Antepartum Haemorrhage Flashcards
what is bleeding in early pregnancy?
bleeding before 24 weeks
what is antepartum haemorrhage?
bleeding after 24 weeks and before the end of the second stage of labour
aka bleeding in late pregnancy
what is the sole source of foetal nutrition from week 6?
placenta
what are the two most common causes of APH?
placental abruption
placenta praevia
what is a minor APH?
<50ml
patient settled
what is a major APH?
50-1000ml
patient not in shock
what is a massive APH?
> 1000ml and/or patient in shock
what is placental abruption?
the separation of a normally implanted placenta before birth
how is placental abruption diagnosed?
a clinical diagnosis
how does placental abruption present?
abdominal pain bleeding preterm labour severe = maternal collapse uterine tenderness hard uterus on palpation
how is placental abruption managed?
IV fluids
assess and delivery of the baby
what is placenta praevia?
when the placenta lies directly over the internal os
what is low lying placenta?
when the placental edge is less than 20mm from the internal os after 16 weeks
what is the lower segment of the uterus?
the part of the uterus below the utero-vesical pouch superiorly and the internal os interiorly
what increases risk of placenta praevia in subsequent pregnancies?
c section
when is screening for placenta praevia done?
foetal anomaly scan
rescan at 32-36 weeks if there is persistent placenta praevia or low lying placenta
how does placenta praevia present?
painless bleeding
what should not be performed in patients with placenta praevia?
vaginal examination
how is the mother managed in placenta praevia?
ABCDE approach
anti D if needed
how is the baby managed in placenta praevia?
assess the babies condition
steroids if preterm and needing delivered
MgSO4 if <32 weeks and needing delivered
when does a baby need MgSO4 and why?
if being delivered <32 weeks for neuroprotection
when does a baby need to receive steroids?
if being delivered between 24 and 35+6 weeks
when should delivery be considered in uncomplicated placenta praevia?
36-37 weeks
when is CS done for placenta praevia?
if placenta covers os or is <2cm from os
