antepartum haemorrhage - GM Flashcards
define APH
genital tract bleeding from 24 weeks gestation and complicates 3-5% of pregnancies
three most important causes of APH
placenta praevia, placental abruption and vasa preavia
less serious causes of APH
lower genital tract sources eg. cervical polyps, vaginitis and cervicitis
why does placenta previa increase the likelihood of APH
poor attachment of the placenta to the uterine wall
marginal placenta praevia
less than 2cm from the os
complete placenta praevia
complete coverage of the cervical os
placental abruption define
complete or partial detachment of the placenta before delivery
risk factors for placental abruption
maternal age greater than 35
multiparity
current pre-eclampsia, HELLP
Hx of hypertension
Hx of previous abruptions
Hx of anti-phospholipid syndrome
Hx of thrombophilia
smoking during pregnancy
use of cocaine during pregnancy
tramua
over distension of the uterus - polyhydramnios, twins
History of placental abruption
abdo pain - posterior placental abruptions may present with back pain
vaginal bleeding
uterine contractions
dizziness and/or loss of consciousness
revealed vs. concealed placental abruption
amount of blood loss often correlates poorly with the degree of abruption
abruption may be revealed where blood tracks between membranes and out of the vagina
may however be concealed where the blood accumulates with no obvious external bleeding
clinical findings of placental abruption include
woody, tense uterus
fetal heart absent or distressed
imaging for placental abruption
US required to identify location of the bleed
lab investigations of placental abruption
FBC, U&Es, LFTs, helps exclude hypertensive conditions such as HELLP or pre-eclampsia
clotting profile
kleihauer test
group and save
crossmatch
differential diagnoses for placental abruption
placenta praevia
vasa praevia
marginal placental bleed: partial abruption
uterine rupture
local causes: polyps, carcinoma, cervical ectropion, infection
initial management for APH
call for help
AA-E
replace fluids
2 large bore cannulas
left lateral position
prepare for theatre if severe
IV fluids
FHR
rin relief, anti-D if negative blood group
consider corticosteroids
management of placental abruption if the fetus is alive
if there is no signs of fetal distress: observe closely and induce and deliver vaginally if over 36 weeks
if there is signs of fetal distress: immediate C-section