Anterpartum Haemorrhage Flashcards
What is antepartum haemorrhage
Bleeding from the genital tract between 20 weeks of gestation until the onset of labour. 24/40 as the cut off
What are some of the symptoms and parameters of antepartum haemorrhage?
- spotting: straining, streaking or blood spotting noted on underwear or sanitary protection
- Minor haemorrhage - blood loss less than 50 ml that has settled
- Major haemorrhage - blood loss of 50-1000 ml with no signs of clinical shock
- Massive haemorrhage : Blood loss greater than 1000 ml and/or signs of clinical shock
- Remember bleeding may be concealed look for signs of shock
Name 6 causes of Antepartum haemorrhage??
- Placental abruption
- Placenta praevia
- Marginal placental bleeding
- local causes: cervical/ vaginal/ uterine pathology
- uterine rupture (rare)
- Vas praevia (rare)
- Intimate partner violence
Maternal Antepartum haemorrhage complications
- anaemia
- infection
- maternal shock
- Renal tubular necrosis
- Consumptive coagulopathy
- Post partum haemorrhage
- Prolonged hospital stay
- Psychological Sequelae
- Complications of blood transfusions
Fetal antepartum haemorrhage complications
Fetal hypoxia
Small for gestational age, fetal growth restrictions
prematurity
Fetal death
what does placental abruption mean?
Premature separation of a normally planted placenta from the uterine wall prior to the delivery of the fetus
What are the risk factors for a placental abruption?
Trauma Smoking PPROM Previous abruption Smoking Cocaine use Hypertensive disorders of pregnancy
Clinical Presentation of placental abruption?
Vaginal bleeding
Uterine tenderness
Uterine contractions/ pain ( esp back pain)
Non reassuring fetal status
Maternal haemodynamic compromise if substantial blood lost
What is placenta praevia?
Placenta praevia occurs when the placenta is partially or completely in the lower uterine segment?
What is the difference between major and minor placenta praevia?
Major: Placenta covers the internal os
Minor: Placenta does not cover the internal os
What are the three types of placental adhesive disorders which generally coexist with placenta praevia?
Placenta accrete: morbidly adherent to the myometrium
Placenta increta: Invaded into, but not through , the myometrium
PLacenta percreta: invaded through the myometrium into the surrounding structures
Name the risk factors for placenta praevia
Prior placenta praevia Prior C section Prior ToP Multiparity Multiple pregnancy Advanced maternal age ART
Should a vaginal examination be performed if placenta praevia is suspected?
No massive iatrogenic haemorrhage may occur, a speculum examination is okay. Placental location should be routinely monitored in mid trimester Fetal morphology svan
What is the commonest local cause of antepartum haemorrhage?
Cervical Ectropian: Eversion of the endocervix exposes columnar epithelium to the vaginal milieu
What is a rare but serious causes of APH
Cervical malignancy
- pap smear must be checked
- HPV history
- Colposcopy
What are the scenarios where Uterine Rupture is likely to occur?
- Generally occurs in labour, in women with prior uterine surgery (C section, myomectomy)
- May occur prelabour
Sudden abdominal painat is the clinical presentation of uterine rupture?
- sudden abdominal pain
- Distension
- Hypovolaemic bleeding
- Management is with aggressive maternal resuscitation nd immediate laparotomy
- Fetal demise likely if delivery not effected within minutes
- Focus must be on maternal well being
What is vasa praevia?
Fetal vessels coursing through the membranes, below the fetal presenting part over the internal cervical os, unprotected by placental tissue or the umbilical cord.
It poses a minimal risk to the mother but a major risk to the fetus, especially due to low blood volume
If vessels rupture e.g. spontaneous or artificial rupture of membranes, then 60% mortality is reported
What is unexplained APH?
Often attributed to marginal placental bleeding or marginal separation that is not true abruption
Pregnancies with these complications at increased risk of adverse outcomes
Increased rates of pre-term birth, SGA babies, admission to NICU, still birth
Fetal anomalies also more common in this context
As a result women with APH are often induced at term 37+ weeks of gestation
