Antepartum Haemorrhage

Question 1

Ongoing management of antepartum haemorrhage

Answer 1

Inpatient mx unless no/minimal bleeding

• Bed rest
• maternal/fetal monitoring
• paeds consult
• Weekly FBE
• correct anaemia orally
• consider corticosteroids
• anti-D as req
• U/S every 2 weeks

Question 2

causes of Antepartum haemorrhage

Answer 2

Obstetric vs non obstetric

Obstetric

• Placental (abruption/praevia)
• Fetal (Vasa praevia)
• Uterus (rupture)

Non Obstetric

• lower genital tract (vaginal or cervical e.g. polyp/CA/cervicitis)
• Bleeding confused w Vaginial (haemorrhoids/UTI)

Question 3

Short term management

Answer 3

• ADMIT TO HOSPITAL
• Maternal resuscitation
• assess fetal well being
• Ascertain Diagnosis
• Delivery (no tocolytics)

Question 4

Investiagions for antepartum haemorrhage

Answer 4

• Imaging (TV Ultrasound)
• Monitoring (CTG)
• Bloods (FBE, Coags, Group and Hold, LFTs)
• Other: Kleihauer if Rh neg

Question 5

Bleeding and pain (back pain/uterine tenderness/contractions) are features of what condition?

Answer 5

Placental abruption

Question 6

Symtoms of placental abruption

Answer 6

Bleeding
PAIN (esp. back pain)
painful uterine contractions
fetal distress
maternal haemodynamic compromise

Question 7

Risk factors for placental abruption

Answer 7

• Prior Hx of abruption
• Smoking
• PPROM
• SROM + polyhydramnios
• Trauma (accidental or abuse- ALWAYS SCREEN)
• Hypertensive disorders of pregnancy
• Intrauterine infections

Question 8

Management of placental abruption

Answer 8

Induction at 37+ weeks unless earlier maternal/fetal compromise

Question 9

Symptoms of placenta praevia

Answer 9

• Painless bleeding > 20 weeks, bright red
• maternal haemodynamic compromise
• decreased fetal movements
• CTG changes
• can be associated w uterine contractions or tenderness

Question 10

Risk factors for placenta praevia

Answer 10

• Prior praevia
• multiple pregnancy
• prior Cesarean
• multiparity
• assisted reproduction
• advanced maternal age

Question 11

Management of placenta praevia (ongoing Mx)

Answer 11

• Expectant management when safe to do so
• Elective CS at 37 weeks if stable
• Ultrasound every 2 weeks for fetal growth and placental location
• Correct anaemia (Fe supplements, transfusion if severe)
• Bloods (weekly FBE and group+hold, consider Anti-D)

Question 12

Acute management of placenta praevia bleeding

Answer 12

-IV Access and resuscitation fluids (+/- transfusion)
-Continuous CTG
-CONSIDER VASA PRAEVIA
-NO DIGITAL EXAM (unless in theatre prepped for CS)
-Bloods (FBE, coags, X-match, Anti-D)
-Ultrasound TV
_consider corticosteroids