Antepartum Hemorrhage: Causes, Management, and Investigations
Antepartum hemorrhage (APH) is a significant complication affecting pregnancies globally, with varying severity and causes such as placenta previa and abruption. Management involves a multidisciplinary approach in hospital maternity units, including resuscitation and emergency delivery. Investigations like CBC, RFT, and ultrasound are crucial for assessment. This condition poses a risk to both maternal and fetal health, highlighting the importance of prompt and comprehensive care.
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Presentation Transcript
Antipartum hemorrhage (APH)
Bleeding from or into genital tract occurring from 24 weeks of pregnancy and prior to the birth of the baby. Affects 3-5% of pregnancies. It s the leading cause of maternal morbidity and prenatal mortality ( mainly due prematurity ) Obstetric hemorrhage remains one of the major causes of maternal death in the developing countries .
50% of estimated 500,000 maternal deaths occurring globally per year. Fifth of very preterm babies are born in association with APH. APH has a heterogeneous pathophysiology and can t be predicted.(70% of cases of abruptio placenta occur in low-risk pregnancies )
There is no consistent definition of the severity of APH(often underestimated) Following definitions have been used : 1-spotting: staining, streaking, spotting 2-minor hemorrhage <50 ml 3- major hemorrhage : 50-1000 ml with no signs of clinical shock 4- massive : more than 1000 ml and/or signs of clinical shock
Causes: 1-placenta previa 2-placenta abruption 3-local causes (cervical or vaginal lesions, cancer, infections or lacerations) 4-vasa previa 5-uterine rupture -unexplained (high risk pregnancy SGA, RRO.M, PTL, IUGR, C/S)
Management: in the hospital maternity unity with facilities for resuscitation such as: 1-anesthetic support 2-blood transfusion resources 3-performing emergency operative delivery 4-multi disciplinary team including: Midwifery, obstetric staff, neonatal staff, anesthetic staff, hematologist, radiologist and vascular surgeon.
Investigations: CBC, RFT, LFT, Coagulation factors, blood grouping, Rh. ABCD : A,B AIRWAY and breathing oxygen 10-15 L/min C: Circulation: two large bore cannulas . 14 gauge IV lines. D: asses fetus and decide delivery -Clinical Examinations -No vaginal digital examination ,speculum examination should be done to rule out local causes. u/s to diagnose placenta previa
Steroids can be given if pregnancy < 34 weeks for fetal lung maturity. Tocolysis shouldn t be used in (unstable patient, fetal compromise, major APH) It s a decision of a senior obstetrician . Avoid nifedipine (HYPOTENSION) Anti DIg should be given to all non sensitized RH-ve if they have APH. At least 500 IU antiDIg followed by a test of FMH if it's more than 40ml of RBC additional Anti D required. Anti D Ig should be given at minimum of 6 weeks intervals(in recurrent bleeding) Risk of PPH: pt should receive active management of 3rdstage of labor using syntometrine (in absence of high B.P) Senior consultant anesthetic care needed in high risk hemorrhage .
maternal -anemia -infection -maternal shock -renal.T.necrosis -DIC -PPH -prolonged hospital stay -psychological sequelae -Complications of b.t Fetal -hypoxia -SGA -IUGR -prematurity -fetal death
