Antepartum haemorrhage Flashcards
functions of the placenta
gas transfer
metabolism/waste disposal
hormone production
protective filter
definition of APH
bleeding from the genital tract after 24 weeks gestation and before the end of the second stage of labour
commonest causes of APH
placental abruption
placenta praevia
what is placental abruption
separation of normally implanted placenta- partially or totally before birth
clinical diagnosis
pathology of placental abruption
vasospasm followed by arteriole rupture into the decidua > blood escapes into amniotic sac and into myometrium
causes tonic contractions and interrupts placental circulation causing hypoxia
couvelaire uterus
haemorrhage from placental blood vessels goes into decidua basalis causing placental separation, followed by infiltration in the lateral portions of the uterus
risk factors for abruption
most are unknown
- pre-eclampsia
- trauma
- smoking/cocaine/amphetamine
- medical thrombophilias
- polyhydramnios
- multiple pregnancy
preterm- PROM
presentation of placental abruption
severe abdominal pain- continuous
backache- with posterior placenta
bleeding
preterm labour
maternal collapse
signs of placental abruption
unwell distressed patient
uterus LFD or normal
uterine tenderness
woody hard uterus
fetal parts difficult to identify
preterm labour
fetal heart rate: bradycardia/absent
management of placental abruption
ABCDE
- 2 large bore IV access
- bloods: FBC, clotting, LFT U&E, X match 4-6 units RBC
- IV fluids
- catherterise
resus mother
assess and deliver the baby
assess fetal heart
definition of placenta praevia
placenta lies directly over the internal os
when should term low-lying placenta be used
after 16 weeks when placental edge is less than 20 mm from the internal os on transabdominal or TVUS scanning
risk factors for placenta praevia
previous caesarean sections
pervious TOP
advanced maternal age
multiparity
smoking
assisted conception
multiple pregnancy
placenta praevia screening
midtrimester fetal anomaly scan should include placental localisation
rescan at 32 and 36 weeks if PP or LLP
TVUS is better than transabdominal
symptoms of placenta praevia
painless bleeding > 24 weeks
usually unprovoked but coitus can trigger bleeding
bleeding can be minor
fetal movements usually present
signs of placental praevia
patients condition directly proportional to amount of observed bleeding
uterus soft non tender
presenting part high
malpresentations- breech/transverse/oblique
fetal heart: CTG usually normal
diagnosis of placenta praevia
check anomaly scan
confirm by TVUS
MRI for excluding placenta accreta
do not do vaginal exam
management of placenta praevia
resus mother
- large bore IV access and G+S
assess baby
- steroids- 24-35+6 weeks
- MgSO4 if < 32 weeks
definition of placenta accreta
a morbidly adherent placenta
abnormally adherent to the uterine wall
placenta invading myometrium
increta
placenta penetrating uterus to bladder
percreta
management of placenta accreta
prophylactic internal iliac artery balloon
c hysterectomy
blood loss expected
conservative management + methotrexate
presentation of uterine rupture
severe abdominal pain
shoulder tip pain
maternal collapse
PV bleeding
signs of uterine rupture
intra-partum loss of contractions
acute abdomen
PP rises
loss of utrine contractions
peritonism
fetal distress/IUD
