Antepartum Haemorrhage Flashcards
What is antepartum haemorrhage?
Bleeding in late pregnancy after 24 weeks.
It is a medical emergency.
What are the 2 most common causes of antepartum haemorrhage?
Placental abruption
Placenta praevia
What is a vasa praevia?
Where foetal circulation is in contact with membranes.
Rare but serious.
When should uterine rupture be considered as the cause of APH?
Previous C-section
Previous uterine surgery
What is placental abruption?
A sudden of a normally implanted placenta.
May be partial or total.
Make up 40% of all APHs.
How does placental abruption present?
Severe continuous abdominal pain
Bleeding (although not always)
Can be cause of maternal collapse or preterm labour.
What is Kleihauer test?
A test used to determine amount of blood lost.
How is placental abruption treated?
Urgent C-section
What may follow placental abruption?
Hypovolaemic shock
Anaemia
PPH
What is placenta praevia?
A low-lying placenta, this is directly covering the cervical os.
This prevents the baby exiting the uterus.
How does placenta praevia present?
As the cervix opens, the placenta becomes disturbed, producing lots of bleeding.
What is placenta accreta?
A placenta growing into the wall of the uterus.
It is morbidly adherent.
How should placenta accreta be investigated?
Perform MRI
How does the uterus feel in placenta praevia?
Soft and tender.
Should a vaginal exam be performed in placenta praevia?
No, this may worsen the situation.
What is given to prevent neural tube defects in babies born before 32 weeks?
Magnesium sulfate
What is given if the mother is rhesus negative?
Anti-D
How is placenta accreta treated?
Prophylactic internal iliac artery balloon.
How does uterine rupture present?
Severe abdominal pain (despite epidural anaesthesia) Shoulder-tip pain Maternal collapse Post-vaginal bleeding Foetal compromise Cessation of contractions
What reduces risk of PPH?
Active management during the 3rd stage of labour.
Why should ergometrine be avoided in hypertensive?CVD patients?
It causes a significant rise in BP.
How is APH treated?
Kleihauer test
Anti-D
Steroids (to reduce risk to baby)
