Antepartum haemorrhage

 

Differentials:

·        Placenta praevia

·        Vasa praevia

·        Placental abruption

·        Uterine rupture

 

Placenta praevia:

Presentation

·      Painless bleeding

Risk factors

·      Prev LUSCS (esp if ≥3)

·      Prev other uterine surgery

·      Older mother

·      Smoking

Pathophysiology

·      Placenta covers the os

Associations

·      Adherent placenta

Complications

·      APH

·      PPH / atony

 

Placental abruption:

Presentation

·      Painful bleeding

Pathophysiology

·      Placenta comes off myometrium

·      Blood extravasates

Associations

·      Pre-eclampsia

Complications

·      APH

·      PPH / atony

·      DIC

 

Approach

Temporise

·      CSL bolus

·      Metaraminol 0.5mg

Assess

Mother:

·      Hx: syncope, dyspnoea, malaise

·      Ex: pale/cold, ↑HR/↑RR/↓BP, volume of blood loss

·      Ix: review ultrasound; Hb, lactate, pH, coags, viscoelastic

Foetus:

·      Foetal movement

·      CTG

Resuscitate

·      Vascular access

·      Whole blood available

·      Clotting adjuncts

·      Warming

·      Testing

Make decision

·      Indications for GA LUSCS

o  Bleeding continues

o  Mother compromised

o  Baby compromised

·      Beware coagulopathy

o  Neuraxial contraindication

o  Expect PPH

 

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