Antepartum Haemorrhage (APH) Flashcards
define antepartum haemorrhage
bleeding >24 weeks and before the 2nd stage of labour
major APH
> 500ml
massive APH
> 1,000ml with or without shock
causes of APH
placental abruption placental praevia placenta accreta uterine rupture vasa praevia
what is placental abruption?
separation of a normally implanted placenta so blood escapes into the amniotic sac interrupting placenta circulation
RF for placental abruption
PET trauma drugs abnormal placenta polyhydramnios
presentation of placental abruption
severe continuous abdo pain painful bleeding maternal collapse tense uterus (woody abdomen) unable to feel foetal parts with foetal demise
management of placental abruption
resuscitation of mother
delivery of baby
what is placenta praevia?
low-lying placenta <20mm from internal os
what is placenta praevia associated with?
previous C/S
grading of placenta praevia
- lower half of uterus
- near but doesn’t cover the cervical os
- partially covers internal os
- covers os
presentation of placenta praevia
painless bleeding
can be triggered by coitus
foetal movements present with no distress
diagnosis of placenta praevia
screened at anomaly scan
re-scanned 32 and 36 weeks TVUS
do not perform DRE or vaginal exam
CTG normal
management of placenta praevia
C/S if <2cm
needs consent for hysterectomy and GA risks
what is placenta accreta?
placenta is abnormally adherent to the uterine wall
RF for placenta accreta
previous C/S and endometrial ablation
define invasion of myometrium
placenta increta
invasion of the bladder
placenta percreta
presentation of placenta accreta
severe bleeding
doughy abdoemn
management of placenta accreta
internal iliac artery balloon
C/S hysterectomy
what is uterine rupture?
full thickness opening of the uterus including the serosa
risk factors for uterine rupture
previous C/S or uterine surgery
presentation of uterine rupture
severe abdo pain + shoulder tip pain
PV bleeding
maternal collapse
foetal distress and loss of engagement
management of uterine rupture
resuscitation
C/S +/- hysterectomy
uterine relaxation with terbutaline, nitroglycerin (beta-mimetics)
