Antepartum haemorrhage Flashcards
What is the definition of Antepartum Haemorrhage (APH)?
APH refers to vaginal bleeding that occurs at ≥ 28 weeks gestation at any time prior to delivery.
What are the initial management steps for a patient presenting with APH?
Immediately call for help and mobilize staff.
Evaluate the patient’s general condition, including vital signs.
Obtain IV access with 2 large-bore cannulae (16G).
Place a Foley catheter to monitor input and output.
Maintain SBP > 100 mm Hg and urine output > 30 ml/hr.
Send blood for FBC, U&Es, Cr, clotting time, and X-match.
Order at least 2 units of PRBC, FFP, and platelets or 2 units of whole blood if heavy bleeding.
Perform an ultrasound to assess fetal condition and rule out placenta previa or evaluate for placental abruption.
What is the Sher grading of Placental Abruption?
Grade 0: Asymptomatic with a small retroplacental clot.
Grade 1: Vaginal bleeding, possible uterine tetany/tenderness, no maternal shock or fetal distress.
Grade 2: Possible external vaginal bleeding, no maternal shock, signs of fetal distress.
Grade 3: Possible external bleeding, marked uterine tetany, persistent abdominal pain, maternal shock, fetal demise (3a), and coagulopathy (3b).
What is the grading system for Placenta Praevia?
Grade I: Low-lying placenta, does not reach the internal os.
Grade II: Marginal praevia, placental tissue reaches the internal os but does not cover it.
Grade III: Partial praevia, placenta partially covers the internal os.
Grade IV: Complete praevia, placenta completely covers the internal os
What is the recommended management for Abruptio Placentae with fetal heart present?
Deliver immediately if the fetus is viable (≥ 28 weeks EGA or EFW ≥ 1000 g). If absent fetal heart, consider vaginal delivery unless there is heavy bleeding or high maternal mortality risk, then perform a caesarean delivery regardless of fetal status
What is the management of uterine rupture?
Immediate action: Emergency laparotomy is required.
Surgical intervention:
Attempt to repair the rupture if possible.
If repair is not feasible, perform a hysterectomy.
Post-operative care:
If the uterus is repaired, counsel the patient that all subsequent deliveries must be by caesarean section.
Advise the patient to seek early antenatal care at a central hospital in future pregnancies.
Document the operative findings and advice in the patient’s health passport.
What are the key clinical features of Placenta Praevia?
Painless per vaginal bleeding (PVB).
Relaxed uterus.
Abnormal lie or high presenting part.
Fetal heart sounds usually present.
May or may not be associated with shock
How should Placenta Praevia with heavy APH be managed, especially if gestational age (GA) is ≥ 28 weeks?
Prepare for caesarean delivery.
What is the management approach for Placenta Praevia with minimal/moderate APH and preterm gestation?
Admit to Antenatal Ward.
Transfuse as needed, pending Hb levels.
Maintain IV access with large-bore cannulae.
Perform obstetric ultrasound.
Administer steroids if GA is < 34 weeks.
What steps should be taken if Placenta Praevia is found on routine ultrasound without APH?
Admit to the antenatal ward at GA ≥ 28 weeks.
Administer a course of dexamethasone.
Plan for elective Cesarean delivery between 36-37 weeks gestational age.
What precautions should be taken for Placenta Praevia with a previous uterine scar?
Be prepared for potential postpartum hemorrhage (PPH).
Be prepared for placenta accreta/increta.
Prepare blood products and counsel the patient about the possibility of a hysterectomy
What are some of the non-obstetric causes of antepartum hemorrhage?
Cervical Infection
vaginal infection
ectropion
vaginal tears
What is a Couvelaire uterus, and when is it observed?
A Couvelaire uterus is a life-threatening condition associated with placental abruption.
It occurs when blood from the abruption infiltrates the myometrium extensively enough to reach the serosa.
The condition gives the myometrium a bluish-purple tone that can be seen on the surface of the uterus.
This sign is typically observed at the time of cesarean delivery.
