Antepartum haemorrhage

Question 1

Antepartum haemorrhage

Answer 1

1. 20wks of gestation - birth
   (<20wks - miscarriage)
2. Admit
3. Anti D gammaglobulin if Rh -ve mom
4. Do not perform vaginal exam
5. Causes:
   Placenta previa
   Abruptio placenta - high risk IUFD, coagilation complications

Question 2

Placenta previa

Answer 2

1. Placenta @ lower uterus
   Grade
   1-Low lying placenta (minor)
   2-Marginal placenta(minor)
   3-Partial previa (major)
   4-Complete previa (major)
2. Painless bleeding
3. Resuscitate mom
   -IV line, fluids
   -Blood sample crossmatch
4. USG- grade (minor/major)
5. Rx
   ●Minor
   - try term delivery
   -heavy bleed/unstable - CS
   -Vaginal delivery in grade 1
   ●Major
   - admit @34wks, rest, CS
   -if bleeding stopped, can wait till term (admitted)/elective CS @37wks

Question 3

Placental abruption

Answer 3

1. Painful bleed per vaginal or
   Concealed (Accumulated in uterus)
   -tense, tender, increase in symphysio fundal height, sev abd pain
2. Cause: multiparus, smoking, cocaine, HTN d/o (pre eclampsia)

Question 4

Mx of abruptio placenta

Answer 4

1. Resuscitate mother, blood transfusion
2. Tests:
   FBE
   Coagulation profile
   Kleihauer test - materno-fetal haemorrhage
   Crossmatching
   Kidney function
   electrolytes
3. CTG - continuous
4. USG - r/o placenta previa
5. Course
   a. IUFD - induction of labour (amniotomy)… vaginal delivery
   b. Fetal distress - CS immediately
   c. Mild - monitor, vag delivery/CS (<36wks)

Question 5

Vasa previa

Answer 5

Rupture of membranes … rupture of fetal umblical blood vessels

Heavy bleed
CTG - distress
Emergency CS req

Question 6

Rectus sheath hematoma

Answer 6

1. Rupture of epigastric artery in preg
2. d/t cough, strain OR Coagulation d/o
3. FBC, Coagulation study
4. Best - USG in preg, CT in gen pop
5. If using warfarin, check INR, give reversal agent
6. rest, ice, compression, and analgesia
   BEST - ANGIOEMBOLISATION