Mx - APH Flashcards
What is antepartum haemorrhage and how commonly does it occur?
APH is defined as vaginal bleeding after 20 weeks gestation. It occurs in approx 2-6% of pregancies
What are the causes of APH?
placental abruption
placenta praevia
others - vasa previa, cervicitis, lower genital tract infection and malignancy
What are the risk factors for placental abruption?
previous abruption hypertension or PET smoking and drug use trauma PPROM multiple pregnancy or polyhydramnios ECV thrombophilia
How does placental abruption present?
PV bleeding
Continuous abdo pain
Tender, firm (“wooden”) uterus -contracts in response to bleeding. A clinical dx - USS detects only 50%
What are the risk factors for placenta praevia?
advanced maternal age
previous C/S
smoking
multiparity
How does placenta praevia usually present?
Painless PV bleeding
Dx using USS
What are the key points for APH assessment?
1) Assessment - is the woman stable or is urgent intervention required? FMF and FHR?
2) If woman is stable - full history should be taken - nature and how much bleeding?
Painful? (placental abruption vs praevia),
SROM? (vasa previa)
Pap smear hx?
3) Exam - BP and HR, abdominal tenderness and rigidity, speculum examination - avoid VE if placenta praevia is possible.
4) Ix
- USS to dx placenta praevia
- FBC, Gp and hold
- Kleihauer test in Rh-neg to quantify FMH to gauge anti-D Ig dose
- Fetal - CTG
Which patients require admission?
Women with heavier than spotting, ongoing bleeding, unexplained APH or placental abruption should remain - mx is consultant led.
Pharmacological mx?
Steroids - 24-34 weeks gestation in case of imminent delivery
Anti-D Ig for Rh-negative women
Tocolysis - considered by consultant obstetrician
When and how should women with APH be delivered?
APH with fetal/maternal compromise - immediate delivery usually by C/S
If no compromise - senior obstetrician to establish timing and mode.
Continuous CTG is required in labour, with active mx of 3rd stage in anticipation of risk of PPH
