Antepartum hemorrhage APH

Bleeding in late pregnancy

Objectives
Identify major causes of vaginal bleeding
in the second half of pregnancy
Describe a systematic approach to
identifying the cause of bleeding
Describe specific treatment options based
on diagnosis
Antepartum hemorrhage APH

APH :is bleeding from the genital tract in

late pregnancy, after the 24th week of
gestation.

Types of APH

Placenta previa.

Abruptio placenta(premature separation of placenta)


Placenta previa
Isa condition by which the placenta is wholly or
partially implemented in the lower uterine
segment.
4 degree of previa

1- Low lying placenta :

Implementation in the lower rather than in
the in the upper portion of the uterus.
2- Marginal implantation:
The placenta is partially located in the lower
uterine segment near the internal cervical os.
3- partial placenta previa:
implantation that occludes a portion of the
cervical os.
4 degree of previa
 Totalplacenta previa:
 implantation that totally obstructs the cervical os


Risk Factors for Placenta Previa
Previous cesarean delivery
Previous uterine curettage
High parity
Advanced maternal age
Smoking
Multiple gestation
Signs &symptoms
Abrupt vaginal bleeding
Painless bleeding .

Can be diagnosed by ultra sonography

before any bleeding occur
Management &delivery
Depend on:
Condition of the mother.
Condition of the fetus.
Gestational age.
Amount of bleeding .
Type of previa
Management………….
Ifthe gestational age is less than36
&maternal &fetal condition is good, NO
active bleeding. Observation & Expectant
management.
No P.V , No intercourse

Corticosteroids like Dexamethazon 24hr

before delivery to enhance lung maturity.
Anti D in Rh negative mother
Management

If the gestational age is more than36

think about delivery .
The delivery type depend on the degree of
placenta previa.
Total placenta previa is by ClS.
If the placenta previa is partial the
decision depend on maternal ,fetal
condition &the blood loss
Nsg care for previa….

Bed rest.
Observe BP& pulse.
2Large IV lines & fluids.

Observe vaginal bleeding.

Monitor FHR& contractions.
Cross match, hematocrit &…………
Avoid PV (vaginal examination).
Instruct the women to avoid intercourse.
Reassurance and support.
Close observation.
Administer Corticosteroid.
Abruptio Placenta
Separation of the normally situated
placenta result in bleeding.

Occur in late pregnancy, may occur

during labour.
OCCUR IN 10% OF all pregnancy & is
the most frequent cause of prinatal death
Causes of Abruptio……….
The primary cause is un known.
There is predisposing factors such as :
High parity.
Short cord.
HTN
Direct trauma.
.Cigarette smoking.
 Criteria Grade
.No symptom from Grade 0
maternal al &fetal
signs, discovered
post delivery.

Minimal separation, Grade 1

vaginal bleeding,
changes in VS,& no
fetal distress.
Grade of abruption

Moderate separation, Grade 2

Evidence of fetal
distress,
Tense painful uterus.

Extreme separation, Grade 3

Maternal shock
&fetal death
Signs of Abruptio…….
Sharp, stabbing pain high in the uterine
fundus with or without contractions.

Abdominal tenderness.
Heavy bleeding may or may not
externally (concealed).
Changes in the fetal heart.
Therapeutic management & Nsg care
Admission.
2Large IV catheter & fluid.
Oxygen by mask.
Monitor for FHR& contractions.
Monitor for VS 5-15 minutes.
Left lateral position.
Don’t perform PV exam.
