antepartum haemorrhage (APH)
• Bleeding in to genital track often period of viability till delivery
• Causes
Abruptio placenta
Placenta previa
Vasa previa
PLACENTA PREVIA
TYPE
- Total central (complete previa) / type 4th - Internal cervical os is covered entirely by placenta when cervix is dilated fully.
- Partial / type 3rd - lower border of the placenta is internal cervical os, but does not fully cover it.
- Marginal placenta / type 2nd- one edge placenta extends to edge of internal cervical os.
- Low lying placenta / type 1th (Q) - placenta edge in lower segment but dose not reach internal cervical os.
NOTE- Dangerous Placenta previa ( Marginal placenta / type 2nd posterior because, it cause cord compression & fetal distress during labour.)
- Advanced age ( ↑35)
- Multiparty
- Multi fetal gestation
- Prior cs
- Previous abortion/ endometritis
- Previous history of placenta previa
- Fetal anomalies
- Sudden onset of painless, bright red vaginal bleeding occurs in 2th & 3th timrester pregnancy.
- Uterus is soft, relaxed, and nontender.
- Postcoital bleeding
- Mal presentation and mal position
- Positive Stallworthys sign (Q) ;-slowing of the fetal heart rate on pressing the head down in to the pelvis which soon recover after pressur is released it suggestive of the low lying placenta specially of posterior type
- Shock
- Mal presemtation
- Prom
- Preterm labour
- Cord prolapse
- PPH
- Retained placenta
- Lbw
- Asphyxia
- Monitor - maternal vital signs
- fetal heart rate
- Maintain bedrest in a side-lying position as prescribed. Monitor amount of bleeding (treat signs of shock).
- Administer intravenous fluids, blood products, or tocolytic medications as prescribed.
- If bleeding is heavy, a cesarean delivery may be performed.
link- abruptio placenta
Link- vasa-previa
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