Anteparum Haemorrhage Flashcards
What classes as an antepartum haemorrhage
Bleeding during pregnancy after 24 weeks from or into the genital tract.
Causes of antepartum haemorrhage
Placental abruption
Placenta praevia
Vasa praevia
Cancer (rare)
Localised trauma
What is placental abruption
Separation of the placenta from the uterine wall and decidua
Risk factors for placental abruption
Previous abruption
Pre-eclampsia
Bleeding early in pregnancy
Trauma
Multiple pregnancy
Fetal growth restriction
Multigravida
Increased maternal age
Smoking
Cocaine or amphetamine use
Low BMI
Presentation of placental abruption
Sudden onset severe abdominal pain which is continuous, vaginal bleeding, shock, CTG signs of fetal distress, ‘woody’ abdomen on palpation, suggesting large haemorrhage
What is a concealed abruption
Cervical os remains closed and any bleeding will be in the uterine cavity, so bleeding can be significantly underestimated.
Management of placental abruption
2 x grey cannula
Bloods
Crossmatch 4 units of blood
Fluid and blood resus
CTG monitoring
Close monitoring of mother
Assessing and treating placental abruption depends on what factors
Amount of placental separation, extent of bleeding, haemodynamic stability of mother and fetus
Treatment of placental abruption
Antenatal steroids for those between 24-34+6 weeks gestation.
anti-D prophylaxis and Kleihauer test.
Emergency C section may be required.
Active management of third stage of labour
Diagnosis of placental abruption
Clinical diagnosis, US used to rule out placenta praevia.
Guidelines to define the severity of antepartum haemorrhage
Spotting - spots of blood on underwear
Minor - less than 50ml loss
Major - 50-1000ml loss
Massive - 1000+ blood loss and signs of shock
What is placenta praevia
Placenta partially or fully within the lower uterine segment, placenta is over the internal cervical os
Risks of placenta praevia
Antepartum haemorrhage
Emergency caesarean
Emegency hysterectomy
Maternal anaemia and transfusions
Preterm birth and low birth weight
Stillbirth
Grade of placenta praevia
Grade 1 - placenta is in the lower uterus but not reaching internal cervical os
Grade 2 - placenta is reaching but not covering the internal cervical os
Grade 3 - placenta is partially covering the internal cervoical os
Grade 4 - placenta is completely covering the internal cervical os
Risk factors for placenta praevia
Previous caesarean
previous placenta praevia
older maternal age
maternal smoking
structural uterine abnormalities
assisted reproduction
Multiparity
Multiple pregnancy
Types of anterior placeta praevia
Acreta, increta and percreta
Presentation of placenta praevia
Seen on 20 week scan
Asymptomatic mainly
Painless vaginal bleeding
Later in pregnancy around 36 weeks
Management of placenta praevia
Repeat scans at 32 and 36 weeks gestation
Corticosteroids between 34-36 weeks
Planned pregnancy between 36-37 weeks
Urgent management for haemorrhage from placenta praevia
Emergency caesarean, blood transfusions, intrauterine balloon tamponade
uterine artery occlusion, emegency hysterectomy
What is a low lying placenta
Placenta is within 20mm of internal cervical os
How is a low lying placenta managed
Similar to placenta praevia
What is vasa praevia
When fetal vessels run unsupported in fetal membranes (surrounding amniotic cavity) and travel across the internal cervical os.
Two instances where fetal vessels can be exposed, outside protection of umbilical cord or placenta
Velamentous umbilical cord.
An accessory lobe of the placenta
What is a velamentous umbilical cord
Umbilical cord inserts into chorioamniotic membranes and fetal vessels travel unprotected through membranes before joining placenta.
