Antepartum hemorrhage in obstetrics.pptx

obstetrics

1. ANTEPARTUM HEMORRHAGE

2. Antepartum Hemorrhage is defined a bleeding from or into the genital tract after the 28 week of pregnancy but before the birth of the baby. DEFINITION

3. Spotting - staining or blood spotting 01 Major hemorrhage - 50-1000 ml 02 Minor hemorrhage - < 50 ml 03 Massive hemorrhage - > 1000 ml 04 SEVERITY OF APH 05 Recurrent APH - More than one episode of APH

4. CAUSES

5. Placenta previa When placenta is implanted partially or completely over the lower uterine segment (over and adjacent to the internal Os) is called Placenta Previa 01

6. Incidence

7. Causes and Risk factors Causes 1. Poor Decidual rection 2. Persistence of Chorionic actaivity 3. Defective decidua 4. Big surface area of the placenta . Risk factors 1. multi parity 2. Maternal age- >35 years 3. Race Asian women 4. Maternal factor- Infertility treatment 5. presence of uterine scar 6. placental size and abnormality 7. smoking- placental hypertrophy.

8. Types of Placenta Previa Low Lying Marginal Incomplete or Partial Central or Complete

9. Signs and symptoms Vaginal bleding- Sudden onset, Painless, recurrent signs of anemia Abdominal examintion- 1.Relaxed, soft uterus without tenderness 2. Head is floating 3. fetal heart sound is present unless major seperation Vulval inspection 1. only inspection 2. bright red bleeding 3.uteroplacental sinuses close to the cervical opeing.

10. Transabdominal (TAS) and Transperineal (TPS) Transvaginal (TVS) Color Doppler Magnetic resonance imaging (MRI) Diagnosis

11. Management At home At Hospital Immediate attention Expectant Managemen t Active management

12. Complications Hemorrhage and shock anemia preterm labour higher incidence of placenta accreta high maternal morbidity and mortality Maternal 1 Fetal 2 Preterm Delivery Low birth weight higher incidence of abnormal fetal presentations Higher risk of fetal Hypoxia Birht trauma Hyaline membrane disease Higher perinatal morbdity and mortality

13. Placenta accreta Placenta accreta is the attachment of placenta directly to the myometrium without any intervening decidua basalis Causes - Absence of decidua basalis, Poor development of fibrinoid layer 03

14. Types of Placental accreta

15. Pathological Blood test 3D doppler USG physical examination Bleeding in 3rd trimester pelvic pain Thining and disruption of uterine serosa ADD YOUR TITLE Dark intraplacental bands Absence of decidua absence of fibrinoid layer Symptoms and diagnosis unexplained rise of Maternal serum alpha feto protein

16. Management If placenta is left in the uterus, closure of the uterus was performed MEDICAL and SURGICAL WBC and Platelet count Blood uria nitrogen, creatinine andurine PH Assess for pulmonary toxicity- Non-productive cough symptoms of gout Methotrexate to destroy the still attached placenta Monitor while taking methotrexate Surgical Management- Cesarean Section Hysterectomy

17. Complication l Antenatal Intranatal Postnatal Neonatal Bleeding before delivery placental dysfucntion Obstetric hemorrhage Uterine rupture Severe bleeding infection post-traumatic stress disorder. Respiratory distress syndrome Intra uterine growth retardation

18. Abruptio Placenta It is one form of antepartum hemorrhage where the bleeding occurs due to prematre seperation of normally situated placenta 03

19. Types Revealed Mixed Consealed

20. No signs and symptoms diagnosis through Fetal heart rate Vaginal bleeding is absent less than 15% of blood loss mild seperation of placenta no complication fetal sound -normal vaginal bleeding -present Moderate seperation of placenta fetal heart rate- decreased Total blood loss- 25% it is complicated grade Severe seperation of the placenta Blood loss- more than 30% shock -present fetal heart rate- absent fetal death occur Grades Grade 0 Grade 1 Grade 2 Grade 3

21. Causes and Risk factors Causes 1. Sudden uterine decomprssion 2. Short cord 3. Supine Hypotension syndrome 4. Placental anomalies . 5. Folic acid definciency 6. Placenta implanted over a septum 7. Torsion of Uterus 8. Thrombophilias Risk factors 1. multi parity 2. Maternal age- >35 years 3. Low socioeconomic status 4. Hypertension in pregnancy 5. Trauma -external cephalic version with grea force and road traffic accident 6. placental size and abnormality 7. Cocaine abuse

22. PathoPhysiology

23. Conveliares uterus complication of severe form of abruption bleeding penetrates into the uterine cavity myometrium forcing its way into peritoneal cavity. diagnosis- Visual inspection of uterus Management- Conservative management Hysterectomy

24. Signs and symptoms Revealed abdominal discomfort Pain followed by vaginal bleeding continuous dark color bleeding Consealed acute intense abdominal pain followed by sligt vaginal bleeding continuous pain with dark color bleeding

25. Laboratory test Revealed- Hb low coagulation profile unchanged urine protein -absent Concealed/Mixed Hb low clotting time (>6min) Fibrinogen- 150 mg/dl platelet count low urine protein- present Diagnosis USG, MRI USG confuses wih fibroid, but negative findings MRI accurately detect negative findings

26. Management Immediate delivery In labour - Continuous monitoring and labour conducted if placaental abruption with a dead fetus Not in labour - cesarean section done for severe abruption. Management of complictions hemorrhagic shock- Early phase- volume replacement Intermediate phase- Adequate management of shock Late Phase- not reversed by fluid replacement, treatment practically less chance to treat DIC- for Rh negative mother administer 300 μg of anti-D immunoglobulin

27. E xpectant Management Intensive observation and monitoring transfusion therapy- usually PRC. IV fluids CVP monitoring Fetal status monitoring. Monitor for complication Monitor fetal lung maturity .

28. Indeterminate Bleeding 4

29. Vasa Previa velamentous umbilical cord -Wartson’s Jelly

30. Implementation Assessment Nursing Management

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