Antepartum Haemorrhage

Question 1

Sequence of events

Answer 1

Open question

Timeline

Question 2

Symptom Analysis

Answer 2

SOCRAT

Question 3

Current pregnancy

Answer 3

Foetal well-being- has baby moved recently, any pain down below or in tummy

LMP

Progress- how has pregnancy been so far? Any high BP, water infections etc.

Tests- what tests have you had done so far?

Question 4

Systems review

Answer 4

see gynae history template

Question 5

Patients perspective

Answer 5

Feelings and effect

ICE

Question 6

Background

Answer 6

PMH (lupus (anti-P syndrome), DM, HTN)
DH (contraindications in pregnancy)
FH
SH

Question 7

Placental abruption

Answer 7

Painful bleeding with foetal distress

Bleeding can be concealed

Question 8

Placenta praevia

Answer 8

Intermittent painless bleeding of increasing intensity and frequency
Foetal distress is uncommon

Question 9

Non-pregnancy causes

Answer 9

Cervical ectropion

Cervical polyp

Cervical cancer

Question 10

Investigations

Answer 10

ABCDE- if acutely unwell
Bedside- no vaginal exam unless placenta previa ruled out by TV USS, CTG
Bloods- FBC cross matching and clotting
Specialist- abdominal USS/TV USS

NB- don’t forget antiD may be required