Antepartum Haemorrhage Flashcards
what are risk factors for antepartum haemorrhage?
- abnormal placental insertion e.g. placenta praaevia/placenta accreta
- vasa praevia
- abnormal cord insertion into the placenta
- trauma
- substance use (including smoking)
- hypertension
- past history of APH
- Multiple pregnancy
- high parity
- polyhydramnios
- uterine anomalies or tumours
- Anaemia
- Haemorrhaging disorders
what are the majority of the APH associated with?
the placenta
what are the major causes of antepartum haemorrhage?
- placenta praevia
- placental abruption
- vasa praevia
- abdominal trauma (RTA eg)
What is placenta praevia?
occurs when the placenta has implanted in part, or completely, in the lower uterine segment and is encroaching upon, or covering the internal cervical os
how is placenta graevia graded?
- grade 1 (1st degree)
- part of the placenta lies in the lower segment but does not reach the os - grade 2
- the lower margin of the placenta reaches the internal os but does not cover it - grade 3
- the placenta covers the os - grade 4
- the placenta lies centrally over the os
regarding placenta praevia, how many cm does the placenta need to be away from the cervical os?
> 2cm
what is a placental abruption?
separation of a normally implanted placenta after 20 weeks of pregnancy and before birth
what are risk factors for placental abruption?
- hypertensive disorders
- previous APH
- Abdominal trauma resulting from motor vehicle accidents, domestic violence or falls
- maternal drug use
what are the 3 causes of placental abruption?
- revealed or marginal
- concealed
- combined or partially revealed
Symptoms of placental abruption?
- tense, tender uterus
- uterine irritability (high frequency/low intensity type contractions)
- dark red vaginal blood loss
- reduced or absent fetal movements
- clinical signs of shock more severe than visible blood loss
When does the Vasa Praevia occur?
the umbilical cord vessels are in front of the presenting part, covered only by chorion and amnion
what are risk factors of Vasa Praevia?
- low lying placenta or placenta praevia
- succenturiate lobe or velementous cord insertion
- ivf or multiple pregnancy
What are the causes of a minor APH?
- Marginal placental bleeds
- cervical erosion
- blood stained show
what are steps to manage an APH?
- measure blood loss
- abdominal palpation (tone and tenderness)
- ISS to ascertain placental site
- do not perform a vaginal examination without first excluding placental praevia
- once excluded; speculum examination. consider VE to assess stage of labour
what is an antepartum haemorrhage?
bleeding from the genital tract from 24 weeks until onset of labour
