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