Antepartum Hemorrhage (APH)

What is the normal placenta
what is the Placental Abnormalities and
Hemorrhagic Complications during pregnancy
What is APH
How to manage The Hemorrhage

1. Placental Abnormalities and Hemorrhagic Complications

2. Normal Placenta The placenta is a new organ formed in the uterus during pregnancy, and connect the fetus to the uterus via the Umbilical cord and surrounded by a thick gel (Amniotic Fluid). The baby's umbilical cord arises from the placenta.

3. This structure provides oxygen and nutrients to the growing baby and removes waste products from baby's blood via umbilical cord. It is a blue-red in color and discoid (Disk) in shape.

4. Is about 22 cm in diameter and 2.5 cm thick in the center. Placenta is about 500 g in weight. Normally ; the placent a attaches at the top or side of the uterus . The baby attach to the placenta via the umbilical cord. The normal umbilical cord is 51-60 cm long , and 2-2.5 cm in diameter. Contains two arteries and one vein.

5. Umbilical Artery Umbilical Vein

6. Placental Abnormalities and Hemorrhagic Complications Blood loss during pregnancy is a first cause of both mother and fetal morbidity and mortality (Death & defect). Up to 1,000 mL/min of maternal blood flows through the placenta at term. Hemorrhage is a MEDICAL EMERGENCY All placental problems can detected and observed by ultrasound.

7. Placental Abnormalities and Hemorrhagic Complications Antepartum Hemorrhage (APH) Postpartum Hemorrhage (PPH ) Ectopic Pregnancy Abortion

8. 1. Antepartum Hemorrhage (APH) Antepartum hemorrhage (APH) is a bleeding from the birth canal (Vagina) after the 24 th week (some said after the 20 th week) of pregnancy. It can occur at any time until the second stage of labor is complete. It called also; the third-trimester bleeding complicates about 4% of all pregnancies and considered as medical emergency. Bleeding before the week 24 of pregnancy is miscarriage.

9. APH Common Causes a. Placental Previa b. Placental Abruption c. Uterine Rupture d. Vasa Previa e. Reproductive system injuries f. Neoplasia Life threatening

10. The condition in which the placenta partially or totally covers the cervix (the lower part of uterus). It may cause anemia and death due to severe blood loss. The most common symptom of placenta previa is painless vaginal bleeding (bright red blood). a. Placental Previa

11. Risk factors: Previous Caesarean section Old mother (>35 years) Previous placenta previa Diabetes or hypertension Cigarette smoking Uterine problems and anomalies Multiple fetuses a. Placental Previa

12. Classification: Total (Complete) : The placenta completely covers the cervix. Partial : The placenta is partially covers the cervix. Marginal : The placenta is near the edge of the cervix. a. Placental Previa

13. Management: Treatment depends on gestational age, severity and type of the pervia , blood loss, and the health of the mom and the baby. Reducing activities and bed rest. Medicines to prevent early labor . Steroid may be given to help mature the baby’s lungs. Blood transfusion for the mother as necessary. After 36 weeks, a caesarean section is usually performed. If the bleeding can't be controlled; an emergency C-section is important even if the baby is premature. a. Placental Previa

14. We called also abruptio placentae. Placental abruption is the separation of a placenta from the wall of the uterus before the delivery. This condition can occur any time after the 20 th week of pregnancy. When the placenta separate from the uterus, the vessels within the placenta detached and start to bleed. b. Placental Abruption

15. b. Placental Abruption Risk factors: Old mother (>35 years) Previous placental abruption High blood pressure Cigarette smoking Uterine problems and anomalies Multiple fetuses Abdominal trauma

16. b. Placental Abruption Effects & Complications: Shock due to blood loss The need for a blood transfusion A serious blood clotting complication Poor blood flow and damage to kidneys or brain of the mother Premature birth Fetus heart rates problems Fetal death

17. b. Placental Abruption Symptoms and signs: Vaginal bleeding (dark red blood) Abdominal pain Uterine contractions that doesn't relax. Blood in amniotic fluid Nausea Faint feeling Decreased fetal movements

18. b. Placental Abruption Classification: Revealed (Visible – External bleeding): Causes vaginal bleeding that helps with early detection. Concealed (Internal): The blood gets trapped, pooling and clotting behind the placenta. It can only be detected only through an ultrasound.

19. b. Placental Abruption Management: The treatment depends on depends on the amount of bleeding, the gestational age, and condition of the fetus. Before week 34 the mom should rest. After week 34: If the fetus is normal, and the bleeding is mild; vaginal labor is possible If not; C-Section is necessary

20. b. Placental Abruption There is no treatment to stop placental abruption or reattach the placenta. After the baby is born, bleeding from the site of the placental attachment is likely. If the bleeding can't be controlled, emergency removal of the uterus (hysterectomy) might be needed.

21. A uterine rupture is a tear in the wall of the uterus. c. Uterine Rupture Risk factors: Previous C-Section Previous uterine surgery Abdominal trauma

22. Uterine Rupture

23. c. Uterine Rupture Symptoms and signs: Excessive vaginal bleeding Sharp pain between contractions Contractions that slow down and relax Unusual abdominal pain or tenderness Baby’s head moving back up not down Rapid heart rate and abnormally low blood pressure in the mother Amniotic fluid embolus

24. c. Uterine Rupture Management: Immediate C-section is necessary in uterine rupture. Followed by repair of the uterus. Antibiotics is important to prevent infection. If the damage to the woman's uterus is extensive and the bleeding can't be controlled, she'll need a hysterectomy.

25. d. Vasa Previa A condition in which blood vessels within the placenta or the umbilical cord are trapped between the fetus and the cervix causing hemorrhage and lack of oxygen.

26. d. Vasa Previa Symptoms: Painless vaginal bleeding Risk factors: Previous C-Section Low-lying placentas (Inferior placenta) Multiple fetuses Management: Steroid treatment to develop fetal lung maturity. The C-section should be done early to avoid an emergency

27. Vasa Previa baby