Antipartum Heamorrhage: Presenter Nsubuga Ivan MBCHB Stud 3.2 Kiu Lira Center Date 23 / 2 /2022
Antipartum Heamorrhage: Presenter Nsubuga Ivan MBCHB Stud 3.2 Kiu Lira Center Date 23 / 2 /2022
PRESENTER
NSUBUGA IVAN MBCHB STUD 3.2 KIU
LIRA CENTER
DATE
23th / 2 /2022
• Introduction
• Definition.
• Causes.
• Placenta previa
• Abruptio placentae
• Indeterminate causes
BLOODY SHOW: small amount of blood with mucus d/c may precede onset of labour by as much as
72 hrs
@DE ORACLE HIGH PRIEST
PLACENTA PREVIA
• Refers to placental implantion in the lower uterine segment.
Classified as ;
1. Low lying (type 1)- placental edge is in lower uterine segment but not reaching
internal os.
2. Marginal (type 2) - placenta reaches margin of internal os but doesn't cover it,
anaterior or posterior marginal
3. Incomplete (type 3) -placenta covers internal os partially when closed but not
when fully dilated
4. Complete (type 4) - placenta covers internal os fully even when fully dilated.
Also classified into
• Placenta previa major; type 2 posterior, 3 & 4.
• Placenta previa minor; type 1 and type 2 anterior.
@DE ORACLE HIGH PRIEST
Epidemiology
• World wide 4 per 1000 births
• It is responsible for 35% of APH cases.
• In 80% of cases is found in multiparous women.
Risk factors.
• Increasing parity
• Advanced maternal age (>35 yrs)
• Multiple gestation
• H/o uterine surgery/ c/s, prior curettage
• H/o P. previa
• Prior uterine artery embolization
• maternal smoking , cocaine use
• assisted conception/ infertility treatment
• Male fetus @DE ORACLE HIGH PRIEST
CAUSES OF BLEEDING
In early pregnancy,
placental tissue growth rate synchronous with uterine distension but in second half
of pregnancy placental tissue growth stops amidst progressive uterine dilatation.
• The inelastic placenta is sheared off the walls of the lower segment.
• This leads to the opening up of the utero placental vessels hence bleeding .
• The blood is always maternal but fetal blood can also be lost(torn villi).
• Placental separation can also occur secondary to trauma caused by coitus actus,
obstetric procedures; V.E, external cephalic version.
• History of
✓Painless recurrent vaginal bleeding (bright red) with no cause. May be mild or
severe.
✓Often occurs during sleep, in most cases before 28wks of gestation.
Puerperium
• Sepsis due to ↑operative inteferences, placental site near to vaginal, anemia and
devitalised state of patient.
• Embolism
• subinvolusion
PREVENTION
• Adequate antenatal care to improve the health status and correction of
anemia.
• Antenatal dx of low lying placenta at 20wks need confirmation at 34wks.
• Significance of warning hemorrhage should not be ignored .