ante part um haemorrhage
TRANSCRIPT
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ANTEPARTUM HAEMORRHAGE
Sources :Textbook of Obstetrics ; D.C Dutta
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Definition Causes Evaluation Management Complications
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Definition
Bleeding from the genital tract from 22 weeks POA until delivery of the fetus
Why 22 weeks POA?This is because fetus is considered to be
salvageable at this gestation(WHO= 22 weeks/ 500g or more)
**Lower segment starts to form at 28 weeks until 34 weeks
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CAUSES :Placental causes (70%) Placenta previa 34.5% Abruptio placenta 34.5% Vasa previa/circumvallate placenta 1%
Unexplained causes (25%)
Extraplacental causes (5%) Cervical polyp Ca cervix Local trauma Cervical or vaginal lesion/ infection
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EvaluationQuick HistoryType of bleeding ? Discharge per vagina
POG Past obst history
Fetal movement Blood group
Previous scan
Quick Maternal AssessmentPulse,BP,Uterine enlargement
Quick Fetal AssesmentUSG,CTG
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ManagementRx follows into 2 categories1.MINOR BLEEDING :without compromised
mother and fetus USG to rule out PP, Fetal well being If no bleeding ascertain cervical causes, Bishop’s
score P/S and High vaginal swab Investigations: FBC,GXM,BUSE,PT/PTTConservative approach Bed rest Anticipate future bleeding Regular fetal well being tests, fetal growth Keep 3 pint blood ready
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2.SEVERE BLEEDING :Compromised mother and fetus Treat as major hemorrhage( altered consciousness
state,SBP< 100mmHg, Pulse >120/min, Blood loss > 1.5L, Decreased peripheral perfusion
Activate Red Alert,Call help ABC -O2 10L/min 2 IV 16 G cannula Foley’s catheter no 16 G 30 ml blood investigation (FBC,PP/PTT,BUSE,GXM) Commence IV Fluids (NS,HM then blood if available) Once hemodynamically stable transfer to HDU
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Bleeding PV > 24 weeks
Placenta previa Abruptio placenta
Painless bleeding Painful bleedingSoft uterus Hard uterusMalpresentation Longitudinal lie
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Placenta previa- placenta located at the lower segment after 20wks of POG
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Placenta Previa
Risk Factors Increased age, parity, Previous scar: LSCS, Myomectomy, MRP Prior placenta previa Tobocco use Multiple pregnancy Previous induced abortion
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TREATMENTPreterm with hemodynamic stable mother < 32 POG: Give Dexamethasone 12 mg 12 hrly x 2 doses Expectant management: Bed rest TILL TERM Fetal well-being and growth tests Anticipate bleeding. Keep blood kit ready Correction and prevention of anemia
At Term : Deliver depending on type of placenta previa If bleeding : recurs or persists,mother is
hemodynamically compromised terminate pregnancy by LSCS
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Term Delivery either vaginally or LSCS.
Vaginal delivery LSCS Type 1 and Type 2 anterior Type 3,4 Cephalic presentation Fetal
distress Hemodynamically stable
Malpresentation
Keep blood ready Anticipate PPH Anticipate adherent placenta If LSCS consent for Cesarean Hysterectomy
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Abruptio placenta-Premature separation of normally situated placenta after the period of viability but before delivery of baby
REVEALED CONCEALED MIXED
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Etiology/Risk factorsHigh risk factors Gest Hpt/Pre-eclampsia Trauma Sudden uterine decompression Short cord Obstetric procedures like ECV Multiple pregnancy Polyhydramnios High parity
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Management
Trendelenberg position & Oxygen
Obtain immediate Intravenous Access Two large bore IV (16-18 gauge) Collect blood for investigation Initiate Isotonic crystaloid bolus
Call for immediate Obstetric and neonatal support ARM and oxytocin/ Induce labor Consider Cesarean Section if fetal distress
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Vasa previa
Fetal vessels travel within the membranes before valementous insertion
Crosses internal os Fetal distress LSCS Fetal mortality is > 50%
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Vasa previa,circumvallate placenta
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Other causes of APH
CERVICAL BLEEDING; Infectious cause Bleeding is controlled by cauterisation
CERVICAL POLYP Self limiting Local infection Polypectomy Histological diagnosis
BLOODY SHOW
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Complications of APH
Couvelair uterus DIVC Amniotic fluid
embolism Acute renal failure PPH Hypovolemic shock Maternal and fetal
death
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