May 11, 2017 antepartum hemorrhage is bleeding from genital tract which usually takes place after 24 wks. Gk, haima, blood, rhegnynai, to burst forth bleeding from the uterus during a pregnancy in which the placenta appears to be normally situated, particularly after the 28th week. Complicates close to 4% of all pregnancies and is a medical emergency. Identificationandassessmentofevidence this rcog guideline is based on an earlier guideline on the management of postpartum haemorrhagedevelopedin1998. Antepartum hemorrhage is one of the major complication. Definition antepartum hemorrhage aph is defined as vaginal bleeding from 22nd week to term.
A retrospective study of cases of antepartum haemorrhage over an 8 year period from january 1999 to december 2006 at the university of maiduguri teaching hospital was carried out. Antepartum haemorrhage aph including placental abruption. Major haemorrhage blood loss of 50 ml, with no signs of clinical shock massive haemorrhage blood loss greater than ml andor signs of clinical shock. Antepartum haemorrhage is defined as bleeding from the vagina after 24weeks.
It occurs in 25% of pregnancies and is an important. Specific contraindications to regional anaesthesia relevant to antepartum haemorrhage include maternal cardiovascular instability and coagulopathy. Exposure was antepartum haemorrhage occurring after the first trimester not attributable to placenta praevia or placental. Dec 17, 2011 case study from hospital antonio lorena, within the obstetrical service. Antepartum hemorrhage chapter 5 page 3 placenta previa definition placenta previa is defined as implantation of the placenta in the lower segment of the uterus so that it comes close to or completely covers the internal cervical os. Tocolytic therapy is contraindicated in placental abruption and is relatively contraindicated in mild haemorrhage due to placenta praevia. Antepartum haemorrhage pv bleeding 20 weeks 25% of pregnancies classification. To explore the risk of adverse maternal and perinatal outcomes in women with antepartum bleeding of unknown origin abuo.
Antepartum haemorrhage aph, is an obstetric emergency which is defined as bleeding from the genital tract after the age of viability, but before the delivery of the baby 1. Up to onefifth of very preterm babies are born in association with aph most of the time unpredictable. Antepartum haemorrhage is defined as bleeding from the genital tract after the 20th. Antepartum hemorrhage is a serious complication of pregnancy occurring within the third trimester. Maternal and perinatal consequences of antepartum haemorrhage. Aph antepartum haemorrhage is the term applied to any event where more than 15 ml blood is passed per vaginum in the 2 nd half of pregnancy. It is associated with significant maternal and fetal morbidity and mortality. Antepartum identification of vasa praevia leads to significant improvement in perinatal mortality. Any bleeding throughout pregnancy, other relevant history e. The patient also reports some contractions, but denies any continuing abdominal pain.
Study of antepartum haemorrhage and its maternal and perinatal outcome. Antepartum hemorrhage online obstetrics course lecturio. Antepartum haemorrhage aph is bleeding from the genital tract after 20. Ultrasonography transabdominal and transvaginal is the standard method of evaluating patients with antepartum haemorrhage aph, but resuscitation takes priority over any form of imaging 46 transvaginal us was more accurate than transabdominal us in placental localisation and diagnosis of placenta praevia in one small randomised controlled. Aph may occur in varying degrees from mild to severe, with concomitant risk to mother and baby and potential to result in severe ma. Evidencebased information on guidelines on antepartum haemorrhage from hundreds of trustworthy sources for health and social care. Antepartum haemorrhage symptom, causes, treatment of antepartum haemorrhage antepartum haemorrhage is the bleeding from the vagina during the second half of pregnancy, earlier labour commences, or it can also be specify as the bleeding from the vagina afterwards 24 weeks gestation up until labour. Although it is responsible for very few maternal deaths in the uk. Oct 21, 2014 management options for antepartum haemorrhage are as follows. Obstetric haemorrhage is responsible for 2560% of maternal deaths. Antepartum bleeding, also known as antepartum haemorrhage or prepartum hemorrhage, is genital bleeding during pregnancy after the 28th week of pregnancy up to delivery it can be associated with reduced fetal birth weight. Please select the most appropriate options for each of the clinical scenarios. The incidence of antepartum haemorrhage aph is reported as 3.
Maternal and perinatal consequences of antepartum haemorrhage of unknown origin s bhandari,a ea raja,b a shetty,c s bhattacharyaa a epidemiology group, institute of applied health sciences, university of aberdeen, aberdeen, uk b medical statistics team, institute of. Cohort study based on data extracted from the aberdeen maternity and neonatal databank. Antepartum and intrapartum hemorrhage occurred in only 8% 767 of. Recurrent aph is the term used when there are episodes of aph on more than one occasion. A multidisciplinary massive obstetric haemorrhage protocol should be available in all units. Depending upon the clinical state of the patient, normal resuscitative measures should be taken. Who guidelines for the management of postpartum haemorrhage and retained placenta 2 establish the cause of the haemorrhage, and possibly obtain the assistance of other care providers, such as an obstetrician, anaesthetist or radiologist.
Antepartum haemorrhage clinical practice guidelines. Feb 03, 2018 assistant professor rakesh kumar sharma, biyani college antepartum hemorrhage, tp 1, types, obstetrics placenta previa causes, symptoms, diagnosis, treatment, pathology play all obstetrics. Differentiate the clinical features of placenta previa, abruptio placenta and other possible causes. The management of antepartum haemorrhage excluding placenta. Advances in obstetric care enable the clinicians to diagnose, anticipate, prevent and treat severe cases of antepartum haemorrhage in most patients. Antepartum haemorrhage is defined as significant bleeding from the birth canal occurring after the 20th week of pregnancy. The most important causes of aph are placenta praevia and placental abruption, although these are not the most common. It can occur at any time until the second stage of labour is complete. Common causes of antepartum hemorrhage are bloody show associated with labor, placental previa, and placental abruption. Antepartum hemorrhage aph refers to vaginal bleeding during the second half of pregnancy 20 weeks gestation. Piper paediatric infant perinatal emergency retrieval. It is defined as bleeding from or into the genital tract after the 28 th week of pregnancy but before the birth of the baby the 1 st and 2 nd stages of labour are thus included. Mar 12, 2016 timing is important to maximize fetal growth but to minimize the possibility of antepartum hemorrhage a national institutes of health workshop concluded that women with a previa are best served by elective delivery at 36 to 37 completed weeks 12.
Is one of the leading causes of antepartum hospitalization, maternal morbidity, and operative intervention. The original and complete rcog guideline can be found at the below link for your reference. Kar medical college and hospital department of gynecology and obstetrics slide 2. Bios scientific publishers limited johanson, r 1997 guidelines for abruptio placenta. Definition antepartum haemorrhage aph is defined as bleeding from or in to the genital tract, occurring from 22 weeks 500g of pregnancy and prior to the birth of the baby. Antepartum hemorrhage definition of antepartum hemorrhage.
Antepartum haemorrhage king edward memorial hospital. Antepartum hemorrhage per vagina blood loss after 20 weeks. It should be regularly updated and rehearsed in conjunction with the blood bank. Antepartum haemorrhage of unknown origin and maternal cigarette smoking beyond the first trimester. Mar 11, 2016 antepartum haemorrhage aph is usually defined as bleeding from the birth canal after the 24th week of pregnancy. Antepartum haemorrhage aph is defined as bleeding from the genital tract during pregnancy, before birth but after 24 weeks of gestationi. Aph occurs in 25 per cent of pregnancies and half are of unknown cause. Antepartum haemorrhage or bleeding in the second half. Aph is unpredictable, and at any time the womans condition may.
Half of the cases are due to antepartum haemorrhage. Placenta praevia inpatient management is recommended for patients with major placenta praevia for bleeding in the third trimester. Delivery practically all women with placenta previa undergo cesarean delivery. Obstetric haemorrhage remains one of the major causes of maternal death in developing. Blood loss is often underestimated, so it is vital to observe for maternal shock and fetal compromise. Cases of placenta praevia were excluded from the series. Pdf study of antepartum haemorrhage and its maternal and. It is an important cause of maternal and perinatal mortality. Perinatal outcome and nearmiss morbidity between placenta previa versus. Rare causes include vasa previa and uterine rupture.
Antepartum hemorrhage knowledge for medical students and. Describe an appropriate management plan based on the probable cause. Incidence aph occurs in 2% to 5% of all pregnancies. North staffordshire nhs trust obstetric guidelines cox, c. Antepartum haemorrhage is a relatively common entity with potentially serious implications for the mother and the fetus. Antepartum haemorrhage aph is defined as bleeding from or in to the genital tract, occurring from. This becomes relevant during the third trimester 2840 weeks when the downward and outward thrust of the developing foetus is accommodated by the thinning and. Antepartum haemorrhage definition bleeding from the vagina any time after 24 weeks gestation until the birth of the baby blood loss greater than 300mls or any amount causing hypovolaemic shock incidence 35% of all pregnancies. Avoiding delays in diagnosis and treatment will have a significant impact on sequelae and chance of survival. Obstetric haemorrhage both antepartum and postpartum is one of the leading causes of maternalperinatal morbidity and mortality in the developed world. Minor haemorrhage blood loss less than 50 ml that has settled major haemorrhage blood loss of 50 ml, with no signs of clinical shock massive haemorrhage blood loss greater than ml andor signs of clinical shock. Antepartum haemorrhage aph is bleeding from the genital tract after 20 weeks gestation and before labour. The causes and proportions of cases of antepartum haemorrhage are shown in table. After a first bleed, the patient may be discharged at the discretion of the consultant in charge of her care, however if there is recurrent bleeding.
1464 1050 1124 994 875 895 788 966 1520 126 1211 543 1205 967 213 538 835 364 1053 1447 223 357 440 1226 514 909 127 973 1232 934 138 258