2. Dr:Abdul
RehmanRajput

3. DEFINATION
Bleeding from the genital tract in
pregnancy between 20 to 24 week’s
gestation & the onset of labour
It affects 4% of all pregnancies.
It Increased risks of fetal & maternal
morbidity & mortality.

4. CAUSES
Placental
– Placental abruption
– Placental praevia
– Vasa praevia
Genital Tract
– Rupture of uterus
– Trauma
– Infections (Vulvovaginitis, cervicitis)
– Tumours
Bleeding
―Congenital
―DIC

5. PLACENTAL
ABRUPTION
Definition:
It is defined as abnormal, pathological separation of the
normally situated placenta from its uterine
attachment.
Incidence:
 1% of all pregnancies.

6. AETIOLOGY
Parity
Nutrition
Hypertension
Chorioamnionitis
Trauma
Placental abnormalities
Auto immune

7. CLINICAL FEATURES
Bleeding
Pain
Shock

8. EXAMINATION
General Examination
– Pallor
– Tachycardia
Abdominal Examination
– Height of fundus is bigger than expected for its
gestational age
– Uterus is tender
– Palpation of foetal parts is difficult
– Fetus is dead in 40 – 50% of cases
Vaginal Examination Blood stain liqour
Speculum Examination
Bimanual Examination

9. MATERNAL
DIC
Renal Failure
Post Partum Haemorrhage
(PPH)
Maternal Mortality
Recurrence
COMPLICATIONS
FOETAL
IUGR
Perinatal Mortality

10. Lab Investigations
Ultrasound
Blood grouping
Coagulation profile
Renal function test
Liver function test
Urea creatinine and serum electrolyte (UCE)

11. PLACENTA PRAEVIA
Definition:
• When the placenta is situated wholly or partially
within the lower uterus segment it is said to be
praevia.
Incidence:
 It is 3% between 28-37 weeks and 0.5% at time of
delivery.
Types:
 Type 1: Lateral Minor
 Type 2: Marginal
 Type 3: Half cervix covered Major
 Type 4: Central

12. AETIOLOGY
Endometrial damage
Uterine Scar
Uterine Pathology
Smoking
Placental problem
Previous History of placenta praevia

13. CLINICAL FEATURES
Bleeding: small bright red episodic
Pain: painless
Shock
Asymptomatic

14. EXAMINATION
General Examination
– Patients looks pale and anxious
Abdominal Examination
– The height of fundus corresponding to weeks of
gestation. Uterus remains soft and foetal part
palpable.
Vaginal Examination
– Never be performed in suspected cases of
placenta praevia

15. Lab Investigations
Ultrasound
Blood grouping
Coagulation profile
Renal function test
Liver function test
Urea creatinine and serum electrolyte (UCE)

16. MATERNAL RISK
Post Partum Haemorrhage (PPH)
Renal damage
Maternal mortality 0.1%
Anemia infection
Recurrence

17. Fetal RISK
Premature birth
Parenatal mortality

18. General Treatment
– Haemoglobin estimation, blood group, coagulation profile,
renal profile
– Restore blood volume be colloid
– Maintain CVP line
– If in shocked patient treat them
– Oxygen inhalation
– Catheterize the patient for intake and output charting
– Analgesia intravenously
– Blood transfusion
– Call seniors for help
Specific Treatment
– Treatment of the cause
Management of
APH