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UNIT 3 - ANTEPARTUM HAEMORRHAGE - Coggle Diagram
UNIT 3 - ANTEPARTUM HAEMORRHAGE
DEFINITION
APH is bleeding from the genital tract after 24th week of pregnancy, and before the onset of labour
Major cause of perinatal mortality and maternal morbidity
CAUSES
Major causes of APH are placenta previa and abruptio placenta
cesarean delivery
varicosities
cancer of the cervix
foriegn bodies
genital lacerations
vaginal infections
COMPLICATIONS
MATERNAL
postpartum hemorrhage
higher rate of c- section
massive transfusions
coagulation and renal failure
pulmonary edema
infective complications like sepsis, shock and death
NEONATAL
pre-term
low birth weight
still birth
increased neonatal intensive care unit admissions
birth asphyxia
neonatal death
PLACENTA PREVIA
implantation of the placenta in the lower uterus
DEGREES OF PLACENTA PREVIA
Partial placenta previa, the placenta partially caps the internal os
Complete placenta previa, the placenta completely covers the internal os
Low-marginal placenta previa, a small placental edge can be felt through maternal os
MANAGEMENT
CONSERVATIVE
appropriate if bleeding is slight and the woman and fetus are well
admitted untill bleeding stops
severity determines the type of birth
IMMEDIATE
severe vaginal bleeding - immediate c-section required
appropriate care of newborn if baby is preterm
comfort sharing information with family
NURSING CONSIDERATION
assess for bleeding
observe for signs of labour
periodic electronic fetal monitoring
warning signs should be notified to physician immediately
inform family and provide psychological support
PLACENTAL ABRUPTION
separation of normally implanted placenta after the 24th week of and before the fetus is born
MANAGEMENT
CONSERVATIVE
small abruption & <34 weeks with no sign sof distress
bed rest and possible administration of tocolytic medications
IMMEDIATE
immediate delivery - if signs of fetal compromise exist or if the mother exhibits signs of excessive bleeding
intensive monitoring of both the women and the fetus is essential
blood products for replacement
large-bore IV lines
NURSING CONSIDERATION
asses for signs of concealed hemorrhage, increased funal height/ hard, boardlike abdomen
axplain the anticipated procedures to pt and family
observe for excessive bleeding and fetal hypoxia
continuous monitoring of both mother and fetus
VASA PRAEVIA
fetal blood vessels from placenta or umbilical cord cross the internal os beneath the baby rupture of membranes lead to damage of the fetal vessels leading to exsanguination and death
RISK FACTORS OF VASA PREVIA
Eccentric (velamentous) cord insertion
Bilobed or succenturiate lobe of placenta
multiple gestation
placenta praevia
IVF pregnancies
History of uterine surgery or D&C
DIAGNOSIS
moderate vaginal bleeding
vessels may be palpable through dilated cervix
vessels may be visible on ultrasound
difficult to distinguish from abruption
Fetal Hb or nucleated RBC's in shed blood
Tachycardia or bradycardia in CTG
MANAGEMENT
urgent delivery
Most of the time urgent LSCS
Neonatologist involvement
Aggressive resuscitation of the baby with blood transfusion following delivery