Antepartum haemorrhage Flashcards
definition
genital tract bleeding from 24 weeks gestation
causes APH
placental abruption, placenta praevia, vasa praevia, uterine rupture, cervical polyps, erosions, carcinoma, cervicitis, vaginitis
signs placenta praevia
shock in proportion to visible loss, NO PAIN, uterus non tender, lie and presentation may be abnormal, fetal heart usually normal, coag probs rare, small bleeds before the large
signs placenta rupture
shock out of keeping with visible loss, pain constant, tender tense uterus, normal lie and presentation, fetal heart absent or distressed, coag problems
what should you be worried about in placental rupture
pre eclampsia, DIC, anuria
what happens to risk of PPH in both praevia and rupture
increased risk. lower segment may not contract well after placenta praevia
what is placenta praevia
placenta lies in lower uterine segment. 0.5%
associations placenta praevia
c section, sharp curette TOP, multiparity, multipole pregnancy, mother >40, assisted conception, D&C, fibroids, endometriosis
management of major and minor placenta praevia
major- C section. minor- normal delivery
what is a minor placenta praevia
doesn’t cross the internal os
presentation APH
APH or failure of head to engage
management placenta praevia
no vaginal exam. assess blood loss and cross match. severe bleeding- urgent delivery if less severe and
what could happen to the baby in episodes of heavy bleeding
hypoxia
complications of placenta praevia
haemorrhage, placenta accreta or percreta
when would an elective c section be planned in placenta praevia
38 weeks
what is placental abruption
placenta becomes detached from uterus
associations abruption
IUGR, smoking, infection, vertex presentation, pre eclampsia, multiple pregnancy, polyhydramnios, incr age, thrombophilia, trauma, assisted reproduction
complications abruption
placental insufficiency, uterine compression leading to tender uterus, DIC, backache
what may concealed abruption lead to
maternal shock
investigations in abruption
FBC, USS, CTG
management abruption- when to admit patient
pain and uterine tenderness. IV fluids and steroids if
what should delivery be in abruption
urgent C section if fetal distress. induction of labour if >37 weeks and no distress
management minor pre term abruption
no distress. give steroids, monitor serial USS
what colour is the blood in praevia/abruption
praevia- fresh red, profuse. abruption- dark red, can be concealed and not bleed
what is placenta accreta
all or part of placenta abnormally attached to the myometrium
treatment placenta accreta
C Section hysterectomy. DIC common
what is released to cause DIC
thromboplastin
what is vasa praevia
fetal vessels lying within placental membranes which cross the internal os.
when is the vasa praevia at risk of tearing
when the membrane ruptures
when is vasa praevia more common
following IVF
