Antepartum

Question 1

Antepartum Haemorrhage

Answer 1

Frank bleeding from genital tract between 24 weeks or pregnancy - > onset of labour.

Question 2

Types of Antepartum Haemorrhage

Answer 2

• Minor Haemorrhage (<50ml)
• Major Haemorrhage (50-1000ml, no signs shock)
• Massive Haemorrhage (1000ml+, clinical shock)

Question 3

Common causes of APH

Answer 3

• Cervical Erosion
• Marginal Placental Bed Bleeding
• Blood-stained show

Question 4

Major APH causes

Answer 4

Placental Abruption

Placenta Praevia

Question 5

Placental Abruption

Answer 5

A portion of abnormally sited placenta pulls away from the uterine wall, causing bleeding (700ml blood/minute to uterus; can cause massive bleeding)

Question 6

Signs of Placental Abruption

Answer 6

• Constant, Continuous Abdominal Pain
• Woody Abdomen
• No subsiding of pain (unlike contractions)
• If revealed blood loss, usually darker in colour

Question 7

Placenta Praevia

Answer 7

When the placenta develops in the lower segment of the uterus; the placental bed completely covers the cervix, causing inevitable bleeding. Always needing c-section. Painless bleeding.

Question 8

Placental Abruption vs. Placenta Praevia

Answer 8

Question 9

Treatment and Management of APH

Answer 9

Convey in lateral position (left lateral)

Do not administer uterotonics

Consider TXA

Question 10

Pre-eclampsia

Answer 10

New hypertension >20 weeks with significant proteinuria

Question 11

Severe Pre-eclampsia

Answer 11

Pre-eclampsia with symptoms (160/110mmHg+)

Severe Frontal Headache

Visual Disturbances

Epigastric Pain

Abdominal Pain

Convulsions

Vomiting

…may -> eclampsia!

Question 12

Eclampsia

Answer 12

One or more tonic-clonic convulsions

Usually beyond 24 weeks

Tonic clonic with self-limiting within 90 seconds usually, hypoxia may lead to significant foetal compromise

44% post-partum
38% antenatal
18% intrapartum

• Convey in lateral position (right lateral in DCA), longer than 2-3 minutes = IV diazepam.