Which of the following is the most common cause of antepartum haemorrhage?
Summary. Antepartum haemorrhage (APH) is defined as bleeding from or in to the genital tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the baby. The most important causes of APH are placenta praevia and placental abruption, although these are not the most common.
What are the clinical features of antepartum haemorrhage?
It presents classically with vaginal bleeding, abdominal pain, uterine contractions and tenderness. On clinical examination, the uterus is irritable, with increased baseline tone. There may be evidence of fetal distress. In severe cases, the mother may show cardiovascular decompensation with evidence of hypovolaemia.
How is antepartum hemorrhage diagnosed?
Any vaginal bleeding at or after 24 weeks must be diagnosed as an antepartum haemorrhage if any of the following are present: A sanitary pad is at least partially soaked with blood. Blood runs down the patient’s legs. A clot of blood has been passed.
What is the complication of APH?
3. Maternal complications of APH are malpresentation, premature labour, postpartum hemorrhage, shock, retained placenta. They also include higher rates of caesarian section, peripartum hysterectomy, coagulation failure, puerperal infections and even death.
What is differential diagnosis of APH?
Differential diagnosis Placenta praevia. Vasa praevia. Marginal placental bleed: partial abruption. Uterine rupture. Local causes: polyps, carcinoma, cervical ectropion, infection.
What steroids are given in APH?
Choice of steroid Common corticosteroids include dexamethasone and betamethasone. Dexamethasone is often recommend over the latter due to its increased efficacy and safety, wide availability, and low cost, while betamethasone is better at preventing the softening of the brain in premature fetuses.
What velamentous means?
Adjective. velamentous (not comparable) Veil-like. (medicine) Of or relating to an abnormal condition during pregnancy in which the umbilical cord inserts into the fetal membranes, then travels within the membranes to the placenta, risking rupture of the exposed vessels.
What is indeterminate APH?
“Indeterminate” APH Providing the bleeding stops and there is no ultrasound evidence of placenta praevia or abruptio, the woman can be managed as an outpatient. Bleeding from fetal vessels is diagnosed by testing the blood for fetal haemoglobin.
What is vasa previa?
Definition: Vasa previa is defined when unprotected umbilical vessels run through the amniotic membranes, and pass over the cervix. Two types: Type I: Velamentous cord insertion and fetal vessels that run freely within the amniotic membranes overlying the cervix or in close proximity of it (2cm from os).
Why is DEXA given in pregnancy?
Conclusion: Dexamethasone accelerates maturation of fetal lungs, decrease number of neonates with respiratory distress syndrome and improves survival in preterm delivered neonates. Optimal gestational age for use of dexamethasone therapy is 31 to 34 weeks of gestation.
What drugs are Tocolytics?
Several different classes of drugs are used for tocolysis, including:
- Betamimetics (such as terbutaline)
- Magnesium sulfate.
- Prostaglandin inhibitors (like indomethacin, ketorolac)
- Calcium channel blockers (such as nifedipine)
- Nitrates (like nitroglycerine)
- Oxytocin receptor blockers (such as atosiban)
What is Circumvallate placenta?
Circumvallate placenta is a form of extrachorial placenta, with a raised placental margin in an annular shape. The chorionic plate is smaller than the basal plate, and misalignment between them causes hematoma retention in the placental margin.
What are the different types of external bleeding?
External blood is when blood leaves the body through any type of wound. First aid responders should be competent at dealing with major blood loss. There are broadly three different types of bleeding: arterial, venous and capillary.
What are the principles of management of APH?
diagnose and manage placental abruption. manage both conditions safely. counsel a woman on the recurrence risks. appreciate the importance of management protocols for the management of obstetric haemorrhage and be able to instigate guidelines including those for women who decline blood transfusion.
What is antepartum hemorrhage (APH)?
This field is for validation purposes and should be left unchanged. Antepartum haemorrhage (APH) is defined as genital tract bleeding from 24+0 weeks’ gestation and complicates 3-5% of pregnancies. 1
What causes antepartum haemorrhage in pregnancy?
Causes of antepartum haemorrhage The causes of APH are: Extraplacental bleeding: From sites other than the placental surface, including cervical lesions, e.g., trauma, cancer of the cervix, cervical polyps; vaginal lesions, genital tears/lacerations (rare), and infections; and vulvoperineal tears (rare).
How does placenta praevia increase the likelihood of acute postpartum hemorrhage (APH)?
Placenta praevia increases the likelihood of APH due to poor attachment of the placenta to the uterine wall. Figure 1 shows the classical grading of placenta praevia.
Which tests are used to diagnose antepartum haemorrhage?
Vasa praevia: This is a rare cause of antepartum haemorrhage in which the umbilical cord is inserted into placental membranes with blood vessels traversing and presenting over the internal cervical ( velamentous insertion of the umbilical cord). Others: Ultrasound, which offers a high degree of diagnostic accuracy in antepartum haemorrhage