Makindo Medical Notes"One small step for man, one large step for Makindo" |
|
---|---|
Download all this content in the Apps now Android App and Apple iPhone/Pad App | |
MEDICAL DISCLAIMER: The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis, or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd. |
Related Subjects: |Antepartum haemorrhage |Postpartum haemorrhage |Acute Haemorrhage
The most important causes of antepartum hemorrhage (APH) are placenta praevia and placental abruption, although these are not the most common. See the link to RCOG guidance below.
Placenta praevia | Seen in 1 in 200 pregnancies. Causes painless vaginal bleeding, contrasting with placental abruption, which causes vaginal bleeding and pain. Placenta praevia can be graded into major and minor, depending on whether the placenta overlies the internal os. |
Placental abruption | The most predictive historical factor is abruption in a previous pregnancy. Always ask about headache, blurred vision, and abdominal pain, and consider preeclampsia. Placental abruption is caused by the detachment of the placenta from the uterus, resulting in maternal blood loss. The blood may remain localized ("concealed") or pass via the os, becoming a "revealed" hemorrhage. |
Vasa praevia | Rare (seen in 1 in 2500 pregnancies). Fetal blood vessels cross over the membranes ahead of the presenting part. It can lead to fetal loss due to exsanguination at the time of membrane rupture. May present with PV bleeding and can be detected with Doppler ultrasound. Needs prompt delivery by cesarean section. |
Other | Circumvallate placenta, or non-uterine causes like cervicitis, cervical polyp, or cervical carcinoma. |
Unknown | In 50% of cases, no specific cause is identified, though the risk of perinatal mortality remains increased. |