Antepartum Haemorrhage [ General ]

Question 1

What is the definition of APH ?

Answer 1

Any bleeding occuring from the genital tract after the period of viability but before the birth of the baby .

Period of viablitity is taken after 24 weeks of gestation

Question 2

what are the causes of the APH ?

Answer 2

1. Miscarriage.
2. Placental :

A. Placenta praevia
B. Placenta abruption [Revealed / Concealed / Mixed ]
C. Vasa praevia

3. Local causes :

A. Cervicitis
B. Cervical ectropian
C. Cervical carcinoma 
D. Vaginal trauma
E. Vaginal infection

4. Uterine causes:

A. Rapture.

Question 3

What are the history that you would like the patient ?

Answer 3

1. Onset of bleeding and any triggering.
2. Duration and amount of bleeding.
3. Associated and amount of bleeding.
4. Foetal well - being - movement
5. Last cervical smear ( normal / Abnormal )

Question 4

What are the examination that we can do in patient with APH ?

Answer 4

Speculum Vaginal Examination: - After excluding placenta praevia:

# General : 
---------------------------
A. Pale 
B. Pulse 
C. Blood pressure

A. Check on the uterus whether it is soft or tender and firm.
B. Assess the gestational age and presentation.
C. Look for the fetal heart auscultation / CTG
D. Transabdominal ultrasound - to exclude placenta praevia.

A. To visualize the cervix ( having established that placenta is not a praevia , preferably using a “portable ultrasound machine” ).

Question 5

What are the placenta praevia ?

Answer 5

Abnormal location of the placenta at or near the internal cervical OS .