APH Flashcards
What is the initial assessment when a Woman presents to MFAU with an APH?
- Is the woman haemodynamically unstable and / or is there evidence of significant abruption i.e. tender/hard/woody uterus? if yes medical assistance!
- If no obs, FHR assess uterus and vaginal loss
- If active bleeding, contractions or tenderness on palpation - gain IV access, take bloods FBC, cross match, Coags, Kleihauer and CTG
- Check ultrasound for location of placenta
- Obs Review
- Discharge or admission
After the initial assessment what should be done next while CTG is running?
- History - onset of bleeding - post coital/ spont / trauma type and colour of bleeding, pain, uterine activity and any active bleeding
- Baseline obs T P R BP FHR
- Fast woman for potential theatre
- position on side
- IV access
- bloods FBC, Coags, U&Es LFTs cross match
- Kleihauer if rh neg, significant trauma, sinusoidal CTG trace, non reactive CTG,
- speculum to assess bleeding
- medical review with registrar
- ultrasound for placental location, fetal wellbeing and presence of retroplacental clot
- provide maternal education regarding decisions and facts
- any sign of APH is a hospitalisation for observation/action - cortiocosteroids, TEDS, bed rest, paed review if preterm labour possible.
What is the definition of placenta previa?
Placenta praevia is when the placenta is inserted wholly or partly into the lower segment of the uterus in the third trimester of pregnancy.
The diagnosis of placenta praevia is made by transvaginal ultrasound, where the distance between the inferior edge of the placenta and the internal cervical os is measured.
If the placenta lies over the cervical os, it is considered a major placenta praevia; otherwise it is considered a minor placenta praevia. This diagnosis has evolved from the original clinical (I–IV) grading system.
What is the definition of Antepartum haemorrhage (APH)?
APH is defined as any bleeding from the genital tract after the 20th week of pregnancy and before the onset of labour. Some of the causes of APH might also cause intrapartum bleeding, such as an abruption or placenta praevia.
APH complicates 2-5% of all pregnancies. It is associated with increased rates of perinatal morbidity and mortality and contributes to significant healthcare costs.1
What are some of the causes of APH?
Placenta Previa 30%
Placental abruption 25%
Vasa previa
cervical and lower genital tract 45%
What is the definition of an APH?
Antepartum haemorrhage (APH) complicates 2-5% of pregnancies and is defined in some literature as any bleeding from the genital tract after the 20th week of pregnancy and before labour. Blood loss may be evident or concealed
What is the clinical emergency management of APH?
- Insertion of two large bore 16 gauge cannula
- Monitoring of O2 saturation levels and application of oxygen as required
- Collection of venous blood samples e.g. full blood picture(FBP), group & cross- match 4 units (or more if required) coagulation studies, urea & electrolytes (U&Es) and liver function tests (LFTs), and may include arterial blood gases
- Commencement of fluid replacement e.g. intravenous therapy / blood products / plasma expanders
Analgesia
Insertion of an indwelling catheter (IDC)8
Preparation for theatre & delivery.8 Severe bleeding requires immediate caesarean birth regardless of the placental location.1
Informing the haematologist8
Inform the paediatrician if birth is anticipated
When taking a history of APH what should be asked regarding blood loss?
amount colour consistency pattern of bleeding when it started
When taking a history of APH what should be asked regarding pain
pattern site, time of commencement, frequency, strength duration.
When taking a history of APH what should be asked regarding uterine tome?
a soft, non-tender uterus may suggest a lower genital tract cause, bleeding from the placenta or vasa praevia.
Increased uterine tone (e.g. tense, rigid or ‘woody’) may indicate placental abruption
When taking a history of APH what should be asked regarding Triggering Factors?
sexual activity,
trauma,
exertion
