APH Flashcards
APH
Bleeding into the genital tract after 24 weeks prior to pregnancy
3 Causes of APH
PP
Vasa previa
Placental Abruption
What is Placenta Previa
Placenta present in the lower segment of the uterus and consists of 3 types:
1) Low lying 2-3cm from the os
2) Marginal - Encroaching os
3) Complete - Covering the os
RFs for APH
- Prev C section
- Prev placenta previa
- Multiple gestation
- Advanced maternal age
- Smoking
- Fibroids
Clinical Features of APH
- Painless vaginal bleeding (usually 2nd-3rd trimester)
- Preterm contractions
- Post-coital bleeding
- Spotting, streaking, staining
Assessment of APH
- NO VE EXAM
- IMEWS
- Speculum exam - determine if blood in posterior fornix
- O/E: Vitals, SFH, Lie and presentation
- Doppler, CTG, US
- Transvaginal US
- Uterus will be soft and non tender
Investigations for APH
- Urinanalysis (PET causing abruption)
- FBC - Hb, MVC, MHC, hematocrit
- Coagulation studies
- Type and crossmatch
- Rhesus status
- US at 32 weeks and 34 weeks.
Complications of Placenta Previa
- Maternal hemorrhage
- Placenta accreta -scarring
- Prematurity
- Delivery complications
RFs for placental ABRUPTION
Abruption previously
BP - HTN or pre eclampsia
R - Ruptured membranes
U - Uterine injury like trauma
P - Polyhydramnios
T - Twins for multiple gestation
I - infection like chorioamnionitis
N - Narcotic use (cocaine or smoking)
Define Placental Abruption
Premature separation of placenta from uterine wall - partial or complete
Complications of placental abruption
Prematurity
Growth restriction
Stillbirth
Hemorrhage
DIC
Features of placental abruption
Abdominal pain
Back pain (posterior abruption)
Increased SFH from blood
Bleeding
ROM
Uterine rupture causes
Previous C/S
Trauma
Oxytocin used inappropriately
Risk Factors of uterine rupture
Adenomyosis
Placental increta or percreta
Prev. uterine surgery
Overdistended uterus
Gestational Trophoblastic Neoplasia
Complications of uterine rupture
Hemorrhage
Hysterectomy
Death
Fetal Resp distress
Death
