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Summary Bleeding in Late Pregnancy

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A 1-4 page document written by a final year medical student with distinction grades in the uploaded modules. These notes are concise and of very high quality - using a combination of textbooks, lectures, and current guidelines (NICE and RCOG). These documents are the only resource you should need f...

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  • December 19, 2018
  • 5
  • 2017/2018
  • Summary
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Bleeding in Late Pregnancy (Antepartum Haemorrhage)
Antepartum haemorrhage = vaginal bleeding afer 24 week’s gestaton and before labour

Epidemiology - 4-5% of all pregnancies

DDXs
Life-threatening:
 Placental praevia (20%) - Low lying placenta covering the cervix
 Placental abrupton (30%) – separates from wall of endometrium
 Ruptured vasa praevia (<1%) – bleeding vessels from foetus
 Uterine scar disrupton – during labour of woman with previous C-sectonn Concealed bleedingn Abdomen
becomes rock hardn Foetal bradycardian
Non-life threatening (<50%):
 Cervical causes - Ectropion, Polyp, Cancer, Cervcits
 Bloody show – mucus plug comes away in labour giving way for uterine blood
 Vaginal trauma

Diagnosis
Examinaton:
 Vital signs
 NO DIGITAL VAGINAL EXAM untl placental praevia has been excluded (~ gentle speculum exam )
 Assess - Foetal lie, weight, and FHR
Bloods:
 Blood group
 FBC + haematocrit
 Coag tests
USS (TVS):
 Locates placental edge & internal sac

Management
Protocol for antepartum haemorrhage
 Foetal distress of Maternal haemodynamic instability (whichever gestaton)
1) ABCD
2) Full dose Ant-D if RhD- (Before emergency delivery)
3) Volume and blood replacement
4) Stll unstable  Emergency delivery
5) Becomes stable  treat as stable
 Foetus and Mother stable
1) USS every 2 weeks
2) Placenta previa  Book Electve delivery for week 37-38
3) No placenta previa  Examine to exclude local causes of bleeding  Expectant management

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