This website is intended for Medical Professionals only. By using this site you confirm that you are a healthcare professional.

News
Prolonged periods of sedentary time strongly ... A team of researchers from the NIHR Leicester Biomedical ... (16 Jan 2018)
A more complete Mediterranean diet may ... New study in The Journal of Urology® finds that a high intake of ... (17 Jan 2018)
Mediterranean Diet May Help Protect Older ... An analysis of published studies indicates that following the ... (16 Jan 2018)
Frozen embryos result in just as many live ... Freezing and subsequent transfer of embryos gives infertile ... (16 Jan 2018)
Camelina oil improves blood lipid profile The use of camelina oil reduces overall and LDL cholesterol ... (16 Jan 2018)
Monday, 29 September 2014 10:42

Antepartum haemorrhage (APH)

Rate this item
(0 votes)

by Sarah Craus

 

APH complicates 3–5% of pregnancies. It is bleeding from or into the genital tract, occurring from 24+0 weeks of pregnancy and prior to the delivery of the baby. APH can lead to both fetal and maternal morbidity and mortality1 such as hypoxia, intrauterine growth retardation, infection, anaemia and post-partum haemorrhage1.

Causes of APH include placenta praevia and placental abruption (Figure 1a and b respectively2).

 


(a)                                                                             (b)

Risk factors include a previous pregnancy complicated by abruption or placenta praevia, multiparity, low BMI, advanced maternal age, pre-eclampsia, fetal malpresentation and smoking.

History and examination are vital when a woman presents with APH3. If there is a suspicion of placenta praevia, a vaginal examination should not be carried out as this leads to catastrophic bleeding. Ultrasound can be used to confirm the presence of a placenta praevia and then the mother should be kept in hospital until delivery, which is normally via caesarean section at 37 weeks.

If the mother is between 24+0 and 34 +6 weeks of gestation, dexamethasone should be given as the fetus’s lungs are not yet well developed. Tocolysis should not be used if the mother is hemodynamically unstable, has suffered major APH or there is evidence of fetal compromise4. The fetus should be monitored using a CTG to detect any signs of fetal distress.

In the acute setting, maternal blood should be taken for a complete blood count and coagulation screen, as well as to obtain a cross match. Oxygen should be given at 15L/minute via a mask with reservoir. Mother can be transfused with O negative blood if blood loss was significant (Figure 2).


Figure 2: Management of APH5

References:

1.    Calleja-Agius J, Custo R, Brincat MP, Calleja N. Placental abruption and placenta praevia. Eur Clin Obstet Gynaecol 2006; 2:121–7

2.    Bleeding in Pregnancy/Placenta Previa/ Placental Abruption [http://www.stanfordchildrens.org/]

3.    Royal College of Obstetricians and Gynaecologists. Placenta Praevia, Placenta Praevia Accreta and Vasa Praevia: Diagnosis and Management. Green-top Guideline No. 27. London: RCOG; 2011

4.    Royal College of Obstetricians and Gynaecologists. Tocolytic Drugs for Women in Preterm Labour. Green-top Guideline No. 1b. London: RCOG; 2011

5.    Late Pregnancy Bleeding ELLEN SAKORNBUT, M.D., Family Health Center of Waterloo, Waterloo, Iowa, LAWRENCE LEEMAN, M.D., M.P.H., University of New Mexico, Albuquerque, New Mexico PATRICIA FONTAINE, M.D., M.S., University of Minnesota, Minneapolis, Minnesota. Am Fam Physician. 2007 Apr 15;75 (8):1199-1206.

Read 5024 times Last modified on Friday, 14 October 2016 20:45

TheSynapse Videos

0
0
0
0
0
0

Highlights

  • AVAILABLE CLINICS

    Rational Pharmacy, Valley Road, B'Kara requires consultants & family doctors for early morning & afternoon sessions.

    Please contact 99891732 or This email address is being protected from spambots. You need JavaScript enabled to view it. for more information.

    Written on October 09, 2017
  • Free Clinic Rooms Available

    Pharmasal, a chain of 6 retail pharmacies has a number of free clinic rooms available within the pharmacies in Tarxien, St. Paul’s Bay, Zejtun, and Dingli. We are looking to increase our list of family doctors and specialists. Family doctors are given preference for the clinic at Zejtun.  For more information, please send an email to This email address is being protected from spambots. You need JavaScript enabled to view it. or call on 99425939.

    Written on October 18, 2017

SPONSOR MESSAGE

No data displayed on the module. Please check some parameters in the module settings again!

Join

Connect with other Medical Professionals on fb in a closed facebook group

Login

Template Settings

Theme Colors

Cyan Red Green Oranges Teal

Layout

Wide Boxed Framed Rounded
Patterns for Layour: Boxed, Framed, Rounded
Top
We use cookies to improve our website. By continuing to use this website, you are giving consent to cookies being used. More details…