APH Flashcards
Incidence of APH is
4-5% of pregnancies
Mention causes of APH
Obstetric causes
Placental hge:placental abruption placenta previa
Extra placental hge : genital trauma,uterine perforation
Fetal cause: vasa previa rare
Unexplained APH frequently attributed to marginal separation of the placenta
Non obstetric causes
Local inflammatory severe vaginitis neoplastic carcinoma trauma
Cervical erosion and polyp
General htn liver failure
Define placenta previa
Placenta that encroaches partially or totally on the LUS
Incidence of placenta previa is ……
It is increasing dt …….
1/200 , 0.5%
It increases dt 1)increase frequency of CS
2)Increase number of pregnancies at an older maternal age
What are causes of placenta previa
Personal causes RISK FACTORS
_A_ge> 1% at 35 y or more
_P_arity >2% in para 5
_C_S >3.5% in prior 5CS
Obstetric causes
Previous pp
Multifetal pregnancy twins and triples
Other causes of large placenta bipartite or multipartite
Explain pathogenesis of placenta previa
It occurs when cervix and LUS undergo changes that cause shearing forces to inelastic placental attachment site
Vaginal examination and colitis can cause bleeding by destructing ipthe intervillous space
Bleeding is usually maternal
Minor placenta previa are…..,…..
Major are…..,…….
Marginal_ low lying parietal pp
Partial and total pp
When the age of placenta encroaches LUS but doesn’t reach the margin of internal os
It is called ………….
According to amarican institute
Normal placental edge…..from internal os
Low lying……
Pp……
Low lying placenta
________________________________
>20mm
<20mm
Covering the internal os
What are the complications of placenta previa
maternal
1)A antepartum hge anemia if severe shock
2)P postpartum hge dt 3T
A) Atony dt anemic uterus &passive LUS è weak contractility
B) Traumatic dt weak friable vascular LUS more vulnerable for laceration
C) Retained tissue dt placenta accreta and uterine atony
3) placenta accreta in 5% ofcases dt poor decidua in LUS
4) A Amniotic embolization ==>anaphylactic shock
5)preterm premature ROM, PPROM
6) Fetal malpresentation
7) Puerperal sepsis
8) remote complications recurrence
Fetal complications
Preterm premature ROM PPROM
Congenital malformation
Fetal distress
IUGR , IUFD
Vasa previa and filamentous umbilical cord
Neonatal complications
Asphyxia and anemia
Mention symptoms of vaginal bleeding
Recurrent painless causeless vaginal bleeding at the end of second trimester
Painless ,painful if in labour
Causeless may be dt cause vaginal examination,coitus
Bleeding bright red in colour mild but may be severe in recurrent attacks
Symptoms of anemia and hypovolemic shock
Signs of pp
GE
according to amount of bleeding
Single Mild attack GE may be not affected
Moderate pallor
Severe signs of hypovolemic shock
AE
Fundus level to the date of amenorrhea except if complicated
Fundal and umbilical grips the abdomen is lax ,uterus is soft & fetal parts are easily felt
Pelvic grip ,malpresentarion
Auscultation FHS May be normal distressed or absent according to severity
Pv#
Investigations of APH are
A) imaging
TAS is the initial for placental localisation(echogenic homogenous placental tissue)
If the placental edge is 20mm away from internal os
A diagnosis of pp is excluded
Asuspected diagnose of pp at 20wks by TAS should be confirmed by TVS
Fup imaging
Suspected minor pp can be left until 36 wks of Gestation
Suspected major pp /p accreta FUP.US should be performed at 32 wks of Gestation
Us also imp to exclude other causes of APH, EFWT and excludes IUGR
MRI , Colour Doppler and 3d power Doppler can also beused to diagnose placenta accreta
B) laboratory
CBC blood grouping RH type and antibodies
Other routine antenatal screening urine and screening of DM
C) Tsts of fetal wellbeing
NST,BPP& Doppler US as indicated
