Antepartum haemorrhage

Question 1

Define antepartum haemorrhage.

Answer 1

APH is bleeding from the genital tract in pregnancy at >/= 24 weeks’ gestation before the onset of labour

Question 2

Define placental abruption.

Answer 2

Partial or complete separation of the placenta from the uterus prior to delivery

Question 3

What are the risk factors for placental abruption?

Answer 3

• Previous abruption
• Pre-eclampsia
• IUGR
• Polyhydramnios
• Older mother
• Multiparity
• Low BMI
• Assisted reproduction
• Intrauterine infection
• Cocaine/amphetamine use

Question 4

What are the clinical features of placental abruption?

Answer 4

• Painful bleeding
• Tachycardia - may be out of proportion to vaginal loss due to concealed blood loss
• Hypotension
• Maternal collapse
• ‘Woody’ hard uterus
• Foetal distress/demise

Question 5

What investigations should be done when placental abruption is suspected?

Answer 5

• TA USS
• Foetal CTG
• Bloods: FBC, coagulopathy

Question 6

How should placental abruption be managed?

Answer 6

• Haemodynamic control (fluids etc)
• RhD prophylaxis in RhD negative mothers
• EmCS in cases of acute symptoms and a live foetus
• If >36 weeks - deliver foetus
• If <34 weeks and mother haemodynamically stable: corticosteroids + tocolysis + aim for normal delivery

Question 7

What are the potential complications of placental abruption?

Answer 7

• Intrauterine foetal death
• Maternal DIC and hypovolaemic shock
• Retroplacental haemorrhage may extend through the uterus into the peritoneum
• Uterine rupture

Question 8

Define vasa praevia.

Answer 8

The presence of foetal placenta vessels lying over the internal cervical os

Question 9

Described the 2 main types of vasa praevia.

Answer 9

Type 1:

• due to a velamentous cord
• this is when the cord inserts into the chorioamniotic membrane with vessels not protected by Wharton’s jelly or the placenta, and crossing the cervical os

Type 2:
- due to bilobed or accessory placenta with connecting vessels that cross the cervical os

Question 10

What are the clinical features of vasa praevia?

Answer 10

• Painless PV bleeding that occurs suddenly after rupture of membranes
• Foetal distress (bradycardia)
• Foetal death can occur quickly through exsanguination or asphyxiation

Question 11

What investigation should be performed if vasa praevia is suspected?

Answer 11

TA or TV USS with colour doppler

Question 12

What is the management for vasa praevia?

Answer 12

EmCS