Antepartam haemorrhage
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Antepartam haemorrhage

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Antepartam haemorrhage Antepartam haemorrhage Presentation Transcript

  • ANTEPARTAM HAEMORRHAGE  IMMEDIATE DELIVERY
  • Significant bleeding from th birth canal after 24 week of gestation till de.
  • CAUSES PLACENTAL    Placenta Praevia Placental Abruption Vasa Praevia NON PLACENTAL     Labour (Heavy show ) Uterine rupture Local / Non obstetrical Cervicitis Polyp Lacerations Bleeding Disorders Conginital acquired
  • PLACENTA PRAEVIA Implantation of placenta in lower uterine segment   Partial Complete
  • DEGREES MINOR MAJOR M a j o r
  • ETIOLOGY Scarred or poorly vascularized endometrium  Advancing age  Multiparity  Previous uterine surgeries caeserian, myomectomy, D&C, ERPC
  • Bleeding Mechanical Seperation Rupture of Cervical dilalatation Venous lakes effacement intravaginal manipulation
  • DIAGNOSIS Presenting complaints Painless vaginal bleeding Mild Moderate Profuse SHOCK
  • CLINICAL FINDINGS  Pallor  Vital Signs Stable Unstable  Hemorrhage Abdomen Soft , relaxed , non tender Lie transverse/oblique Presenting part high Fetal hearts present
  • DIAGNOSIS  History  Clinical examination  Ultrasonography  Colour Doppler  C T scan  MRI
  • MRI USG
  • MANAGEMENT Depends Amount of hemorrhage Gestational age
  • MANAGEMENT  Airway  I/V Line  Fluids 16 / 18 Gauge cannula crystalloids / colloids  Blood transfusion /FFP  Indwelling urinary catheter  Inform Senior Obstetrician  Avoid pelvic examination
  • MANAGEMENT  Investigations  Blood grouping & cross match  Complete blood counts  Coagulation profile (Platelet count, APTT,PT,FDPs)  Ultrasound scan ( full bladder )
  • EXPECTANT MANAGEMENT (Preterm fetus)  AIM  Haemodynamically stable with mild bleeding and no uterine contractions Close observation vital signs & vaginal bleeding Correction of anaemia Steroids for fetal lung maturation Counseled and prepared for Caeserian section     To prolong pregnancy till Term
  • IMMEDIATE DELIVERY  Caeserian Section / Hysterotomy Haemodynamically unstable. Profuse vaginal bleeding. After 37 completed weeks of gestation. If patients has palpable uterine contractions. SURGEON / ANAESTHETIST GENERAL ANAESTHESIA SENIOR
  • COMPLICATIONS  Maternal Anaemia Shock Complications of surgery & Anaesthesia Post Partam hemorrhage Maternal mortaliy  Fetal Morbidity / Mortality
  • PLACENTAL ABRUPTION  Bleeding following premature separation of a normally situated placenta.
  • AETIOLOGY Advance age  Multiparity  Poor nutritional status  Past History ( recurrence 15 –20% )  Hypertention  Abdominal Trauma  Smoking  Uterine Decompression ( polyhydramniose , Twins )  Chorio amnionitis  Fibroid, Folic Acid deficiency 
  • PATHOPHYSIOLOGY Local Vascular injury (Pre eclampsia) Haematoma Formation in Decidua Basalis Separation of Placenta Venous Engorgement Abrupt uterine venous pressure
  • Revealed Concealed
  • SIGNS & SYMPTOMS Small separation of the placenta :   Vaginal bleeding ± Mild pain or discomfort. Abdominal pain. Back pain  Vital signs Stable Abdomen Soft/ Tenderness ±  Foetus  uncompromised
  • Large separation of the placenta:  Heavy vaginal bleeding.  Severe pain in the lower abdomen or back.  Hard, tender abdomen.  Shock (tachycardia, fall in BP rapid breathing, and dizziness).  Fetal distress;  Coagulopathy [DIC]) – Thromboplastine from fetal heart sounds inaudible. placenta is released into the mother's circulation causing blood clotting defects.  Renal cortical necrosis ---- Anurea
  • EXAMINATIOBN  GPE depends upon Hemorrhage.  Pallor  Pulse  B.P  ABDOMINAL EXAMINATION  Fundal height larger than dates  Hard and tender  Fetal Part and FHS  PELVIC EXAMINATION Exclude placenta praevia by USG P/S examination P/V examination
  • INVESTIGATIONS  Blood grouping. Blood Complete picture.  Coagulation Profile, Platelet counts, PT, APTT, FDPs Serum Fibrinogen  Renal Profile  Viral Serology 
  • INVESTIGATION : Ultrasonography (Useful but not reliable )
  • MANAGEMENT  I/V access       Two large bore cannulas. Save blood for cross match/ investigation(20 ml) I/V fluids Crystelloids /colloids Indwelling urinary catheter Analgesia Blood transfusions / Fresh frozen plasma ( Screened & Cross matched ) Vital Signs monitoring
  • MANAGEMENT  Expectant : Mild marginal Abruption with stable mother & Strict maternal & fetal monitoring.  fetus . Vaginal Delivery: If degree of separation is limited , revealed hemorrhage After amniotomy & oxytocin infusion short labour is expected. Dead fetus No complications
  • MANAGEMENT  Caeserian Section: Maternal Indications Uncontrollable revealed hemorrhage Rapidly expanding concealed hemorrhage Vaginal delivery is not imminent Fetal Indications Alive fetus with reasonable chances of survival
  • COMPLICATIONS  MATERNAL Shock (Hypovolemic, / Neurogenic ) DIC Renal failure PPH ( Couvelier uterus ,uterine atony , DIC ) Maternal mortality ( 0.5% --- 5 % )  FETAL Perinatal mortality ( 50 % --- 80 % )
  • FOLLOW UP  Follow up visits  Contraception  Counsel for chances of recurrence in next pregnancy ,  early antenatal booking