antepartum haemorrhage (APH)
• Bleeding in to genital track often period of viability till delivery
• Causes
Abruptio placenta
Placenta previa
Vasa previa
Abruptio placenta
• Premature separation placenta uterine wall in 3rd trimester bleeding (usually after the 26th week (Q) gestation and before the fetus is delivered.)
• Two principal forms
( A ) Concealed form (20%)
Bleeding collects behind placenta
Detachment placenta may be complete (Q)
Complication often severe
Associated with DIC
( B ) Revealed / Marginal abruption with external bleeding (80%)
blood drain through cervix
Placenta detachment incomplete (Marginal) (Q)
Most important complication - possibility of premature labor (Q)
Previous placental separation
Hypertension (Q)
Advanced maternal age
Multiparty (Q)
Uterine distention (multiple gestation, hydramnios)
Cigarette smoking (0)
Alcohol consumption
Maternal blood group - O group
cocaine use
Precipitating causes
Circumvallate placenta
Trama
Sudden reduction uterine volume ( Rapid amniotic fluid loss, Delivery of a first twin )
Abnormal short cord
Increased venous pressure
Nursing assessment
Increased uterine tone and frequency of contraction may provide early clues of abruptio
Dark red vaginal bleeding (Q). If bleeding high in uterus or is minimal, there can be absence of visible blood.
Uterine pain or tenderness or both (Q)
Uterine rigidity
Severe abdominal pain
Signs of fetal distress
Signs of maternal shock if bleeding is excessive
Nursing intervention
- Monitor - ( maternal vital signs, fetal heart rate. )
- Assess - ( excessive vaginal bleeding, abdominal pain, increase fundal height. )
- Maintain - ( bedrest, administer oxygen, intravenous fluids, and blood products as prescribed )
- give Trendelenburg's position or place in the lateral position with head of the bed flat if hypovolemic shock occurs.
- Monitor and report any uterine activity.
- Prepare for delivery of the fetus as quickly as possible, with vaginal delivery preferable if the fetus is healthy and stable
- emergency cesarean delivery performed if fetus is a live but shows signs of distress.
- Monitor for signs disseminated intravascular coagulation (DIC) in postpartum period.
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