Antepartum Haemorrhage Flashcards
What is APH?
Bleeding >24 weeks of pregnancy
What are important causes of APH?
Placental abruption
Placenta praevia
Vasa praevia
What are risk factors of placental abruption?
History of previous abruption
PET
Multiple pregnancy
Increasing age
Smoking
Proteinuric HTN
Cocaine use
What are symptoms of abruption?
Sudden onset severe abdo pain
PV bleeding- may be minimal
Tender, woody uterus
Shock out of keeping with visible loss
What investigations are used in abruption and what is the management?
Clinical Diagnosis
CTG monitoring required
Resuscitate
If no foetal distress- consider urgent C section
If no foetal distress and
- >37 weeks induce labour
-< 37 weeks admit, give steroids if needed
What is placenta praevia?
Low lying placenta which overides the internal cervical OS
What are associated factors in placenta praevia?
Multiparity
Multiple pregnancy
Previous C section
Fibroids
What are the symptoms of placenta praevia?
Painless PV bleeding
Shock in proportion to loss
How is placenta praevia diagnosed?
Transvaginal US
Do NOT exam as increases risk of haemorrhage
What is the management of placenta praevia?
If found at 20 week scan
-rescan at 32 weeks to confirm
- If present then scan every 2 weeks
- 36 week scan to determine mod of delivery
- C section at 37-38 weeks if grade II/IV
- grade 1 can trial vaginal delivery
What is the grading of placenta praevia?
1- placenta reaches lower segment but not internal os
2- placenta reaches internal os but does not cover
3- placenta covers internal os prior to dilation but not when dilated
4- placenta completely covers internal os
What is vasa praevia?
Foetal blood vessels are exposed and run across or near to internal os
What are features of vasa praevia?
Bleeding following rupture of membranes with foetal distress (bradycardia)
Painless bleeding
Need planned C section 34-36 weeks to avoid ROM- give steroids
