Antepartum Hemorrhage Flashcards
What is the first line killer in obeststricS?
hemorrhage (wither antepartum post partum or intrapartum) but mostly postpartum
What are the other causes of maternal death?
Hemorrhage, embolism, hypertensive disease, infection
What is antepartum hemorrhage
Bleeding in late second trimester or third trimester
What does painful bleeding at third trimester indicate
Abruptio placenta
What are the causes of painless bleeding in the 3rd trimester
Placenta previa
What are the most common causes of antepartum hemorrhage?
1- placenta previa
2- abriptio placenta
What are the other causes of APH?
- local causes
- uterine rupture
- vasa previa
- bleeding disorder
- uknown
Can uterine rupture present as bleeding
Yes but not the most common presentation
The most common causes of bleeding is
Maternal or fetal
Mostly materna, if it was vasa previa then it is fetal
When is it okay to preform digital examination of cervix for patient presenting with antepartum hemorrhage
Only after ruling out placenta previa on ultrasound
Why avoid digital examination of cervix in patient with placenta previa?
Because she might cause moblization & further damage
Is sterile speculum examination recommended for patients with antepartum bleeding
Yes to rule out local causes of bleeding (tears, leisons, assess bleeding severity, cervix open or not)
What are the investigations you’d like to order in antepartum bleeding
CBC, coagulation profile, types\crosshatched 4 units of blood, US, NST
Why do coagulation profile (PT,PTT) in patients with antepartum bleeding?
Because it might cause DIC and provide these patients with fresh frozen plasma or cryoprecipitate
What is the role of gestational age in antepartum hemorrhage
Should i do C\S, delivery or management
(If severe»_space; always C\S
If mild & stable»_space; GA 36\37= deliver - 28\29= manage
What is the most comon type of abnormal placentation & anteparrtum hemorrhage?
Placent previa
What are the predisposing factors for placenta previa
1- multiparity & multiple gestation
2- increased maternal age
3- prev placenta previa
4- C\S
What are the classifications of placenta previa?
Complete, partial, marginal, low lying
How to deliver paitents with complete, partial, marignal, low lying placenta
- Complete & partial: always C\s
- Marginal: depend on case
- Low lying: no bleeding, high enough to not touch cervix then do NVD
What is previa
Covering the os with placnta Completey: complete Partially: partial Marginal: the edge is on the edge Low lying: the edge is <2cm from the edge
At which trimester it’s okay to confirm placenta previa
After 28 weeks, because it might grow
But if it’s complete, then it’s less likely to grow
What to do if the placenta is low but it’s >2cm away from the OS
No need to document or follow up
How to diagnose placenta previa?
1- clinically: painless bleeding
2- US
Which type of US is more accurate in detecting placenta previa
Transvaginal US (diff if it’s post or lateral)
What are the precaution tips to give patients with placenta previa?
1- no intercourse
2- no digital exam
3- come to ER with any bleeding
