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Obstetrics 2

Antepartum Haemorrhage

QuestionAnswer
Define antepartum haemorrhage. Bleeding from the genital tract during pregnancy after 24 weeks. Before 24 weeks the baby is not considered viable and is then called threatened miscarriage.
Antepartum Haemorrhage causes? Haemorrhage from placental site and uterine cavity. Lesions of the vagina or cervix. Fetal bleeding from vasa previa.
Define the condition vasa previa. A condition in which blood vessels within the placenta or the umbilical cord are trapped between the fetus and the opening to the birth canal. High risk for haemorrhage at labour / when waters break and fetal hypoxia.
Major causes for uteroplacental haemorrhage. Placenta praevia. Abruptio placentae or abortion. Uterine rupture. Unknown aetiology.
Is it easy to determine the cause of PV bleeding? No.
Define abruptio placentae. A disorder of pregnancy in which the placenta prematurely separates from the wall of the uterus.
How common is placenta praevia? At term approx 1 in every 200 pregnancies.
How does placenta praevia present? Painless, causeless and recurrent vaginal bleeding.
What are the risk factors for placenta praevia? Multiparity. Maternal age >35yrs Previous uterine surgery. Multiple pregnancy. Previous placenta praevia. Previous spontaneous abortion. Smoking - 200% risk.
What may may result in the clearing of the cervical os with time. Growth of the uterus.
What causes other than placentae praevia causes antepartum haemorrhage? Abruption. Premature labour. Premature SROM. Infection. Trauma (laceration). Vasa praevia. Cervical cancer - rare.
Define vasa praevia. Fetal vessels crossing or running in close proximity to the inner cervical os.
Is vasa praevia common? No it is the rarest cause of antepartum haemorrhage.
What is the prehospital management of antepartum bleeding? Support ABC's. IV access. Obtain Hx of gestation, scans with diagnosis of placenta praevia, previous placenta praevia/c section. Take soilde linen and pads with woman. No PV examination. Manage shock. Observation frequently - compromise occurs late.
Define placenta accreta. Abnormally firm adherence of the placenta to the uterine wall - suspect this if no placenta delivery within 30 min.
Define placenta increta. Villi of the placenta invade into the myometrium of the uterus.
Define percreta. Villi of the placenta invade THROUGH the myometrium of the uterus.
Define placental abruption. Haemorrhage resulting from premature separation of normally situated placenta after 24/40.
Is trauma the most common cause of placenta abruption? No, most occur spontaneously.
Is the exact cause of placenta abruption known? No.
What are the associations and risk factors of placenta abruption? Hypertensive disorders. Poor nutrition. Folic acid deficiency. Advanced maternal age. Chorioamnionitis. Low birth weight. HX of previous abruption. Smoking, Trauma. Drug use. Sudden increase in uterine volume.
Define chorioamnionitis. Inflammation of the fetus's membranes and possibly the amniotic fluid.
What is the presentation of abruption? External bleeding. Concealed bleeding 20%. Partially revealed bleeding. Pain. Increased uterine activity/tone. Vaginal bleeding.
What is a sign that haemorrhage may be internal? An increase in uterine volume and fundal height. Uterine tone is increased and may become rigid and tender.
What are the signs and symptoms of placental abruption? Continuous pain. Back pain. Uterine tenderness. Uterine tone/shape change. Mother may notice less baby movement. Contractions. Haemorrhage. Decreased HR if BP severe increase in BP initially. Increase in HR if a severe drop in BP initially.
What is the management of placental abruption? Focus on transport. Assess: pain, bleeding, gentle palpation of uterus to judge fundal height and tone. Level of shock. Obstetric and medical Hx. Position left lateral. IV access and fluid if necessary. Oxygen. Pain releif - Entonox and opiates. E
Created by: boermedic