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Antepartum haemorrhage (ancillary (bloods (group and hold, coags, FBC),…
Antepartum haemorrhage
definition
bleeding from the genital tract after 24/40
aetiology
common
undetermined
placental abruption
placenta praevia
edge bleeding
rare
incidental genital tract pathology
cervical polp
ectropion
genital infection
cervical carcinoma
uterine rupture
vasa praevia
incidence
3-5%
risk factors
PA
previous abruption
preeclampsia
high parity
abdo trauma
smoking
thrombophilia
PP
previous uterus surgery
multiple pregnancy
high parity
increasing age
fibroids
pathophysiology
PA
premature separation of the placenta from the uterus
PP
the placenta has implanted low in the uterus and may or may not be covering the cervical os
clinical
signs
PP
profuse haemorrhage
hypotension
tachycardia
soft non-tender uterus
normal fetal heart tones
PA
uterine tenderness
shock
absence of fetal heart rate
increasing fundal height
symptoms
PA
abdo pain
sudden onset cramping
continous pain but has exacerbations
+/- PV bleeding
revealed bleeding is typically darker
uterine tenderness
contractions
premature labour
decreased fetal movement
PP
painless bleeding over several weeks
bright red
often third trimester
scan results
diagnosis
USS
rule in/out PP
34/40
abruption clinical diagnosis
ancillary
bloods
group and hold
coags
FBC
fetus
CTG
fluid balance
IDC
CVP monitoring
treatment
PP
if bleeding
admit and observe
manage shock if present
steroids if <34/40
anti-D if Rh -ve
asymptomatic
managed at home
hospital if start bleeding
admit 37/40
delivery by 39/40
can be vaginal
c section if <2cm from os
PA
admit
IV fluid +/- RBC if indicated
opiate analgesia
anti-D for Rh-ve
steroids if <34/40
monitor fluid balance
close fetal monitoring
delivery
if fetal distress
urgent C/s
if no fetal distress and >37/40
IOL
if distress ensues --> C section
prognosis
dependent on severity
complications
PP
haemorrhage
transfusion
preterm delivery
C section
hysterectomy
maternal death
blood loss
DIC
increased risk PPH
placenta acreta
PA
maternal
shock
massive haemorrhage
coagulopathy
DIC
renal failure
liver failure
maternal/fetal death
increased risk PPH
premature labour
Fetus
fetal demise