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Obstetric Complications

Question
76 out of 80
 

Grading system used for abruptio placenta (AIIMS NOV. 2010)



A MacFee
B Johnson

C Page classification
D Apt grading

Ans. C

Page classification

a. The Apt test is a medical test used to differentiate fetal or neonatal blood from maternal blood.

b. The Apt test is most commonly used in cases of vaginal bleeding late during pregnancy (antepartum haemorrhage) to determine if the bleeding is from the mother or the fetus.

c. (Fetal hemoglobin is resistant to alkali (basic) denaturation, whereas adult hemoglobin is susceptible to such denaturation. Therefore, exposing the blood specimen to sodium hydroxide (NaOH) will denature the adult but not the fetal hemoglobin)

Page’s classification of abruption

1. Class 0:

a. Asymptomatic.

b. Diagnosis is made retrospectively by finding an organized blood clot or a depressed area on a delivered placenta.

2. Class 1:

Mild and represents approximately 48% of all cases.

Characteristics include the following:

a. No vaginal bleeding to mild vaginal bleeding o Slightly tender uterus

b. Normal maternal BP and heart rate

c. No coagulopathy

d. No fetal distress

3. Class 2:

Moderate and represents approximately 27% of all cases.

Characteristics include the following:

a. No vaginal bleeding to moderate vaginal bleeding

b. Moderate-to-severe uterine tenderness with possible tetanic contractions

c. Maternal tachycardia with orthostatic changes in BP and heart rate

d. Fetal distress

e. Hypofibrinogenemia (ie, 50-250 mg/dL)

4. Class 3:severe and represents approximately 24% of all cases.

Characteristics include the following:

a. No vaginal bleeding to heavy vaginal bleeding

b. Very painful tetanic uterus

c. Maternal shock

d. Hypofibrinogenemia (ie, <150 mg/dL)

e. Coagulopathy

f. Fetal death

Obstetric Complications Flashcard List

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