Antepartum haemorrhage Flashcards
WHt is antepartum haemorrhage?
Haemorrhage from the genital tract after 24th week of pregnancy, but before delivery
What are the causes of antepartum haemorrhage?
Placenta praevia Placental abruption Uterine rupture Vasa praevia Placenta accreta Local lesions Unknown
What is placenta praaevia?
Placenta attached to lower segment of uterus after 34 weeks- before this, termed low lying placenta
What are the grades of placenta praevia?
- encroaching on lower segment
- reaches internal os
- covers internal os
- central
What are the risk factors for placenta praevia?
Parity
Previs C section
Multiple pregnancy
What is the presentation of placenta praevia?
Asymptomatic
Painless PV bleeding
Soft, non tender uterus
Malpresentation- often oblique
What investigations are done for placenta praevia?
Transabdo US
NEVER do vaginal exam
What is the management of placenta praevia?
Dependent on severity and gestation
Require C section to deliver
What are the types of placental abruption?
Revealed= major haemorrhage apart externally
Concealed= haemorrhage between placenta and uterine wall
Mixed
hat are the risk factors for placental abruption?
Pre-eclampsia, hypertension Multiple pregnancy Parity Previous abruption Polyhydramnios Increasing age
What are the features of placental abruption?
Constant abdo pain
Contractions and increased uterine activity
Hard, tender uterus
Vaginal bleeding- can be inconsistent with patient’s condition
Decreased foetal movements and HR
What are the complications of placental abruption?
Maternal shock DIC Foetal death Renal failure PPH
What is uterine rupture?
Tear of muscular wall of uterus during pregnancy or labour
What are the features of uterine rupture?
Non specific Sharp abdo pain and peritonism PV bleeding Transabdo bleeding- can be catastrophic HAematuria
How is uterine rupture diagnosed?
Often clinical
