Antepartum Haemorrhage

Question 1

What are the 5 assessment points in an APH?

Answer 1

1. Perfusion status
2. External bleeding
3. Pt Hx
4. Abdominal pain
5. > 20 weeks gestation

Question 2

If ?APH, but no signs of altered perfusion, what is the Mx?

Answer 2

Place pt in left lateral tilt.

Tx to obstetric hospital.

Question 3

If any clinical signs of altered perfusion, what is the Mx?

Answer 3

• Place pt in left lateral tilt
• Tx to obstetric hospital with notification
• If less than adequate perfusion, consider:
  Normal Saline IV (max. 40mL/kg) to pt response
  consult for further, or if no consult, rpt 20ml/kg
• Mx pain

Question 4

Why is the threshold for treating altered perfusion so low in APH?

Answer 4

• Internal bleeding may far greatly exceed visible external bleeding
• Signs of poor perfusion may present late and are always significant