APH definition
Bleeding from or in the genital tract occurring from 24 weeks of pregnancy and prior to the birth of the baby
Causes of APH
Praevia
Abruption
Local causes (bleeding from vulva, vagina, and cervix)
Risk factors for abruption
PET FGR Non-vertex presentations Polyhydramnios Advanced maternal age Multiparity Low BMI Preg from ART Intrauterine infection PROM Abdo trauma Smoking Drug misuse (cocaine, amphetamines) Bleeding in the first trimester Maternal thrombophlias
Maternal complications of APH
Anaemia Infection Shock Renal tubular necrosis Consumptive coagulopathy PPH Prolonged hospital stay Psychological sequelae Complications of blood transfusion
Fetal complications of APH
Hypoxia
SGA/FGR
Prematurity
Fetal death
Important history points for APH
Pain w bleeding Risk factors for abruption/praevia FMs SROM Cervical smear history
Exam findings APH
SNT uterus: lower genital tract cause or bleeding from placenta or vasa praevia
Spec exam
VE if excluded praevia
Invx for APH
Kleihauer in Rh- women FBC, cosy, 4 units cross matched U/Es and LFTs in major haem Minor haem: FBC + G&S USS to confirm placentation CTG