Antepartum haemorrhage is defined as

bleeding from or into the genital tract after the 28th week of pregnancy but before the birth of the baby.

Placental Bleeding ( 70% )

-Placenta Praevia ( 35%) -Abruptio Placentae ( 35% )

Unexplained / Indeterminate ( 25% )

Extra Placental Causes ( 5% )

Local cervico vaginal lesions cervical polyp, carcinoma cervix, varicose veins, local trauma

1.

Accidental hemorrhage or abruption

placenta

2. 3.

unavoidable antepartum hemorrhage Unclassified antepartum hemorrhage

1.PLACENTA PRAEVIA

 When

the placenta is implanted partially or

completely over the lower uterine segment is called Placenta Praevia.

 Dropping

down theory chorionic activity

Persistant Increased Defect

surface area of placenta

in decidua

Symptoms
Vaginal Sudden Painless

bleeding onset bleeding

Recurrent Unrelated

activity

Signs
Size

of the uterus according to the period of

gestation
Uterus

feels relaxed, soft, elastic and

tenderness
Malpresentation
Floating

head

Presence

of fetal heart rate in mild cases

DIAGNOSIS

Differential diagnosis
Abruption Vasa

placenta

praevia
cervical lesion

Local

Circumvallate

placenta

1.

Maternal pregnancy hemorrhage

During

Antepartum

Malpresentation

Premature

labour

During labour
Early Cord Slow

rupture of membranes prolapsed dilatation hemorrhage

Intrapartum Increased Post

operative deliveries

partum hemorrhage placenta

Retained

Puerperium 15th day of puerperium may be incidence of sepsis

Fetal
Low

birth weight baby

Asphyxia Intrauterine Birth

death

injuries

Congenital

malformation

At

home
attention treatment

Immediate Expectant Definitive Nursing

treatment

management

 Primordial
Primary

prevention

prevention prevention

Secondary Teriary

prevention

ABRUPTIO PLACENTA

 It

is one form of antepartum hemorrhage

where the bleeding occurs due to premature separation of normally situated placenta

1.

Direct causes Hypertension Trauma

Sudden uterine decompression

Short cord

Supine hypotension syndrome

Sick placenta
Folic acid deficiency

Torsion Cocaine

abuse

Thrombophilia

1.
2. 3.

Revealed
Concealed Mixed

 Mild

Abruptio placenta
abruption placenta

Moderate Severe

abruption placenta

 Grade Grade Grade Grade

0 1 2

Class Class Class

0 1 2

Class

 Placenta Rupture Rectus

praevia uterus

Sheath hematoma

Apendicular
Twisted Volvulus Acute Tonic

or interstinal perforation

ovarian tumor

hydramnios uterine contractions

 Maternal In

revealed type-maternal risk is proportionate to

visible blood loss. Maternal death is rare.

In concealed type
Hemorrhage

leads to intra peritoneal or

braod ligament hematoma

Shock

due to release of thromboplastin in

maternal circulation
Blood

coagulation disorders for example

disseminated intravascular coagulopathy

 Oliguria
Post

and anuria due to hypovolemia

partum hemorrhage due to atony of

uterus
Puerperal Ischemic

sepsis

pituitary necrosis syndrome

Sheehans

 Fetal
Prematurity Anoxia Fetal

death in revealed ( 25-30%) and in

concealed type (50-100%)

Treatment
In

at home

the hospital Treatment

Definitive

 Preacautions:
Immediate

interventions:

Monitoring: Nursing

management

Differences between placenta praevia abruption placenta

Origin
Bleeding

due to marginal separation of a

normally sited placenta leading to a reduced functional reserved.

COMING INTO DIAGNOSIS

Painless

per vaginal bleeding where placenta is in

the upper segment

Amount
Clinical

of bleeding is not profuse

assessment : fetal parts easily palpable

and fetal heart sound easily heard.

Speculum

examination No abruption or local lesion to access the site of placenta

Ultrasound FBC,

CTG examination

PROGNOSIS
Good

prognosis for fetus and mother

 Rarest
Onset

cause of hemorrhage
with membrane rupture

Blood
Seen

loss is fetal, with 50% mortality

with low-lying placenta,

velamentous insertion of the cord or

succenturiate lobe

Antepartum
Amnioscopy

diagnosis

Color

doppler ultrasound
vessels during vaginal

Palpate

examination

 Immediate

cesarean delivery if fetal

heart rate is non-reassuring

Administer

normal saline 10 20 cc/kg

bolus to newborn, if found to be in shock after delivery