Antepartum Haemorrhage Flashcards
DDX of Antenatal bleeding
Placenta Praevia Placenta Abruption Unclassified bleeding eg Marginal, Show, Cervicitis, Trauma, Vulvovaginal Varicosities Genital Tumours Genital infections Vasa Previa Hematuria haemorrhoids
Differentiate between placenta previa and placenta abruption
Placenta previa occurs with Hx of placenta previa, multiparty, increase material age, multiple gestation, uterine tumour or fibroids, uterine scar and in painless.
Placenta abruption - Hx of previous abruption, HTN, vascular disease, cigarette smoking, lots of EOTH, Cocaine, Multiparty and age greater then 35yr, PPROM, fibroids, trauma, Painful.
Q to ask on Hx for antenatal bleeding
How much bleeding, are there contractions, cramping, pain, description, colour, clotting etc.
Levels of placenta invasion
Placenta accrete - AT myometrium - most common
Placenta increta - Into myometrium
Placenta percreta - through the myometrium
Mx of Placenta previa
Mx - prolong as long as possible, ABCD, large bore IV with hydration, Ox for Hypotensive pt, Monitoring, bloods, CTG, US. If less then 37 wk and minimal bleeding then expectant management - admit, limited physical activity or sex, steroids, delivery when fetus matures or haemorrhage dictates. If greater then 37 wks or profuse bleeding deliver by C/S.
Mx of Placenta abruption
Mx - ABCD - lg bore IV hydration, O2 for hypotensive pt, Monitoring Bloods, CTG, Give blood products as high risk of DIC, Kleihauer betke test, Mild abruption - less then 37 use serial Hct to assess concealed bleeding, deliver when fetus is mature or when haemorrhage dictates. If greater then 37 weeks stabilise and deliver. Moderate to severe abruption - Hydrate and restore blood loss and correct coagulation defect if present, vaginal delivery if safe or C/S if distress, or live fetus, or fail to progress.
Vasa previa
Blood from fetal veins in cord
Presentation - Painless vaginal bleeding and fetal distress, 50% perinatal mortality which increases to 75% in ROM.
Ix - Apt test to determine if bleed is baby or mum.
Mx - emergency C/S as fetus only has a small amount of blood.
Types of placenta praevia
Grade 1 - < 2cms from the internal OS Grade 2 - Reaches in the internal OS Grade 3 – Partially covering the OS Grade 4 – Placenta praevia minor Minor–Grade1&2 Major–Grade3&4
Cx of placenta praevia
Maternal APH PPH C/S Hysterectomy Maternal Morbidity Recurrence of risk Placenta accreta Fetal Pre-term Birth IUGR Congenital Malformations – double
Presentation of placenta praaevia
Unprovoked, painless vaginal bleeding or after S.I.
Pain – 10% have co-existing abruption
Malpresentation
Diagnosis of Placenta praaevia
DIGITAL VAGINAL EXAMINATION IS CONTRAINDICATED IN WOMEN WITH PLACENTA PRAEVIA”
Ultrasound scan – Transvaginal / Translabial
Define placenta praaevia
Insertion of placenta partially or wholly in the lower uterine segment
Types of placenta abruption
Concealed in 20-35%
Revealed in 65 – 80%
Cx of placenta abruption
Maternal Risks Maternal mortality Hypovolemic shock Acute renal failure DIC PPH Fetomaternal hemorrhage Fetal Risks Fetal mortality Pre-term delivery IUGR Congenital Malformation Fetal anaemia
Presentation of placenta abruption
PV Bleeding, 70 – 80% Abdominal pain Labour Abdominal tenderness – “woody hard” Fetal distress hypovolemia
