Antepartum hemorrhage Flashcards
Definition
Bleeding after 20 weeks, prior to labour
Definition
Bleeding after 20 weeks, prior to labour
Incidence
3-5%
Etiology
Uterine: placenta previa, placental abruption, vasa praevia, circumvallate placenta
Lower genital tract: cervical extropion, polyp, carcinoma, cervicitis, vaginitis
Unknown in 50%
Association of preterm infants and APH
20% preterm infants result of APH
History
Amount of bleeding Onset Pain Contractions Mucoid discharge Triggering event-> intercourse (ectropion etc) Last pap smear STD history
Most important distinguishing feature between placental abruption and placenta praevia
Constant abdominal pain
Examination
Maternal well being: Pulse, BP, T Pallor Abdominal tender, distension, ridigity Speculum for cervical abnormalities Digital examination- only when placenta praevia excluded, when contractions, to assess progress of cervix
Fetal well being:
Abdominal palpation for lie/presentation/engagement
CTG
Investigations
FBC Group hold/screen, cross match Rhesus-->?Anti-D Urine UEC LFT Coagulation profile Kleihauer tests
What is the Kleihauer test and what does it indicate
Blood film->shows fetal RBCs in maternal circulation indicating placental abruption
Definition of placenta praevia
Placenta encroaches on lower segment
Define the lower segment of uterus
Etiology of placenta praevia
Multiparity Multiples Previous cesaerean Smoking \+Age Fetal anomalies
Grading of PP
1: At lower segment, not reaching os
2: Reaches os, does not cover
3: Covers os only when not dilated
4: Covers os even when dilated
Presentation of PP
Diagnosed on US Painless bleeding Pain->10% also have placental abruption Postcoital bleeding Spotting
Placenta previa and bleeding
ABCs 2 large IV cannula, IDC Infusion NS Bloods group/screen/xmatch, anti-Dif Rh negative Avoid all vaginal examination USS, gentle speculum If anemia, no longer bleeding, 10.5 Continue until can do C section Consent and book for C section Be sure to always have group and hold up to date- risk of PPH If
Placenta previa and bleeding
ABCs 2 large IV cannula Infusion NS Bloods group/screen/xmatch, anti-Dif Rh negative Avoid all vaginal examination USS, gentle speculum If anemia, no longer bleeding, 10.5 Continue until can do C section Be sure to always have group and hold up to date- risk of PPH
When might you consider an MRI
If suspect placenta accreta
Why is there +risk of post partum hemorrhage in PP
Lower segment does not contract as well and therefore less compression of the placental vessels
Recurrence rate of PP
4-8% in subsequent pregnancies