Antepartum haemorrhage Flashcards
What is APH?
Bleeding before 24 weeks
What are the causes
abruption
placenta praevia
vasa praevia
What are lower genital tract sources of bleeding during pregnancy?
− Cervical polyps − Erosions − Carcinoma − Cervicitis − Vaginitis − Vulval varicosities
What is placental abruption?
where part of the placenta becomes detached from the uterus
what increases the risk of placental abruption
pre-eclampsia smoking IUGR PROM Multiple pregnancy polyhydramnios increased maternal age thrombophilia abdo trauma infection
What is the nature of bleeding in placental abruption?
bleeding may be localised to one placental area and therefore may be concealed and shock not in keeping w visible loss
What are the signs of placental abruption?
fetal anoxia or death tenderness - compression of uterine muscles by blood backache if posterior abruption uterine hypercontractibility (>5/10min) DIC If thrombosis[plastin released
What are some severe complications of placental abruption?
sheehans syndrome
renal failure
What are the clinical features of placental abruption
shock out of keeping with visible loss pain constant tender, tense uterus normal lie and presentation fetal heart: absent/distressed coagulation problems beware pre-eclampsia, DIC, anuria
How does abruption differ to placenta praevia
in praevia - shock is in proportion to visible loss no pain uterus not tender fetal heart normal small bleeds before large
What is placenta praevia?
placenta lies in the lower segment of the uterus
What is the management of APH w mild bleeding?
Crossmatch
HR, BP, blood loss
Establish diagnosis: US, speculum
If diagnosis is placenta praevia: keep in hosp, CS at 37-28w
What is the management of severe bleeding w APH?
DELIVER - CS for placenta praevia IVI Take bloods Raise legs Give O2
What is the management of shock w APH?
Give fresh ABO Rh compatible or O Rh-ve blood until systolic BP >100mmHg
How should 3rd stage of labour be managed?
syntometrine
