Antepartum Haemorrhage
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| 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.
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| Antepartum Haemorrhage causes? | Haemorrhage from placental site and uterine cavity.
Lesions of the vagina or cervix.
Fetal bleeding from vasa previa.
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| 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.
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| Major causes for uteroplacental haemorrhage. | Placenta praevia.
Abruptio placentae or abortion.
Uterine rupture.
Unknown aetiology.
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| Is it easy to determine the cause of PV bleeding? | No.
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| Define abruptio placentae. | A disorder of pregnancy in which the placenta prematurely separates from the wall of the uterus.
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| How common is placenta praevia? | At term approx 1 in every 200 pregnancies.
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| How does placenta praevia present? | Painless, causeless and recurrent vaginal bleeding.
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| 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.
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| What may may result in the clearing of the cervical os with time. | Growth of the uterus.
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| What causes other than placentae praevia causes antepartum haemorrhage? | Abruption.
Premature labour.
Premature SROM.
Infection.
Trauma (laceration).
Vasa praevia.
Cervical cancer - rare.
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| Define vasa praevia. | Fetal vessels crossing or running in close proximity to the inner cervical os.
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| Is vasa praevia common? | No it is the rarest cause of antepartum haemorrhage.
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| 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.
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| Define placenta accreta. | Abnormally firm adherence of the placenta to the uterine wall - suspect this if no placenta delivery within 30 min.
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| Define placenta increta. | Villi of the placenta invade into the myometrium of the uterus.
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| Define percreta. | Villi of the placenta invade THROUGH the myometrium of the uterus.
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| Define placental abruption. | Haemorrhage resulting from premature separation of normally situated placenta after 24/40.
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| Is trauma the most common cause of placenta abruption? | No, most occur spontaneously.
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| Is the exact cause of placenta abruption known? | No.
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| 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.
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| Define chorioamnionitis. | Inflammation of the fetus's membranes and possibly the amniotic fluid.
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| What is the presentation of abruption? | External bleeding.
Concealed bleeding 20%.
Partially revealed bleeding.
Pain.
Increased uterine activity/tone.
Vaginal bleeding.
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| 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.
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| 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.
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| 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
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boermedic
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