Antepartum Haemorrhage Flashcards
What is the definition of an antepartum haemorrhage?
ANY bleeding from the genital tract anytime past 22 weeks
What are the 4 types of antepartum bleeding?
Spotting
Minor
Major
Massive
Define minor antepartum haemorrhage?
<50mls
Typically settles on it’s own
Define major anterpartum haemorrhage?
50 - 1000mls
WITHOUT SIGNS OF SHOCK
Define massive antepartum haemorrhage?
> 1000mls
OR
Any blood loss with signs of shock
How can causes of antepartum haemorrhage be split?
MATERNAL
- Local
- Systemic
FOETAL
What 3 structures can bleed and be the local maternal causes of antepartum haemorrhage?
Placenta
Uterine
Cervical
What are placental causes of bleeding?
Placental abruption
Placenta praevia
Placenta accreta
What is placenta accreta and what commonly causes it?
Placenta implants in myometrium
What are the other malimplantation of the placenta deformities?
Placenta increta (almost at serosa)
Placenta percreta (all the way through)
What may cause bleeding from the uterus?
Asherman’s syndrome
Fibroids
What is asherman’s syndrome and what causes it?
Fibrotic cords that traverse the uterus and cause stricture
Typically caused by multiple surgery
What may be cervical causes of bleeding?
Polyps
Erosions
What are the systemic maternal causes of bleeding?
Thrombocytopenia
- ITP
- DIC
Von willebrands
What is a foetal cause of bleeding?
Vasa previa
What is vasa previa?
Umbillical cord compressed as lies over birth canal when foetus descends
Treatment of vasa previa?
Requires urgent C-section
What are the risk factors of placenta praevia?
Multiparity
Smoking
Previous c section
What is the grading of placenta praevia?
Low lying - edge of placenta between 2-3.5 cm from os
Marginal - edge within 2cm of os
Partial - doesn’t completely occlude os but covers some of it
Complete - os completely occluded
Treatment of low lying and marginal placenta praevia?
Should be a normal delivery but offered c section
Treatment of partial and complete placenta praevia?
c section
What tests should be done for antepartum haemorrhage?
Placental abruption must be excluded first
USS
Abdo exam
CTG
What may be seen on abdominal exam in placental abruption?
Woody abdomen
What examination must not be done in antepartum haemorrhage?
Vaginal exam
