Antepartum Hemorrhage Overview

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Questions and Answers

Antepartum hemorrhage (APH) is defined as vaginal bleeding from the genital tract after 20 weeks of gestation but before the delivery of the baby.

True

What are the two main categories of causes of antepartum hemorrhage?

Placental causes and non-placental causes

Which of the following is NOT a type of placental previa?

Complete

Umbilical (correct)

Marginal

Partial

Placental abruption is characterized by painless vaginal bleeding.

False Signup and view all the answers

Vasa previa is associated with fetal distress or exsanguination.

True Signup and view all the answers

Which of the following is NOT a non-placental cause of antepartum hemorrhage?

Placenta previa Signup and view all the answers

Which of the following is a risk factor for placenta previa?

Previous cesarean delivery Signup and view all the answers

Which of the following is a clinical feature of placenta previa?

Painless, bright red bleeding Signup and view all the answers

A vaginal examination is always recommended when evaluating a patient with suspected antepartum hemorrhage.

False Signup and view all the answers

Ultrasound is a first-line imaging technique used to identify placenta previa or abruption.

True Signup and view all the answers

In the management of antepartum hemorrhage, the initial focus should be on stabilizing the fetus.

False Signup and view all the answers

Bed rest and corticosteroids are recommended for mild bleeding with a stable mother and fetus in the case of placenta previa.

True Signup and view all the answers

In cases of severe abruption with maternal/fetal distress, the recommended management is immediate delivery via cesarean section.

True Signup and view all the answers

Which of the following is a potential complication of antepartum hemorrhage?

All of the above Signup and view all the answers

Early diagnosis and timely intervention are crucial for improving outcomes in cases of antepartum hemorrhage.

True Signup and view all the answers

Which of the following is a preventive measure for antepartum hemorrhage?

All of the above Signup and view all the answers

Study Notes

Antepartum Hemorrhage (APH)

APH is vaginal bleeding after 20 weeks of gestation and before delivery.
It's a significant cause of maternal and fetal morbidity and mortality, requiring prompt evaluation and management.

Causes of Antepartum Hemorrhage

APH can be categorized into placental and non-placental causes.

Placental Causes

Placenta Previa:
- The placenta implants in the lower uterine segment, partially or completely covering the cervical os.
- Types: Marginal, Partial, Complete
- Presentation: Painless vaginal bleeding, often bright red, common in later second or third trimester.
Placental Abruption (Abruptio Placentae):
- Premature separation of a normally implanted placenta from the uterine wall.
- Presentation: Painful vaginal bleeding.

Non-Placental Causes

Genital Tract Lesions:
- Cervical ectropion, polyps, carcinoma, vaginal varices, or trauma.
Uterine Rupture:
- A tear in the uterine wall, often associated with uterine surgery (e.g., C-section or myomectomy).
- Presents with severe abdominal pain, shock, and fetal distress.
Infections:
- Cervicitis or vaginitis.
Coagulopathy:
- Maternal bleeding disorders (e.g., thrombocytopenia, disseminated intravascular coagulation).
- Uterine tenderness, rigidity, or frequent contractions.

Risk Factors for APH

Placenta Previa: Previous C-section, advanced maternal age, multiparity, uterine surgeries, smoking, substance use.
Placental Abruption: Hypertension (chronic or gestational), trauma, external cephalic version, premature rupture of membranes (PROM), smoking, cocaine use, previous abruption, low-lying placenta, multiple gestation, in vitro fertilization.
Vasa Previa: Low-lying placenta, multiple gestation, in vitro fertilization.

Clinical Features

Placenta Previa: Painless, bright red bleeding, sudden onset, often recurrent, uterus non-tender, relaxed.
Placental Abruption: Painful, dark red bleeding, sudden onset, may be associated with trauma or hypertension, rigid, tender uterus with frequent contractions, fetal distress is common.
Vasa Previa: Painless bleeding associated with rupture of membranes, severe fetal distress, may lead to fetal exsanguination.

Differential Diagnosis

Bloody show (labor), cervical or vaginal trauma, cervical ectropion or polyps, genital tract infections.

Diagnosis of Antepartum Hemorrhage

History: Onset, amount, character of bleeding, associated symptoms (pain, uterine contractions), risk factors (previous C-section, hypertension).
Physical Examination: Assess maternal vital signs, uterine tenderness, rigidity, fetal heart tones.

Investigations

Ultrasound: First-line imaging to identify placenta previa or abruption, assesses placental location, fetal viability, and amniotic fluid volume.
Laboratory Tests: Complete blood count (CBC) to assess for anemia or thrombocytopenia, coagulation profile to rule out coagulopathy or DIC, blood group and cross-match.
Fetal Monitoring: Non-stress test or biophysical profile for fetal well-being.

Management of Antepartum Hemorrhage

Initial Management: Stabilize mother (ABCs, IV access, fluid resuscitation), monitor fetus (continuous fetal heart rate monitoring), determine cause (ultrasonography).
Specific Management: Different approaches based on cause (mild/severe bleeding, stable/unstable mother/fetus, gestation).
- Placenta Previa: Mild - observation, bed rest, corticosteroids if gestation <34 weeks; Severe - emergency C-section.
- Placental Abruption: Mild - observation, supportive care, corticosteroids if <34 weeks; Severe - immediate delivery (C-section).
- Vasa Previa: Confirmed diagnosis before labor - elective C-section at 34-36 weeks, or emergency C-section for acute bleeding.
Uterine Rupture: Emergency laparotomy and C-section, repair of rupture or hysterectomy.

Complications of APH

Maternal: Hemorrhagic shock, DIC, increased risk of C-section, hysterectomy, death.
Fetal: Preterm delivery, IUGR, hypoxia, stillbirth, neonatal anemia.

Prognosis

Early diagnosis and timely intervention significantly improve outcomes.
Close monitoring and multidisciplinary care is crucial.

Prevention

Early identification and management of high-risk pregnancies, smoking cessation, proper antenatal care, use of corticosteroids for fetal lung maturity.

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Description

This quiz covers the critical topic of Antepartum Hemorrhage (APH), discussing its definition, causes, and classifications. You'll explore both placental and non-placental causes, including specific conditions like placenta previa and placental abruption. Understand the implications of APH on maternal and fetal health as well.