Post Contents List
- 1 APH (Antepartum Haemorrhage) and Placenta previa (PP) Diagnosis Symptoms
- 2 APH (Antepartum haemorrhage)
- 3 Cause of APH
- 4 Placenta previa (PP)
- 5 APH Epidemiology
- 6 Other risk factors
- 7 APH Etiology
- 8 Cause of bleeding
- 9 Clinical Manifestations symptoms –
- 10 APH Diagnosis
- 11 Examination.
- 12 Laboratory Studies
- 13 Complications
APH (Antepartum Haemorrhage) and Placenta previa (PP) Diagnosis Symptoms
APH (Antepartum Haemorrhage) and Placenta previa (PP)
APH (Antepartum Haemorrhage)
- } It is defined as bleeding from or into the Genital tract.
APH (Antepartum haemorrhage)
Cause of APH
} I. Placenta previa (PP) is defined as the presence of placental tissue over or near the internal cervical os.
} PP can be classified into four types based on the location of the placenta relative to the cervical os: to the internal os.
Placenta previa (PP)
- } Type-1/low-lying placenta,
- ◦ placenta is located near (2 to 3 cm) but not directly adjacent
- } Type-2/marginal previa,
- ◦ the edge of the placenta lies adjacent to the internal os;
- } Type-3/partial previa,
- ◦ the margin of the placenta covers part but not all of the internal os;
- } Type-4/complete or total previa,
- ◦ the placenta covers the entire cervical os;
- } 1. the incidence of PP is 1 in 200 to 1 in 390 pregnancies over 20 weeks’ gestational age).
- ◦ varies with parity,
- ◦ For nulliparous, the incidence is 0.2%, in grand multiparous, it may be as high as 5%
- } 2. The most important risk factor for PP is a previous cesarean section.
- ◦ PP occurs in 1% of pregnancies after a cesarean section.
- ◦ The incidence after four or more cs increases to 10%
- ◦ increasing maternal age after age 40),
- ◦ multiple gestation, and previous uterine curettage
- ◦ the placenta covers the cervical os in 5% of pregnancies when examined at midpregnancy.
- ◦ The majority resolve as the uterus grows with gestational age.
- ◦ The upper third of the cervix develops into the lower uterine segment, and the placenta “migrates” away from the internal os.
Other risk factors
- } Unknown –
- ◦ a. Endometrial scarring.
- ◦ b. A reduction in uteroplacental oxygen promotes need for an increase in the placental surface area that favors previa formation.
- } Bleeding occur in association with the development of the lower uterine segment in the third trimester.
- } Placental attachment is disrupted because this area gradually thins in preparation for labor.
- } the thinned lower uterine segment is
Cause of bleeding
- } unable to contract adequately to
- } prevent blood flow from the open vessels.shearing action
- } Vaginal examinationHow to take good medical history & examination. Read more ... » or intercourse may also cause separation of the placenta from the uterine wall.
- } 80% of affected patients present with painless vaginal bleeding
- } Most commonly, the first episode is around 34 weeks of gestation;
- } one-third of patients develop bleeding before 30 weeks
- } Anaemia
Clinical Manifestations symptoms –
- } Abnormal growth of the placenta into the uterus can result in one of the following 3 complications:
- } i. Placenta Previa Accreta.
- } ii. Placenta Previa Increta.
- } iii. Placenta Previa Percreta.
- } 1. History.
- ◦ PP presents with acutePericardiaI Diseases Diagnosis Causes and Physical findings and PericardiaI Diseases Treatment. Read more ... » onset of painless vaginal bleeding.
- ◦ A thorough history should be obtained from the patient, including obstetric and surgical history as well as documentation of previous ultrasound examinations.
- ◦ Other causesPericardiaI Diseases Diagnosis Causes and Physical findings and PericardiaI Diseases Treatment. Read more ... » of vaginal bleeding must also be ruled out, such as placental abruption.
- } Vaginal sonography –
- ◦ is the gold standard for diagnosis of previa
- ◦ Placental tissue has to be overlying or within 2 cm of the internal cervical os to make the diagnosis.
- ◦ The diagnosis may be missed by transabdominal scan,
- ◦ if the placenta lies in the posterior portion empty bladder may help in identifying anterior previas, and Trendelenburg positioning may be useful in diagnosing posterior previas.
Complete placenta previa. Sagittal mid-line view of the lower uterus performed tau the placenta (PL) completely covering the cx
Marginal/partial placenta previa in 3RD trimester patient with bleeding. Tvu shows inferior edge of posterior pl (P) located at internal CX os
- } If PP is present, digital examination is contraindicated.
- ◦ a. A speculum examination can be used to evaluate the presence and quantity of vaginal bleeding, the amount of vaginal bleeding can be assessed without placing a speculum and potentially causing more bleeding.
- ◦ b. Maternal vital signsPericardiaI Diseases Diagnosis Causes and Physical findings and PericardiaI Diseases Treatment. Read more ... », abdominal exam, uterine tone, and fetal heartPericardiaI Diseases Diagnosis Causes and Physical findings and PericardiaI Diseases Treatment. Read more ... » rate monitoring should be evaluated.
- } 4. . The following laboratory studies should be done for a patient with PP with vaginal bleeding:
- ◦ a. Complete blood cell count
- ◦ b. Type and cross-match
- ◦ c. Prothrombin time and activated thromboplastin time
- ◦ d. Kleihauer test to assess for fetomaternal hemorrhage
- } Maternal—
- ◦ Anaemia with shockShock Presentation Risk Factors Pathogenesis Management Treatment. Read more ... » or CHF
- ◦ Malpresentation
- ◦ Premature labour
- ◦ Rarly rupture of membrain
- ◦ Post partum haemorrhage
- ◦ SepsisSepsis (Septic Shock) Definition Diagnosis and Pathophysiology. Read more ... »
- ◦ subinvolution
- } Foetal complications include
- ◦ Low birthweight baby
- ◦ Asphyxia
- ◦ IUD
- ◦ Birth injury
- ◦ Congenital malformation
- } 1. Standard ManagementChronic Renal Failure (CRF) Risk factors Causes Stage CRF Treatment. Read more ... »
- ◦ a. In the third trimester in a patient who is not bleeding, recommendations include
- } ultrasound confirmation
- ◦ pelvic rest (nothing in the vagina, including intercourse or pelvic exams),
- ◦ explanation of warning signs and when to seek immediate medicalDizziness cause diagnosis treatment. Read more ... » attention,
- ◦ avoidance of exercise and strenuous activity, and fetal growth ultrasounds every 3 to 4 weeks.
- ◦ Fetal testing semiweekly