Ante-Partum Haemorrhage Flashcards
What is Antepartum haemorrhage?
Bleeding of the genital tract from 24 weeks of gestation until birth
What causes APH? (5)
- Placental abruption
- Placenta Privea
- Uterine rupture
- Vasa Privea
- Other Gynacological reasons- cervical lesions, infection etc.
What is placenta Privea?
When the placenta is partially of fully implanted into the lower uterine segment
When is it normal to have the placenta in the lower uterine segment?
<20 weeks of gestation
What causes placenta privea?
- Twins
- Multiparity
- Increased maternal age
How do we classify Placenta Privea?
- Marginal (types 1+2) is when the placenta is in the lower segment however not over the OS
- Major (types 3+4) is when the placenta is completely or partially covering the OS
What are the complications of placenta privea? (4)
- CS due to obstructed head engagement
- Haemorrhage
- Placenta accreta
- Placenta precreta
What is Placenta accrete?
Implantation into previous CS and myometrium
What is Placenta Percreta?
Penetration of the placenta through the uterine wall into surrounding structures
What are the clinical features of placenta privea?
- Intermittent painless bleeding
2. Breech/transverse lie
Should a VE be done in suspected placenta privea?
NO - can provoke massive bleed
How do we investigate placenta privea?
- US to locate the placenta.
IF the placenta is <2CM from the internal OS at term it is positive
- FBS, 6 units crossmatch, clotting
- CTG
What would you do if an US shows placenta privea at 20 weeks?
Re-scan at 32 weeks
How is Placenta accreta diagnosed?
- On US - if placenta is anterior with pre LSCS order an MRI
How is placenta privea managed?
- Admission
- IV access
- Steroids if <34 weeks
- Blood ready to be transfused
- Anti-D if RH -ve