Antepartum Hemorrhage

ANTEPARTUM HEMORRHAGE
 LAURA
 Previously had an emergency caesarean section 11 months ago for a delay in the first
labour at 3 cm dilation
 7 days overdue and has presented spontaneous labour to the central delivery suite
ASSESSMENT
 Contracting 4 in 10
 On examination 4 hrs ago she was 4 cm dilated, midwife re-examined and became 6 cm
dilated
 Jane noticed laura some fresh red spotting pad
RECOMMENDATION
 request for obstetric review
 They did vaginal examination

 Weighing the pad
Diagnosed as antepartum haemorrhage. Giving Laura oxygen

 Weigh the pad (200 ml blood loss)
 IV fluids
 Blood test
 A bit tachycardic
 Having a bradycardia
 hematuria
 Contractions are completely gone and uterus is higher
 Get the baby born as quickly
ANTEPARTUM HAEMORRHAGE (APH)

 Bleeding from the genital tract before labor
 PV bleeding after 20 weeks of gestation
 It is classified as PV spotting
 minor APH less than 50 ml of blood lost and it must have settled
 major APH 50-1000 ml with no shock
 massive APH greater than 1000 ml and all signs of shock
 leading cause of perinatal and maternal mortality worldwide
 OBSTETRIC HAEMORRHAGE-one of the major causes of the maternal death
RISK/ CAUSES OF APH

 placenta praevia
 placental abruption
 vasa previa
 uterine rupture
RISK FACTORS FOR PLACENTAL ABRUPTION
 abruption in a previous pregnancy
 pre-eclampsia
 fetal growth restriction
 multiparity
 low BMI
 premature rupture of membranes
 abdominal trauma
RISK FOR PLACENTAL PREVIA

 previous placental previa
 previous caesarean section
 previous termination of pregnancy
 multiparity
MANAGEMENT
 avoid penetrative sexual intercourse
ASSESSMENT
 HX (history)
 Examination
 Vitals
 Abdominal exam
 investigations
MEDICATION principles
 Resuscitate/call for help
 Assess fetal and maternal condition
 Seek and treat cause
PLACENTA PREVIA
 Placental location below presenting part of fetus
 Placenta covers the opening of cervix
CASE SCENARIO
 Lynn halloman
 38 weeks pregnant
 Painless, profuse vaginal bleeding for the last hour
 HISTORY CHIEF CONCERN

 “gushing” vaginal blood
 Bp: 95/60 mmhg
90 bpm
 Same episode 1 week ago while at the amusement park, but bleeding has stopped by
the time she returned home
 FAMILY PROFILE
 Client smokes half pack of cigarettes daily
 Drank alcohol “occasionally” early in pregnancy before realizing she is pregnant
 HISTORY OF PAST ILLNESSS

 Chicken pox at 4y/o
 Ovarian cyst (right ovary removed at 16 y/o)
 Accidentally swallowed aspirin 2 yrs ago
 HISTORY OF FAMILY ILLNESS

 Mother has chronic back pain
 Father aunt has diverticulosis
 Sister has ectopic pregnancy 4 yrs ago
 GYNECOLOGY HISTORY
 Menarche- 9y/o
 Cycle duration-30 days
 Menstruation-5 days
 Treated for herpes genitalis- 1 year ago
 Sexually active since age 15
 OBSTETRIC HISTORY
 Therapeutic abortion 15 years
 Spontaneous miscarriage
 MEDICATION
 Magnesium Sulfate
 Oxytocin
 Methergins
 INTERVENTION:
PLACENTA PREVIA (due to severe blood loss)
-monitor vital signs
-position in side-lying
-maintain strict bed rest
-monitor for lab results like CBC, type and cross match, platelet count
ANTEPARTUM
-assess fetal and maternal condition
-maintain circulatory fluid volume
-avoid complication
-provide emotional support
-provide knowledge
NORMAL-500 ml
CS-1000 ml
ANTEPARTUM HEMORRHAGE
PLACENTAL ABRUPTION IS THE MOST COMMON CAUSE OF ANTEPARTUM HAEMORRHAGE LEADING TO

FETAL DISTRESS.
WHY ANTEPARTUM HEMORRHAGE A SERIOUS CONDITION?

 The bleeding can be severe that it can endanger the life of both the mother and the fetus
 Placental abruption is the common cause of antepartum haemorrhage and an important cause
of perinatal death in many communities
ADVICE YOU GIVE TO ALL PATIENT

 Any vaginal bleeding is potentially serious and told that this complication must be reported
immediately
MANAGEMENT OF AN APH
 Maternal condition must be evaluated and stabilised
 Assess for the condition of fetus
 Diagnosing the cause of haemorrhage
 Definitive management of an antepartum haemorrhage, depending on the cause, must be given.
SYMPTOMS OF APH DUE TO PLACENTAL ABRUPTION

 Vaginal bleeding
 Abdominal pain
 Back pain
 Uterine tenderness
 Uterine contraction
MEDICATION
 Oxytocin (Pitocin) is the first line treatment for the prevention of the postpartum haemorrhage

Antepartum Hemorrhage

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ANTEPARTUM HEMORRHAGE

 They did vaginal examination

Diagnosed as antepartum haemorrhage. Giving Laura oxygen

ANTEPARTUM HAEMORRHAGE (APH)

RISK/ CAUSES OF APH

RISK FOR PLACENTAL PREVIA

 HISTORY CHIEF CONCERN

 HISTORY OF PAST ILLNESSS

 HISTORY OF FAMILY ILLNESS

PLACENTAL ABRUPTION IS THE MOST COMMON CAUSE OF ANTEPARTUM HAEMORRHAGE LEADING TO

WHY ANTEPARTUM HEMORRHAGE A SERIOUS CONDITION?

ADVICE YOU GIVE TO ALL PATIENT

SYMPTOMS OF APH DUE TO PLACENTAL ABRUPTION

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