Antepartum Haemorrhage (APH) Flashcards
what is APH?
bleeding after 24 weeks and before 2nd stage of labour (delivery of the baby)
quantifying APH
spotting
minor= <50ml
major= 50-1,000ml, no shock
massive= >1,000ml and/or shock
causes
placental abruption placental praevia placental accrete uterine rupture vasa praevia
what is placental abruption?
separation of a normally implanted placenta
blood escapes into amniotic sac and there is interruption of placental circulation
what does placental abruption cause?
couvelaire uterus (haematoma bruised uterus)
risk factors for placental abruption
PET trauma drugs abnormal placenta polyhydramnios
presentation of placental abruption
severe continuous abdominal pain (backache if posterior placenta)
painful bleeding
preterm labour
maternal collapse
what is a potential cause of placental abruption
in association with trauma
diagnosis of placental abruption
large tense uterus
woody abdomen
unable to feel foetal parts
foetal demise
management of placental abruption
resuscitate mother
delivery of baby= urgent C/S or IOL by amniotomy
what is placental praevia?
placenta lies over the internal os
define a low-lying placenta
after 16 weeks the edge is <20mm from the internal os
what increases the risk of placental praevia?
C/S
presentation of placental praevia
painless bleeding >24 weeks (3rd trimester)
usually unprovoked but can be triggered by coitus
foetal movements present/ no foetal stress
diagnosis of placental praevia
screening at foetal anomaly scan (18-20 weeks)
re-scanned at 32 and 36 weeks
do NOT perform vaginal or PR exam
CTG normal
what do you not do in placental praevia?
perform a vaginal or PR exam
management of placental praevia
C/S if placental covers os or <2cm
need consent for hysterectomy and risk of GA
when can a vaginal delivery be done in placental praevia?
placenta >2cm from os and no malpresentation
what is placenta accrete?
placenta is abnormally adherent to the uterine wall
what increases the risk of placenta accrete?
multiple C/S
post-endometrial ablation
what is an increta?
placenta has invaded the myometrium
what is a percreta?
placenta has invaded the bladder
which condition do you always give contraception in?
placenta accrete
presentation of placenta accreta
severe bleeding
doughy abdomen
management of placenta accreta
internal iliac artery balloon
C/S hysterectomy
what is uterine rupture?
full thickness opening of the uterus (including serosa)
risk factors for uterine rupture
previous C/S
uterine surgery
presentation of uterine rupture
severe abdominal pain shoulder tip pain PV bleeding maternal collapse foetal distress and loss of engagement
risk factors for uterine rupture
previous C/S or surgery
management of uterine rupture
resuscitation- tranexamic acid
what is vasa praevia?
unprotect foetal vessels transverse the membranes below the presenting part over the internal os
what will happen in vasa praevia?
vessels will rupture during labour or amniotomy
what is vasa praevia associated with?
vessel connected to a velamentous umbilical cord or connect placenta with a succenturiate or accessory lobe
presentation of vasa praevia
foetal blood + sudden foetal distress
dark red bleeding
diagnosis of vasa praevia
USS TA and TV with doppler
management of vasa praevia
elective C/S before labour (34-36 weeks)
if APH, emergency C/S
