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Understanding Antepartum Hemorrhage Causes

This document summarizes two causes of ante-partum haemorrhage (APH): placenta previa and abruption placentae. Placenta previa is when the placenta is inserted in the lower uterine segment, complicating 0.5% of pregnancies and accounting for 20% of APH cases. Abruptio placentae is the partial or complete separation of a normally implanted placenta before delivery, complicating 0.5-1.5% of pregnancies. Both causes are treated as obstetric emergencies depending on the severity of bleeding, gestational age, and maternal and fetal conditions, with options including cesarean section or conservative management.

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336 views15 pages

Understanding Antepartum Hemorrhage Causes

This document summarizes two causes of ante-partum haemorrhage (APH): placenta previa and abruption placentae. Placenta previa is when the placenta is inserted in the lower uterine segment, complicating 0.5% of pregnancies and accounting for 20% of APH cases. Abruptio placentae is the partial or complete separation of a normally implanted placenta before delivery, complicating 0.5-1.5% of pregnancies. Both causes are treated as obstetric emergencies depending on the severity of bleeding, gestational age, and maternal and fetal conditions, with options including cesarean section or conservative management.

Uploaded by

Ojambo Flavia
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd

APH

Ante- Partum Haemorrhage

Def.
Vaginal bleeding after 28 WOA but before delivery

Causes
Common -Placenta previa -Abruptio Placentae Rare causes -Vasa previa -Cervical erosion -Ca Cx -Vaginal tears

PLACENTA PREVIA
Insertion of the placenta partially or completely into the lower ut. Segment Complicates 0.5% of preg. Accounts for 20% APH Associations -Multiparity -^ maternal age -Prior PP -Multiple gestation -Prev. ut. scar

Presentation
Painless vaginal bleeding Severe anaemia/shock Persistent malpresentation FH>> WOA Placenta on lower segment

Grades/ Classification
I- Placenta extends to lower uVt. Segment But not reaching the os . II- Placenta extends to edge of os but not covering .III- Pl cover the closed os but not the open one .IV- Centrally placed placenta.

Management
Obstetric emergency Investigations -FBC ( Hb ) -Grouping x-matching -US -EUA

Definitive mgt
Depends on - Severity of bleeding -Maternal condition -Gestation age

Mgt options
A- C/s.. - Severe bleeding -GA >34 B- Conservative mgt - Stable/ Bleeding stopped -GA <34

ABRAPTIO PLACENTAE
Partial or complete seperation of normally implanted placenta before the 3rd stage Epidemiology -Complicates 0.5% -1.5% of pregnancies -Associations ..Maternal HTN ..Prev Abruptio ..Trauma ..Polyhydramnios ..PROM ..Short cord ..Smoking ..Folate deficiency

Pathophysiology
Possibly starts by haemorrhage from a ruptured spiral arteriole into the decidua basalis. This may be central or marginal. With increasing Haematoma size the placenta is progressively sheared off.

Presentation
Pv bleeding ( dark blood)..80% Abdomenal pain ^ Ut. Tone Fetal distress/ Demise Ut. Tender

Clinical Types
Revealed Pv bleeding Concealed- No Pv bleeding Mixed type- Pv bleeding+ Retained blood

Investigations
FBC- Hb, Platelets count Bleeding, Clotting time Plasma fibrinogen level

Management
Depends on .. Maternal , fetal conditions ..Gestational age ----EUA to r/o PP Options --Membrane rupture + Vaginal delivery --Conservative mgt>> Mother+ fetus stable ( Marginal AP)

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