APH

Question 1

What are the causes of APH?

Answer 1

Placenta praevia
Placental abruption
Local cervical/ vaginal/ uterine pathology e.g. cervical ectropion, trauma (domestic violence)
Rare: vasa praevia, uterine rupture

Question 2

What is placental abruption?

Answer 2

Premature separation of a normally implanted uterus prior to delivery of a fetus

Question 3

What is placenta praevia?

Answer 3

Placenta that approaches or covers the internal cervical os in late second or third trimester

Question 4

What are the Sx and signs of placenta praevia?

Answer 4

Painless APH in late second or third trimester

May be associated with malpresentation

Question 5

What Ix should be done for placenta praevia?

Answer 5

Most women are asymptomatic and dx at the routine second trimester U/S (18-22 weeks’)
When discovered, follow up U/S should be performed at 32-34 weeks’ to confirm presence of placenta praevia, and to exclude vasa praevia and placenta accreta

Question 6

What is the management of placenta praevia?

Answer 6

Inpatient management until delivery is generally recommended for these pts, especially those who have bleed
Steroids should be administered if APH likely to lead to delivery prior to 34 weeks
Elective early delivery by C/S
MgSO4 for neuroprotection, if delivery anticipated <30 weeks’

Question 7

What are the Sx and signs of placental abruption?

Answer 7

Painful APH
Uterine tenderness
Uterine contractions/ pain (especially back pain)

Question 8

What is the definition of vasa praevia?

Answer 8

Fetal vessels coursing through membranes below the fetal presenting part over the internal cervical os, unprotected by placental tissue or the umbilical cord

Question 9

Why do we worry about vasa praevia?

Answer 9

Because it is fetal blood and there is major risk to the fetus given much smaller blood volume

Question 10

What are the Sx and signs of uterine rupture?

Answer 10

Sudden abdominal pain
Distension
Hypovolemic collapse