Answer 1

Haemorrhage from the Genital Tract:

1. After the 24th week of Pregnancy
2. Before the Delivery of the Baby

Question 2

What is the prognosis for Antepartum Haemorrhage?

Answer 2

Antepartum Haemorrhage is one of the Gravest Obstetric Emergencies and is associated with significant Maternal and Neonatal Morbidity and Mortality

Question 3

What are the Causes of Antepartum Haemorrhage?

Answer 3

1. Placenta Praevia
2. Placental Abruption
3. Antepartum Haemorrhage of Unknown Origin
4. Local Lesions of the Genital Tract
5. Vasa Praevia (Very Rare)

Question 4

What is Placenta Praevia?

Answer 4

All / Part of the Placenta implants in the Lower Uterine Segment

Question 5

Who is Placenta Praevia more common in?

Answer 5

1. Multiparous Women
2. Multiple Pregnancies
3. Previous Caesarian Section
   Note - This occurs in 1/200 pregnancies

Question 6

What are the Classifications of Placenta Praevia?

Answer 6

Grade 1 - Placenta Encroaching on the Lower Segment but not the Internal Cervical Os
Grade 2 - Placenta Reaches the Internal Os
Grade 3 - Placenta Eccentrically Covers the Os
Grade 4 - Central Placenta Praevia

Question 7

What is the Presentation of Placenta Praevia?

Answer 7

1. Painless Antepartum Haemorrhage
2. Sift, Non-Tender Uterus
3. Malpresentation of the Fetus

Question 8

What causes the Bleeding in Placenta Praevia?

Answer 8

Separation of the Placenta as the Lower Uterine Segment forms and the Cervix Effaces
Note - Blood comes from the Venous Sinuses in the Lower Segment

Question 9

How is a Diagnosis of Placenta Praevia made?

Answer 9

1. Ultrasound Scan
2. MRI - Rarely used
   Note - Vaginal Examination must not be done

Question 10

What is the management of Placenta Praevia?

Answer 10

Dependent on Gestation and Severity

Caesarian Section - watch for Post-Partum Haemorrhage

Question 11

What is Placental Abruption?

Answer 11

Haemorrhage resulting from the Premature Separation of the Placenta before the Birth of the Baby

Question 12

What are the Factors Associated with Placental Abruption?

Answer 12

1. Pre-Eclampsia / Chronic Hypertension
2. Multiple Pregnancies
3. Polyhyramnios
4. Smoking / Increasing Age / Parity
5. Previous Placental Abruption
6. Cocaine use

Question 13

What are the Clinical Types of Placental Abruption?

Answer 13

1. Revealed - Major Haemorrhage apparent
2. Concealed - Haemorrhage between Placenta and Uterine Wall
3. Mixed

Question 14

What is the Presentation of Placental Abruption?

Answer 14

1. Severe Abdominal Pain
2. Antepartum Haemorrhage - May be Minimal
3. Increase Uterine Activity

Question 15

What are the Complications of Placental Abruption?

Answer 15

1. Maternal Shock, Collapse - May be disproportional to the Amount of Blood Seen
2. Foetal Death
3. Maternal Disseminated Intravascular Coagulation (DIC) / Renal Failure
4. Postpartum Haemorrhage - Couvelaire Uterus

Question 16

What are some examples of Local Lesions of the Genital Tract, which can cause Antepartum Haemorrhage?

Answer 16

1. Cervical Erosions
2. Polyps
3. Cervical Cancer (occasionally)

Question 17

What is Vasa Praevia?

Answer 17

Blood loss is due to a Ruptured Foetal Vessel, within the Foetal Membranes
Note - This is Catastrophic for the Foetus

Question 18

What is the General Management of Antepartum Haemorrhage dependent on?

Answer 18

1. Amount of Bleeding
2. General Condition of the Mother / Baby
3. Gestation
   Note - The Management will vary from attempting Vaginal Delivery to immediate Caesarian Section