ANTEPARTUM

HAEMORRHAGE

Obs/Gynae Unit I

Holy Family Hospital, Rawalpindi.

DEFINITION

Bleeding from the genital tract in pregnancy before

the onset of labor and after the age of viability.

AETIOLOGY

• Placenta Praevia

• Placental Abruption

• Others

Marginal placental bleed

Show

Local infection

Genital tract tumors

Vasa praevia

PLACENTA PREVIA

PLACENTA PREVIA

PLACENTA PRAEVIA

Definition

Grades

Aetiology and Associations

• Uterine Surgery

• Maternal age

• Smoking

• Painless Bleeding

• Recurrent episodes

• High Presenting Part

• Mal -Presentation

• Less chance of fetal demise

DIAGNOSIS

MANAGEMENT

Achieve as much maturity as possible with feto–maternal

monitoring

Placental edge < 2cm from internal os

C- section

Placental edge >4.5 cm from internal os

Vaginal delivery

Placental edge from 2-4 cm from internal os

Clinical assessment

Indications of examination in theatre

PLACENTAL ABRUPTION

Aetiology and Associations

H/O abruption

Rapid uterine decompression

Trauma

Smoking

Abnormal Placentation

Pre-eclampsia

Thrombophilias

PLACENTAL ABRUPTION

Painful bleeding

Uterus irritable, hard, tetanic

Fetal compromise

Ultrasonography

DIAGNOSIS

DIC

ATN

COMPLICATION

Disturbance of conscious state

SBP < 100 of Hg

HR 120 beats / min

Blood loss > 1500

Peripheral perfusion is reduced

MAJOR HEMORRHAGE