Antepartum haemorrhage

Question 1

What does AH refer to?

Answer 1

vaginal bleeding occurring between the 24th week of pregnancy and birth.

Question 2

What are differentials for AH?

Answer 2

Placental abruption: Symptoms may include vaginal bleeding, abdominal pain, and uterine tenderness or rigidity.

Placenta praevia: This condition may present with painless, bright red vaginal bleeding.

Vasa praevia: Signs may include vaginal bleeding and abnormal foetal heart rate patterns.

Genital tract malignancy or trauma: Symptoms may include vaginal bleeding, pelvic pain, and in cases of trauma, a history of injury.

Genital tract infection: Symptoms can include vaginal bleeding accompanied by fever, pelvic pain, and abnormal vaginal discharge.

Uterine rupture: This may present with sudden severe abdominal pain, vaginal bleeding, and signs of shock.

Inherited bleeding disorder: This condition can present with vaginal bleeding and a personal or family history of bleeding disorders.

Gestational trophoblastic disease: Symptoms may include vaginal bleeding, elevated hCG levels, and larger than expected uterine size.

Cervical ectropion: This condition may present with vaginal bleeding, especially post-coital.

Question 3

How is AH investigated?

Answer 3

Thorough clinical history

Abdominal examination

Speculum examination

Blood tests including group and save, crossmatch, full blood count, coagulation screen, urea and electrolytes, LFTs, and Kleihauer test in rhesus negative women.

Ultrasound to exclude placenta praevia

Cardiotocography to assess and monitor the foetus

Question 4

How is AH managed?

Answer 4

Assessing haemodynamic status and initiating resuscitation if necessary

Admitting the patient to the hospital for observation

Obtaining intravenous access

Monitoring for concealed haemorrhage

Administering antenatal corticosteroids between 24 and 34 weeks of gestation if there is a risk of preterm birth.