Weeks 2 - Antepartum Haemorrhage(1).pdf

Miscarriage and Antepartum Hemorrhage Advanced Obstetric, Neonatal and Pediatric Emergencies (HEM 4006) Wednesday, August 28, 2024 Session Overview Overview of miscarriage and antepartum haemorrhage and the prehospital management thereof.  Group Discussion Miscarriage/Spontaneous Abortion...

Miscarriage and Antepartum Hemorrhage Advanced Obstetric, Neonatal and Pediatric Emergencies (HEM 4006) Wednesday, August 28, 2024 Session Overview Overview of miscarriage and antepartum haemorrhage and the prehospital management thereof.  Group Discussion Miscarriage/Spontaneous Abortion Miscarriage/Spontaneous Abortion Definition: Risk Factors: Pregnancy loss before the fetus is Maternal age (risk increase with age), viable – 20th week of gestation Prior pregnancy loss, (variation in definition – some place state 24 weeks). Medical conditions in patients (infections, stress and chronic conditions), Aetiology: Medications (NSAIDs, psychiatric medication) Multifactorial, pathophysiology and drug exposures (caffeine and alcohol dependent on the cause. consumption), Common causes: Smoking, Trauma, Environmental factors (Toxins and pollutants) Chromosomal abnormalities, – lead, arsenic and air pollution, Maternal anatomical anomalies. Ethnicity.  6 Miscarriage/Spontaneous Abortion Clinical Presentation: Uncomplicated (bleeding and/or cramping) Vaginal bleeding (range from light to heavy - passage of tissue and/or clots), Pain (pelvic area or lower back) often cramping in nature (mild to severe, particularly during passing of gestational tissue). Complicated (bleeding and/or infection) Heavy vaginal bleeding with signs of blood loss and hypovolemic shock, Infection (spontaneous or after medical/surgical intervention) - Abdominal or pelvic pain, uterine tenderness, purulent discharge, and other signs of infection – fever, tachycardia, hypotension, etc.  8 Miscarriage/Spontaneous Abortion Prehospital Management: Obtain history, vital signs and conduct physical examination. Provide emotional support and sanitary pads. Most patients are stable. Transport to hospital for evaluation and further management. Treat symptomatic: Supplemental O2, if indicated Signs of shock: NaCl 500 ml to maintain palpable radial pulse Antepartum Haemorrhage Antepartum Haemorrhage Antepartum haemorrhage is bleeding from the genital tract in pregnancy of ≥ 20 weeks (variation in definition – same places state 24 weeks) gestation and before onset of labour. Common causes: 1. Placenta Previa 2. Placenta Abruption 3. Vasa Previa 4. Uterine Rupture Placenta Previa  12 Placenta Previa Definition Presence of placental tissue extending over the internal cervical os. Potential Complications: Antepartum haemorrhage, Preterm labour/birth, Intrapartum haemorrhage, Postpartum haemorrhage. Pathogenesis: Unknown 13  14 Placenta Previa – Risk Factors Previous placenta previa, Previous cesarean birth, Multiple gestations (Multigravida), Increased maternal age Previous uterine surgical procedures Infertility treatment Maternal smoking Endometriosis Abortion (induction or spontaneous) 1. Placenta Previa Placental bleeding major complication associated with: Uterine contraction, Gradual changes of the cervix and the uterus, Coitus, Vaginal examination. Clinical presentation: Commonly identify on ultrasound Predicted Painless vaginal bleeding (90%) Bright red bleed (variation). Placenta Abruption Placental Abruption Definition Premature detachment of the placenta from the uterine wall at or after 20 weeks gestation. Blood accumulates behind placenta in uterine cavity or is lost through cervix. Significant cause of maternal and neonatal mortality – requires promote intervention.  18 2. Placental Abruption Risk Factors: Trauma (abdominal trauma), Cocaine, other drug exposure and smoking, Polyhydramnios, Chronic hypertension, Pre-eclampsia and eclampsia PROM Increase age, Multigravida, Previous abruption  19 Placental Abruption Types: Concealed: no external bleeding evident (