hge in late preg

8/22/2019 Hge in Late Preg

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Antepartum haemorrhage is defined as

bleeding from or into the genital tract after

the 28th week of pregnancy but before the

birth of the baby.


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Placental Bleeding ( 70% )

-Placenta Praevia ( 35%)

-Abruptio Placentae ( 35% )

Unexplained / Indeterminate ( 25% )

Extra Placental Causes ( 5% )

Local cervico vaginal lesions cervical polyp, carcinoma

cervix, varicose veins, local trauma


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1. Accidental hemorrhage or abruption

placenta

2. unavoidable antepartum hemorrhage

3. Unclassified antepartum hemorrhage


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1.PLACENTA PRAEVIA


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When the placenta is implanted partially or

completely over the lower uterine segment

is called Placenta Praevia.


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Dropping down theory

Persistant chorionic activity

Increased surface area of placenta

Defect in decidua


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Symptoms

Vaginal bleeding

Sudden onset

Painless bleeding

Recurrent

Unrelated activity


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Signs

Size of the uterus according to the period of

gestationUterus feels relaxed, soft, elastic and

tenderness

Malpresentation

Floating head

Presence of fetal heart rate in mild cases


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DIAGNOSIS


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Differential diagnosis

Abruption placenta

Vasa praevia

Local cervical lesion

Circumvallate placenta


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1. Maternal

During pregnancy

Antepartum hemorrhage

Malpresentation

Premature labour


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During labour

Early rupture of membranes

Cord prolapsed

Slow dilatation

Intrapartum hemorrhage

Increased operative deliveries

Post partum hemorrhage

Retained placenta


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Puerperium

15th day of puerperium may be incidence of

sepsis


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Fetal

Low birth weight baby

Asphyxia

Intrauterine death

Birth injuries

Congenital malformation


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At home

Immediate attention

Expectant treatment

Definitive treatment

Nursing management


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Primordial prevention

Primary prevention

Secondary prevention

Teriary prevention


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ABRUPTIO PLACENTA


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It is one form of antepartum hemorrhage

where the bleeding occurs due to

premature separation of normally situatedplacenta


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1. Direct causes

Hypertension

Trauma

Sudden uterine decompression

Short cord

Supine hypotension syndrome


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Sick placenta

Folic acid deficiency

Torsion

Cocaine abuse

Thrombophilia


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1. Revealed

2. Concealed

3. Mixed


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Mild Abruptio placenta

Moderate abruption placenta

Severe abruption placenta


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Grade 0

Grade 1

Grade 2

Grade 3


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Class 0

Class 1

Class 2

Class 3


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Placenta praevia

Rupture uterus

Rectus Sheath hematoma

Apendicular or interstinal perforation

Twisted ovarian tumor

Volvulus

Acute hydramnios

Tonic uterine contractions


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Maternal

In revealed type-maternal risk is proportionate to

visible blood loss. Maternal death is rare.


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In concealed type

Hemorrhage leads to intra peritoneal or

braod ligament hematoma

Shock due to release of thromboplastin in

maternal circulation

Blood coagulation disorders for example

disseminated intravascular coagulopathy


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Oliguria and anuria due to hypovolemia

Post partum hemorrhage due to atony of

uterus

Puerperal sepsis

Ischemic pituitary necrosis

Sheehans syndrome


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Fetal

Prematurity

Anoxia Fetal death in revealed ( 25-30%) and in

concealed type (50-100%)


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Treatment at home

In the hospital

Definitive Treatment


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Preacautions:

Immediate interventions:

Monitoring:

Nursing management


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Differences betweenplacenta praevia abruption

placenta


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Origin

Bleeding due to marginal separation of a

normally sited placenta leading to a

reduced functional reserved.


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COMING INTO DIAGNOSIS

Painless per vaginal bleeding where placenta is in

the upper segment

Amount of bleeding is not profuse

Clinical assessment : fetal parts easily palpableand fetal heart sound easily heard.

Speculum examination No abruption or local lesion

Ultrasound to access the site of placenta

FBC, CTG examination


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PROGNOSIS

Good prognosis for fetus and mother


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Rarest cause of hemorrhage

Onset with membrane rupture

Blood loss is fetal, with 50% mortality

Seen with low-lying placenta,

velamentous insertion of the cord or

succenturiate lobe


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Antepartum diagnosis

Amnioscopy

Color doppler ultrasound

Palpate vessels during vaginal

examination


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Immediate cesarean delivery if fetal

heart rate is non-reassuring

Administer normal saline 10 20 cc/kg

bolus to newborn, if found to be in

shock after delivery

hge in late preg

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