Download MBBS (Bachelor of Medicine and Bachelor of Surgery) OBS and Gynec Antepartum Haemorrhage PowerPoint PPT presentation
? A 32-year-old multigravida at 31 weeks gestation is admitted to the
obs dept after a motor-vehicle acci-dent. She complains of sudden
onset of moderate vaginal bleeding for the past hour. She has
intense,constant uterine pain and frequent contractions. Fetal heart
tones are regular at 145 beats/min. On in-spection her perineum is
grossly bloody
? Diagnosis, investigations & management.?
? CASE 2
? A 34-year-old multigravida at 31 weeks gestation comes to the obs
dept stating she woke up in themiddle of the night in a pool of
blood. She denies pain or uterine contractions. Examination of the
uterusshows the fetus to be in transverse lie. Fetal heart tones are
regular at 145 beats/min. On inspection herperineum is grossly
bloody.
? Diagnosis. ?
? Investigation & management?
ANTEPARTUM
HAEMORRHAGE
?Antepartum haemorrhage is defined as bleeding from genital tract after foetal
viability and before delivery
?Viability ---28 weeks onwards
?Due to improvements in foetal survival
qWHO ? 22 weeks
qUK ? 24 weeks
?It complicates 2-5% of all pregnancies , and lead to a high foetal and maternal
mortality and morbidity
CAUSES
vPlacenta previa
vAbruptio placenta
vCircumvallate placenta
vVasa praevia
vUnclassified or intermediate haemorrhage
vLocal causes: polyp , ca cervix, varicose veins
local trauma
PLACENTA
PREVIA
C J A B D U L K A L A M
qPlacenta praevia is defined as a
placenta located partly or
completely in the lower uterine
segment
qThe bleeding is called inevitable or
unavoidable haemorrhage as dilation
of internal os inevitable results in
haemorrhage
? Incidence 1 in 300
AETIOLOGY
? it has been suggested that damage to endometrium or myometrium can
predispose to a low implantation & subsequent implantation of placenta
praevia
? Prior surgery on uterus
? CS , myomectomy ,D & C
? Infection or chorioamnionitis
? Previous placenta praevia
? Advanced maternal age
? Multiparity ,multiple pregnancy , malpresentations , smoking
PATHOGENESIS
Risk factor
Defective placental migration\large placenta
Low lying placenta
Separation of placenta during formation of lower uterine segment &
dilation of internal os
Inability of the lower uterine segment to contract
bleeding
CLASSIFICATION
? Low lying placenta or lateral placenta praevia ,the
placenta edge does not reach internal os but is in close
Type 1
proximity
? Marginal placenta praevia, placental edge reaches the
margin of internal os ,but does not cover it
Type 2
? Partial or incomplete central placenta praevia
? Placenta covers internal os when closed ,but only
partial y when the os is dilated
Type 3
? Total ,central or complete placenta praevia
Type 4
? Placenta covers internal os even on dilation
? Type 1 & 2 minor
? Type 3 & 4 major
? Placenta can be anterior or
posterior
? Type 2 posterior placenta is called
dangerous type as it is likely to be
compressed between foetal head
& sacral promontory
CLINICAL FEATURES
? SYMPTOMS
? Painless and recurrent bouts of antepartum haemorrhage
? SIGNS
? Pallor [proportionate to bleeding]
? Size of uterus corresponds to period of amenorrhoea
? Uterus soft & non tender
? Malpresentation common `if cephalic head is usually floating
? Foetal parts can be felt in anterior placenta & difficult in posterior placenta
? foetal heart sound usually heard
? Stallworthy`s sign : slowing of heart rate on pressing the head down into the
pelvis & prompt recovery on release
? Vaginal examination should not be done
DIFFERENTIAL DIAGNOSIS
? Al causes of antepartum haemorrhage
COMPLICATIONS
? MATERNAL
? FOETAL
? Shock due to haemorrhage
? prematurity
? Increased chance of cs
? Hypoxia due to placental
? Postpartum haemorrhage
separation
? Morbidity adherent placenta
? Placenta accreta
? Placenta increta
? Placenta percreta
MORBIDITY ADHERENT PLACENTA
? The placenta is adherent to the uterine wal due to partial or total
absence of decidua basalis and fibrinoid layer ( Nitabuch layer )
? Thank you
This post was last modified on 12 August 2021