Dr:Abdul RehmanRajput4thy year MBBS.Pakistan

DEFINATIONBleeding from the genital tract in pregnancy between 20 to 24 week’s gestation & the onset of labour

It affects 4% of all pregnancies.

It Increased risks of fetal & maternal morbidity & mortality.

CAUSESPlacental– Placental abruption– Placental praevia– Vasa praevia

Genital Tract– Rupture of uterus– Trauma– Infections (Vulvovaginitis, cervicitis)– Tumours

Bleeding―Congenital ―DIC

PLACENTAL ABRUPTION

Definition: It is defined as abnormal, pathological separation of the

normally situated placenta from its uterine attachment.

Incidence: 1% of all pregnancies.

AETIOLOGYParityNutritionHypertensionChorioamnionitisTraumaPlacental abnormalitiesAuto immune

CLINICAL FEATURESBleedingPainShock

EXAMINATIONGeneral Examination– Pallor– Tachycardia

Abdominal Examination– Height of fundus is bigger than expected for its

gestational age– Uterus is tender– Palpation of foetal parts is difficult– Fetus is dead in 40 – 50% of cases

Vaginal Examination Blood stain liqourSpeculum ExaminationBimanual Examination

MATERNALDICRenal FailurePost Partum Haemorrhage (PPH)Maternal MortalityRecurrence

COMPLICATIONSFOETAL

IUGRPerinatal Mortality

Lab Investigations

UltrasoundBlood groupingCoagulation profileRenal function testLiver function testUrea creatinine and serum electrolyte (UCE)

PLACENTA PRAEVIADefinition: • When the placenta is situated wholly or partially

within the lower uterus segment it is said to be praevia.

Incidence: It is 3% between 28-37 weeks and 0.5% at time of

delivery. Types: Type 1: Lateral Minor Type 2: Marginal Type 3: Half cervix covered Major Type 4: Central

AETIOLOGY

Endometrial damageUterine ScarUterine PathologySmokingPlacental problemPrevious History of placenta praevia

CLINICAL FEATURES

Bleeding: small bright red episodicPain: painlessShockAsymptomatic

EXAMINATION

General Examination– Patients looks pale and anxious

Abdominal Examination– The height of fundus corresponding to weeks of

gestation. Uterus remains soft and foetal part palpable.

Vaginal Examination– Never be performed in suspected cases of

placenta praevia

Lab Investigations

UltrasoundBlood groupingCoagulation profileRenal function testLiver function testUrea creatinine and serum electrolyte (UCE)

MATERNAL RISK

Post Partum Haemorrhage (PPH)Renal damageMaternal mortality 0.1%Anemia infectionRecurrence

Fetal RISK

Premature birthParenatal mortality

General Treatment– Haemoglobin estimation, blood group, coagulation profile,

renal profile– Restore blood volume be colloid– Maintain CVP line– If in shocked patient treat them– Oxygen inhalation– Catheterize the patient for intake and output charting– Analgesia intravenously– Blood transfusion– Call seniors for help

Specific Treatment– Treatment of the cause

Management of APH