Antepartum haemorrhage

11,305 views
10,735 views

Published on

Published in: Health & Medicine
2 Comments
7 Likes
Statistics
Notes
No Downloads
Views
Total views
11,305
On SlideShare
0
From Embeds
0
Number of Embeds
17
Actions
Shares
0
Downloads
523
Comments
2
Likes
7
Embeds 0
No embeds

No notes for slide

Antepartum haemorrhage

  1. 1. Bleeding after the 20thweek of pregnancy before the birth of the baby<br />Antepartum Haemorrhage<br />
  2. 2. Epidemiology<br />Complicates 4% of pregnancies (Cunningham et al, 2001)<br />Emergency/maternal death<br />
  3. 3. Causes<br />Placenta Previa 0.5% pregnancies (Boyle, 2002)<br />Placental Abruption 1:150 births (Boyle, 2002)<br />Other causes of bleeding in pregnancy 50% are made up of the following (Cunningham et al, 2001)<br />Fetal Vessel rupture<br />Velamentous cord insertion<br />Vasa Previa<br />Uterine rupture<br />Clotting disorders, severe cervicitis, polyps, benign & malig. Neoplasms, vaginal lacerations, varices.<br />Haemorrhoids, congenital bleeding disorder<br />Abdominal/pelvic trauma<br />2nd trimester miscarriage<br />Preterm labour & multiple pregnancy<br /> *As always there are unknown causes<br />
  4. 4. ABRUPTIO PLACENTA<br />NORMAL PLACENTA<br />PLACENTA ACCRETA<br /> PLACENTA PREVIA<br />
  5. 5. TYPES OF PLACENTA PREVIA<br />LOW LYING<br />MARGINAL<br />TOTAL<br />PARTIAL<br />
  6. 6. Cervix<br />Placenta<br />Uterus<br />A PLACENTA WHICH HAS IMPLANTED OVER THE OS<br />
  7. 7. Causes of Placenta Previa<br />Previous caesarean section<br />In the U.S. alone the C/S in 2009 was 32.9%. It is predicted that if it continues to rise at the current rate then it will be 56.2%.<br />This will cause a rise in the rate of possible complications:<br />an additional 6236 placentaprevias<br />An additional 4504 placentaaccretas<br />An additional 130 maternal deaths annually (Solheim et al, 2011)<br />
  8. 8. SYMPTOMS of Placenta Previa<br />Painless vaginal bleeding<br />Bleeding with contractions<br />Bleeding post coitus<br />Breech presentation or unstable lie<br />Fetal distress<br />Soft Uterus <br />In excessive blood loss symptoms of shock<br />(Boyle, 2002)<br />
  9. 9. Midwifery Actions-Identified at 19wk scan <br />5-6% of all pregnancies (Boyle, 2002)<br />Due to the formation of the lower segment of the uterus:<br />Order rescan at – 32wks (Boyle, 2002)<br /> Order rescan at – 36wks (Pairman et al, 2006)<br />Initial advice to woman<br />Reassurance that 90% of women rescanned will be normal<br />Contact maternity unit should there be any bleeding during pregnancy<br />Anecdotal evidence that sex should just be avoided in the last trimester when placenta previa has been diagnosed<br />
  10. 10. Midwifery Actions-Woman presents with painless bleeding<br />Calm attitude<br />Inform Obstetric staff<br />T, P, BP<br />CTG<br />Palpation<br />NO Vaginal Examination until location of placenta has been confirmed by ultrasound<br />Take history of amount of blood loss, explore possible causes.<br />Establish venous access<br />Take blood for Group & Hold, Full blood count, clotting & Kleihauer if rhneg<br />IV fluids as prescribed<br />Usually occurs after 34wks + 50% of cases birth before 35wks (Boyle, 2002)<br />
  11. 11. Induction of labour <br />Is possible in:<br /><br /><br />
  12. 12. Management<br />In the absence of excessive bleeding expectant management until 37 wks gestation<br />Ensure blood available<br />Monitor for anaemia<br />Anti D if Rh Neg<br />Steroids for fetal lung development<br />
  13. 13. Midwifery Actions<br />Consider anxieties of woman in hospital with other children to care for<br />Possible visit to the neonatal unit<br />Include in discussions surrounding expectant birth date of the baby<br />
  14. 14. Possible complications<br />Uncontrollable bleeding<br />Anaemia<br />Infection<br />Renal failure due to severe shock<br />Hysterectomy<br />Sheehan’s syndrome as a result of severe shock<br />(Damage to the pituitary gland – hypopituitarism)<br />Fetal hypoxia<br />Premature birth<br />Fetal death<br />Psychological effects<br />Placenta accreta<br />
  15. 15. Placental Abruption<br />
  16. 16. Causes<br />Trauma<br />-Polyhydramnioswith rapid decompression on membrane rupture<br />-cocaine use<br />-tobacco use<br />-PPROM<br />-short umbilical cord<br />
  17. 17. Signs and Symptoms<br />Red or brown loss PV<br />Signs of shock<br />Abdominal Pain<br />Tense, firm uterus<br />Tender to palpate<br />Reduced or excessive fetal movements<br />Fetal distress or no fetal heart<br />
  18. 18. Bleeding Characteristics<br />SEVERITY OF BLEEDING:<br />
  19. 19. Full History involves<br />Record of bleeding characteristics<br />Assessment of associated factors<br />Pain – Pelvic, abdominal, back pain<br />Contractions<br />Vaginal discharge<br />Rupture of membranes<br />Assessment of causal factors<br />Recent examination<br />Abdominal or pelvic trauma<br />Intercourse<br />Assessment of<br />Fetal movements<br />Reading of<br />Previous ultrasounds<br />
  20. 20. Physical Examination<br />Record of vital signs <br />can be normal despite significant blood loss<br />Abdominal Examination<br />Pain on palpation<br />Contractions on palpation<br />Hypertonic Uterus<br />Pregnancy Assessment<br />CTG<br />Scan<br />Emotional support<br />Woman & partner will be very anxious<br />
  21. 21. Management<br />Stabilize the woman<br />T, P, BP<br />Full history<br />IV access<br />Blood for group & hold, Full blood count, Coag & Kleihauerif rhneg<br />
  22. 22. Midwifery Input<br />Keep woman and family informed at all times<br />Effective communication in the multidisciplinary team<br />Monitoring of the woman & baby’s condition<br />
  23. 23. References<br />Boyle, M., (2002). Chapter 5, Antepartum haemorrhage, Emergencies Around Childbirth. Oxon U.K. Radcliffe Medical Press<br />Cunningham, F.G., Grant, N., Leveno,K.J., Gilstrap iii, L.C., Hauth, J.C. & Wenstrom, K.D. (2001). Williams Obstetrics. (21st ed.). New York:Mcgraw Hill<br />Pairman, S., Pincombe, J., Thorogood, C., Tracy, S., (2006) Midwifery Preparation for Practice (1st ed.). Elsevier, Australia<br />Solheim, K. N., Esakoff, T. F., Little, S. E., Cheng, Y. W., Sparks, T. N., & Caughey, A. B. (2011). The effect of cesarean delivery rates on the future incidence of placenta previa, placenta accreta, and maternal mortality. J Matern Fetal Neonatal Med.<br />

×