Antepartum Haemorrhage



Abruption

Separation of the normally located placenta after the 20th week of gestation and prior to the birth of the fetus. Caused by bleeding into the decidua basalis.

Occurs in about 1% of pregnancies.

15% foetal mortality.

Abruption Signs

  • Woody hard large for dates tender uterus
  • Constant pain
  • FH present or absent
  • Concealed or revealed haemorrhage

Abruption Treatment

  • Immediate abdominal palpation
  • Auscultate FH
  • Call Obstetric SpR
  • Two 16G cannulae
  • Hb, X-match 4 units, clotting
  • Theatre
  • VE by Obstetrician
  • Vaginal delivery vs. C section

Praevia

Implantation of the placenta over or near the internal os of the cervix. Varies from total to partial to low lying placenta.

  • Higher incidence in older women.
  • Occurs in 0.5% of pregnancies.
  • Foetal mortality low.

Praevia Signs

  • Bright red blood
  • Soft
  • High presenting part
  • Painless
  • Bleeding may be profuse

Praevia Treatment

  • Mx depends on degree of bleeding
  • IV infusion.
  • X-match.
  • FH
  • Contact Obs Registrar for advice
  • Conservative vs. Delivery. Grade / Gestation / Amount

Other causes of APH

  • Infection
  • Cervical erosion
  • Cervical neoplasia
  • Vaginal tears
  • Undefined bleeding
  • Marginal abruption
  • Marginal sinus haemorrhage

All rhesus negative women must have a Kleinhauer test and be given Anti-D (<20/40 = 250 i.u., 20/40 = 500 i.u.)


Content by Dr Íomhar O' Sullivan. Reviewed by Dr ÍOS 10/07/2002, 01/05/2005, 20/01/2007, 30/05/2007. Last review Dr ÍOS 18/01/15.