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Antepartum Haemorrhage
Antepartum Haemorrhage
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PLACENTA PREVIA
Rosydaniah Zaskia 'Avif
B23. RSUD Jombang
Identitas
Ny.Nurul Komariah
28 th, IRT
pendidikan terakhir SLTA
alamat: Jombang Jogoroto
ANTEPARTUM HAEMORRHAGE
Obstetric Haemorrhage
Causes:
placenta previa (1/200)
placental abruption (1/100)
uterine rupture (<1% in scarred uterus)
vasa previa (1/2000-3000)
Local causes
Unknown origin
Vasa Previa
I. ABRUPTIO PLACENTA
Definition:
Recurrence:
2.
3.
4.
Clinical Severity
Class 2: moderate -approx
27% of all cases.
No vaginal bleeding to
mild vaginal bleeding
Slightly tender uterus
Normal maternal BP and
heart rate
No coagulopathy
(clotting problems)
No fetal distress
Clinical Severity
Class 3: Severe form: Approx 24% of all cases.
No vaginal bleeding to heavy vaginal bleeding
Very painful tetanic uterus
Maternal shock
Coagulopathy
Fetal death
Hypertensive Disease
Multiple pregnancy
Trauma
PPROM
Anaemia
Polyhydramnios sudden
intrauterine pressure
Short cord
Vaginal bleeding
Maternal distress
Often I.U.F.D
Shock
DIC
Consumptive coagulopathy 2 to
hypofibrinogenemia along with elevated
levels of fibrinogenfibrin degradation
products
Fetal distress/demise
PPH
Couvelaire Uterus:
Sheehan syndrome
Puerperal sepsis
fetal maturity,
degree of severity,
viability of the fetus/fetal distress
Treatment modalities
1. Delivery
Resuscitation
Monitor BP
ARM
Induce/Augment labour
Done regularly
salvageable baby,
Severe vaginal bleeding,
Poor progress,
Transverse lie, inadequate pelvis
Why?
Myometrial myofibrin loose contractility
Failure to clot
2.
Low-lying placenta
The placenta is implanted in the lower uterine
segment such that the placental edge actually
does not reach the internal os but is in close
proximity to it.
Multiparity
Confirmed by ultrasound
i.
GA 34 weeks
ii.
Placenta Praevia
PLACENTA PRAEVIA
Comparison of Presentation of
Abruption v. Previa v. Rupture
Abruption
Previa
Rupture
Abdominal pain
present
absent variable
Vaginal blood
old
fresh fresh
DIC common
rare
rare
Fetal distress
common
rare
common
Vasa Previa
Vasa Praevia
Diagnosis
C/S,
Rupture of uterus
Carcinoma of cervix
Trauma
Cervical polyp
Bilharzia of cervix
Cervicitis