APH Flashcards

1
Q

What is the definition of an APH?

A

Bleeding from or into the genital tract, occuring from 24+0 weeks - prior to birth of the baby.

(RCOG)

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2
Q

There are no consistent definitions of the severity of an APH, but in what 4 catergories is it typically broken down into?

A

Spotting- staining/streaking of blood in underwear or on pad

Minor haemorrhage- blood loss >50mls and settles

Major haemorrhage- blood loss of 50-1000mls with no signs of clinical shock

Massive haemorrhage- Blood loss >1000mls with signs of clinical shock

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3
Q

What are the two most important causes of APH?

A

Placenta praevia and Placental Abruption

(Although not the most common causes)

(RCOG)

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4
Q

What are the risk factors for placental abruption?

A
  • previous abruption (reoccurs in 19-25% of those who have had 2x previous)
  • pre-eclampsia
  • FGR
  • Low BMI
  • Abdominal trauma (Accident/Dom Violence)
  • Polyhydramnios
  • FGR
  • PROM
  • Advanced maternal age and multiparity
  • Smoking and drug use (amphetamines/cocaine) during pregnancy
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5
Q

What are the risk factors for placenta praevia?

A
  • previous praevia
  • previous LSCS
  • previous TOP
  • multiparity
  • advanced maternal age >40
  • smoking
  • assisted conception
  • deficient endometrium due to: uterine scars, fibroids, prev manual removal of placenta or previous endometrisis (inflammation of endometrium/inner lining of uterus)
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6
Q

What are the maternal complications of an APH?

A
  • Anaemia
  • infection
  • Maternal Shock
  • Renal Tubular necrosis
  • PPH
  • complications of a blood transfusion
  • Risk of DIC
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7
Q

What are the fetal complications of an APH?

A
  • Hypoxia
  • SGA and FGR
  • Premature delivery
  • Fetal Death
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8
Q

How is placenta praevia clinically presented?

A

-Signs of hypovolaemia (pale, sweating, tachycardia, increased RR, decreased BP and urine output)

  • Painless bleeding
  • Soft Uterus
  • Often no fetal compromise
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9
Q

How is placental abruption clinically presented?

A
  • signs of hypovolaemia
  • concealed or revealed bleeding
  • severe, constant abdominal pain
  • tender, rigid uterus
  • fetal compromise
  • risk of DIC
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10
Q

How is a uterine rupture clinically presented?

A
  • signs of hypovolaemia
  • sudden onset of constant pain
  • presenting part is high
  • bleeding, which may be concealed
  • pathological CTG
  • contractions may cease
  • haematuria
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11
Q

How is vasa praevia clinically presented?

A
  • PV bleeding following ROM
  • Acute fetal compromise
  • Sinusoidal CTG trace
  • Fetal Bradycardia
  • No change in maternal condition

(Fetal blood- catastrophic to fetus)

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12
Q

Management of Massive APH?

A
  • Obstetric emergency- call for soaps. 2222 for neonatologist (may need to transfuse baby) and haematoligist.
  • Lay mother on left lateral positon
  • Give high flow oxygen 15L/min
  • Gain IV access x2
  • take bloods: FBC, clotting, g&s, Xmatch 4 units and check Rh status.
  • Rapid fluid replacement x2 of crystalloid, haartmans or 0.9% saline
  • Assess fetal wellbeing via continuous CTG
  • Maternal obs (resps, BP, pulse and sats)
  • find source of bleed, clinical history
  • examine abdomen for tone/pain
  • measure blood loss
  • fluid balance
  • consider expediting birth and mode of birth
  • advise active management of 3rd stage followed by IV syntocinon infusion for 4 hours (40iu of synt to 46ml of saline)
  • hourly fluid balance assessment following birth
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