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243840845185Antepartum Haemorrhage00Antepartum Haemorrhage1551305843915Definition: bleeding from genital tract after 20/40 gestation and prior to onset of labourEpidemiology: affects 2-5% pregnanciesOther causes: ectropion, cervical incompetence, polyps, vulval varices, trauma, infection, malignancy00Definition: bleeding from genital tract after 20/40 gestation and prior to onset of labourEpidemiology: affects 2-5% pregnanciesOther causes: ectropion, cervical incompetence, polyps, vulval varices, trauma, infection, malignancy2438408580120Vasa PraeviaBad 4 Baby00Vasa PraeviaBad 4 Baby15513058580120Definition: fetal blood vessels in amniotic membrane distant from placental mass, in placenta / umbilical cord trapped between fetus and cervical os / vagina torn at time of labour or artifical ROM, or may occur spontaneously late in pregnancy; lateral insertion of umbilical cord into placentaEpidemiology: 1:3000 pregnancies; 75% fetal mortality rateRisk factors: placenta praevia, IVFComplications: fetal deathAssessment: small amounts PV bleeding cause severe fetal compromise; painless, seldom recognised prior to vessel disruption; fetal distress without maternal distressInvestigation: CTG for decelerations; USS (bilobed placenta, altered placental flow), Apt test (detects HbF or nucleated RBC in PV blood)Management: emergent caesarian section00Definition: fetal blood vessels in amniotic membrane distant from placental mass, in placenta / umbilical cord trapped between fetus and cervical os / vagina torn at time of labour or artifical ROM, or may occur spontaneously late in pregnancy; lateral insertion of umbilical cord into placentaEpidemiology: 1:3000 pregnancies; 75% fetal mortality rateRisk factors: placenta praevia, IVFComplications: fetal deathAssessment: small amounts PV bleeding cause severe fetal compromise; painless, seldom recognised prior to vessel disruption; fetal distress without maternal distressInvestigation: CTG for decelerations; USS (bilobed placenta, altered placental flow), Apt test (detects HbF or nucleated RBC in PV blood)Management: emergent caesarian section2438407431405Uterine Rupture00Uterine Rupture15513057431405Epidemiology: rare; high maternal and fetal mortality and morbidityCauses: obstructed labour, malposition, large baby, previous uterine scar (10x ? risk), grand multiparity, IOL, CT disorders, bicornate uterusAssessment: abdo pain, PV bleeding, fetus easily palpable through abdo wall, uterine irritability, uterus smaller than expected datesManagement: resus, delivery00Epidemiology: rare; high maternal and fetal mortality and morbidityCauses: obstructed labour, malposition, large baby, previous uterine scar (10x ? risk), grand multiparity, IOL, CT disorders, bicornate uterusAssessment: abdo pain, PV bleeding, fetus easily palpable through abdo wall, uterine irritability, uterus smaller than expected datesManagement: resus, delivery2489204405630Placental Abruption20% APHBad 4 Mum and Baby00Placental Abruption20% APHBad 4 Mum and Baby15513054404360Definition: separation of normally located placenta; can conceal 2-4LEpidemiology: 1% incidence (in 2-4% minor trauma, in 50% major trauma); 15-35% fetal perinatal mortality; maternal mortality <1%; fetal and maternal death due to haemorrhage and coagulopathyCauses: HTN (in 45% cases), trauma (due to indirect trauma and shearing forces), smoking, alcohol, African-American, previous caesarian section, previous placental abruption, cocaine, short umbilical cord, sudden uterine decompression (eg. PROM, delivery of 1st twin), retroplacental fibroid, retroplacental bleeding (eg. Post-amniocentesis)Classification: complete / partial / concealedSymptoms: diagnosis is clinical; PV bleeding (80%; dark blood, there may be no bleeding (concealed), often mild); abdo/back pain (70%), fetal distress (60%), maternal shock, abnormal uterine contractions (35%), premature labour (25%), fetal death (15%); tender, tense, contracted uterus; uterus larger than expected dates; may have little external abdo wall traumaComplications: DIC (due to thromboplastic release), uterine rupture, multi-organ failure, fetal death, maternal shockInvestigation: CTG for 4hrs, USS (only 2-25% sensitivity)Management: urgent help, monitor, resus, reverse coagulopathy, consider steroids (if <34/40, betamethasone), anti-D if indicated; if small, serial USS and induce at 37/40; observe woman @ least 6hrs if >24/40 with trauma00Definition: separation of normally located placenta; can conceal 2-4LEpidemiology: 1% incidence (in 2-4% minor trauma, in 50% major trauma); 15-35% fetal perinatal mortality; maternal mortality <1%; fetal and maternal death due to haemorrhage and coagulopathyCauses: HTN (in 45% cases), trauma (due to indirect trauma and shearing forces), smoking, alcohol, African-American, previous caesarian section, previous placental abruption, cocaine, short umbilical cord, sudden uterine decompression (eg. PROM, delivery of 1st twin), retroplacental fibroid, retroplacental bleeding (eg. Post-amniocentesis)Classification: complete / partial / concealedSymptoms: diagnosis is clinical; PV bleeding (80%; dark blood, there may be no bleeding (concealed), often mild); abdo/back pain (70%), fetal distress (60%), maternal shock, abnormal uterine contractions (35%), premature labour (25%), fetal death (15%); tender, tense, contracted uterus; uterus larger than expected dates; may have little external abdo wall traumaComplications: DIC (due to thromboplastic release), uterine rupture, multi-organ failure, fetal death, maternal shockInvestigation: CTG for 4hrs, USS (only 2-25% sensitivity)Management: urgent help, monitor, resus, reverse coagulopathy, consider steroids (if <34/40, betamethasone), anti-D if indicated; if small, serial USS and induce at 37/40; observe woman @ least 6hrs if >24/40 with trauma2463801566545PlacentaPraevia20-30% APHBad 4 Mum00PlacentaPraevia20-30% APHBad 4 Mum15513051566545Definition: implantation of placenta over / near to internal os, infront of presenting part of fetusClassification: total (internal os covered completely) partial (os partially covered) marginal (placenta reaches margin of os) Low lying placenta – implants in lower uterine segment; may self correct (>2/3 women with distance >10mm from os will have SVD without incr risk of bleedEpidemiology: occurs in 2nd and 3rd trimesters; maternal mortality 0.03% (due to haemorrhage and coagulopathy)Causes: PMH same (4-5%), prev caesarian section, multiparity, ? maternal age, more babies, previous termination, smokingSymptoms: PV bleeding (sudden onset, profuse, bright red, painless, onset usually at 27-32/40, usually settles then recurs); do not perform PV in patient in labour with PV bleeding; soft, non-tender uterus; maternal shock, no fetal distressComplications: maternal shock, premature deliveryInvestigation: urgent USS (95% sensitivity; careful TVUS more sensitivity); bloods, Kleihauer testManagement: XM, urgent help, emergent caesaria section if severe haemorrhage; IV fluids, consider steroids, anti-D if indicated00Definition: implantation of placenta over / near to internal os, infront of presenting part of fetusClassification: total (internal os covered completely) partial (os partially covered) marginal (placenta reaches margin of os) Low lying placenta – implants in lower uterine segment; may self correct (>2/3 women with distance >10mm from os will have SVD without incr risk of bleedEpidemiology: occurs in 2nd and 3rd trimesters; maternal mortality 0.03% (due to haemorrhage and coagulopathy)Causes: PMH same (4-5%), prev caesarian section, multiparity, ? maternal age, more babies, previous termination, smokingSymptoms: PV bleeding (sudden onset, profuse, bright red, painless, onset usually at 27-32/40, usually settles then recurs); do not perform PV in patient in labour with PV bleeding; soft, non-tender uterus; maternal shock, no fetal distressComplications: maternal shock, premature deliveryInvestigation: urgent USS (95% sensitivity; careful TVUS more sensitivity); bloods, Kleihauer testManagement: XM, urgent help, emergent caesaria section if severe haemorrhage; IV fluids, consider steroids, anti-D if indicated246380211455Post-Partum Haemorrhage / Antepartum Haemorrhage00Post-Partum Haemorrhage / Antepartum Haemorrhage ................
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