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

·      Foetal compromise

 

Placental abruption:

Presentation

·      Painful bleeding

Pathophysiology

·      Placenta comes off myometrium

·      Blood extravasates

Associations

·      Pre-eclampsia

Complications

·      APH

·      DIC

·      Atony

·      Foetal compromise

 

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

·      Wait: if bleeding stops, mother ok, baby ok

·      Spinal + LUSCS: if small volume but baby compromised

·      GA + LUSCS: if large volume and mother or baby compromised

 

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