Antepartum Haemorrhage

Question 1

Antepartum Haemorrhage Definition

Answer 1

• Bleeding from birth canal after 24th week of pregnancy (before birth)
• If before 24 weeks; miscarriage

Question 2

Antepartum Haemorrhage Aetiology

Answer 2

• No definite cause in 50% of women, placenta praevia and placental abruption are major causes
• Also local causes (infection, trauma, tumour)
• Partner violence
• Vasa praevia: bleeding from foetal vessels
• Uterine rupture
• Inherited bleeding problems

Question 3

Antepartum Haemorrhage Presentation

Answer 3

• Bleeding (if painless; praevia, if painful; abruption)
• Contractions may be provoked
• May be malpresentation with praevia
• May be foetal distress
• If severe, may be signs of shock
• Young, fit women can compensate very well until sudden and catastrophic decompensation occurs

Question 4

Antepartum Haemorrhage Management

Answer 4

• Always admit even if small amount
• Estimate volume of loss
• If severe bleeding mothers life should take priority, A-E management (with left lateral position)
• If foetal distress, urgent delivery
• No vaginal examination until placenta praevia excluded with USS; may initiate torrential bleeding.
• Bloods: FBC, group and save, clotting studies, crossmatch 4 units, U/Es, LFTs
• Gentle palpation of abdomen to determine gestational age, presentation and position
• Foetal monitoring
• Urgent USS (cannot exclude placental abruption (clinical diagnosis))
• If mother is R-neg, Kleihauer test and prophylactic anti-D immunoglobulin
• Maternal corticosteroids if 24-37 weeks

Question 5

Antepartum Haemorrhage Complications

Answer 5

• Premature labour
• DIC
• AKI
• Postpartum haemorrhage
• Placenta accreta