antepartum haemorrhage - rmur.edu.pk · antepartum haemorrhage obs/gynae unit i holy family...
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ANTEPARTUM
HAEMORRHAGE
Obs/Gynae Unit I
Holy Family Hospital, Rawalpindi.
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DEFINITION
Bleeding from the genital tract in pregnancy before
the onset of labor and after the age of viability.
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AETIOLOGY
• Placenta Praevia
• Placental Abruption
• Others
Marginal placental bleed
Show
Local infection
Genital tract tumors
Vasa praevia
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PLACENTA PREVIA
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PLACENTA PREVIA
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PLACENTA PRAEVIA
Definition
Grades
Aetiology and Associations
• Uterine Surgery
• Maternal age
• Smoking
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• Painless Bleeding
• Recurrent episodes
• High Presenting Part
• Mal -Presentation
• Less chance of fetal demise
DIAGNOSIS
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MANAGEMENT
Achieve as much maturity as possible with feto–maternal
monitoring
Placental edge < 2cm from internal os
C- section
Placental edge >4.5 cm from internal os
Vaginal delivery
Placental edge from 2-4 cm from internal os
Clinical assessment
Indications of examination in theatre
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PLACENTAL ABRUPTION
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Aetiology and Associations
H/O abruption
Rapid uterine decompression
Trauma
Smoking
Abnormal Placentation
Pre-eclampsia
Thrombophilias
PLACENTAL ABRUPTION
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Painful bleeding
Uterus irritable, hard, tetanic
Fetal compromise
Ultrasonography
DIAGNOSIS
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DIC
ATN
COMPLICATION
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Disturbance of conscious state
SBP < 100 of Hg
HR 120 beats / min
Blood loss > 1500
Peripheral perfusion is reduced
MAJOR HEMORRHAGE
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