Antepartum Haemorrhage APH Flashcards
What is antepartum haemorrhage (APH)?
antepartum haemorrhage is vaginal bleeding from the genital tract after 24 weeks of gestation and before delivery of the baby.
What are the major causes of antepartum haemorrhage?
Causes include placenta praevia, placental abruption, vasa praevia, and local causes (e.g., cervical ectropion, infection, or trauma).
What is placenta praevia?
Placenta praevia occurs when the placenta partially or completely covers the internal cervical os.
What is placental abruption?
Placental abruption refers to the premature separation of the placenta from the uterine wall before delivery.
What is vasa praevia?
Vasa praevia is when fetal blood vessels traverse the cervical os, unprotected by the placenta or umbilical cord.
How is antepartum haemorrhage classified by severity?
antepartum haemorrhage is classified as minor (<50 ml blood loss) or major (≥50 ml blood loss), with major further divided into moderate and severe.
What are the risk factors for placenta praevia?
Risk factors include previous placenta praevia, multiple pregnancies, advanced maternal age, and previous caesarean sections.
What are the risk factors for placental abruption?
Risk factors include maternal hypertension, trauma, smoking, cocaine use, previous abruption, and multiple pregnancies.
What are the clinical features of placenta praevia?
Features include painless vaginal bleeding, often in the third trimester, and soft, non-tender uterus.
What are the clinical features of placental abruption?
Features include painful vaginal bleeding, uterine tenderness, contractions, and signs of maternal or fetal compromise.
What are the potential complications of antepartum haemorrhage for the mother?
Complications include haemorrhagic shock, disseminated intravascular coagulation (DIC), and maternal death.
What are the potential complications of antepartum haemorrhage for the fetus?
Complications include fetal hypoxia, preterm delivery, intrauterine growth restriction (IUGR), and stillbirth.
What is the initial management of antepartum haemorrhage?
Management includes ABC assessment, IV access, resuscitation with fluids or blood products, and monitoring maternal and fetal wellbeing.
How is placenta praevia diagnosed?
Diagnosis is made via transabdominal or transvaginal ultrasound to identify the position of the placenta relative to the cervical os.
How is placental abruption diagnosed?
Diagnosis is clinical, supported by history, examination findings, and ultrasound to assess for retroplacental haematoma.
What is the role of ultrasound in antepartum haemorrhage?
Ultrasound identifies the location of the placenta and assesses for retroplacental haematoma or fetal wellbeing.
What investigations are performed in antepartum haemorrhage?
Investigations include full blood count (FBC), coagulation profile, group and save, crossmatch, and Kleihauer test if Rhesus-negative.
What is the Kleihauer test, and why is it performed in antepartum haemorrhage?
The Kleihauer test detects fetal red blood cells in maternal circulation to determine the need for anti-D immunoglobulin.
How is placenta praevia managed?
Management includes monitoring, corticosteroids for fetal lung maturity, and planned delivery via caesarean section if persistent.
How is placental abruption managed?
Management involves stabilisation, continuous fetal monitoring, and expedited delivery if maternal or fetal compromise occurs.
What is the management of vasa praevia?
Immediate caesarean delivery is required if vasa praevia is suspected or diagnosed to prevent fetal exsanguination.
When is delivery indicated in antepartum haemorrhage?
Delivery is indicated for maternal instability, fetal compromise, or significant ongoing bleeding.
What are the differential diagnoses for antepartum haemorrhage?
Differential diagnoses include cervical ectropion, vaginal trauma, cervical cancer, and infections like cervicitis.
What is the role of corticosteroids in antepartum haemorrhage?
Corticosteroids are administered to promote fetal lung maturity if preterm delivery is anticipated.
What is the prognosis for antepartum haemorrhage?
Prognosis depends on the cause, severity, and promptness of treatment, with early intervention improving maternal and fetal outcomes.
How can antepartum haemorrhage be prevented?
Prevention involves addressing modifiable risk factors like smoking, hypertension, and ensuring proper antenatal care.
What psychological support might be needed for women with antepartum haemorrhage?
Women may need counselling and support to cope with anxiety, trauma, or grief associated with antepartum haemorrhage.
