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Obstetric Hemorrhage (Aph)

Definition

 

Antepartum haemorrhge is defined as bleeding from the genital tract after fetal viability and before delivery. In the past viability was considered to be from 28 weeks onwards, but due to the improvements in neonatal survival, this has been changed. The cut off point for fetal viability is now considered as 22 weeks by the WHO.

 

Causes:

  1. Placenta praevia
  2. Abruptio placenta
  3. Local causes like polyp, caner cervix, varicose veins and local trauma
  4. Circumvallate placenta
  5. Vasa praevia
  6. Unclassified or indeterminate

Distinguishing features of placenta previa and abruptio placenta
 

Clinical Features

Placenta Previa

Abruptio Placenta

Nature of bleeding

a. Painless, profuse

a. Painful

 

b. Bleeding is always revealed

b. Revealed, concealed, or usually mixed

 

c. Periodic

c. Progressive

General condition and anemia

Proportional to visible blood

loss

Out of proportion to the visible blood loss in

concealed or mixed variety

Features of preeclampsia

Unrelated

Very likely to be present

Height of uterus

Proportionate height

May be disproportionately enlarged in concealed type

Feel of uterus

Soft and relaxed

Tonically contracted uterus

Malpresentation

Malpresentation is common

(breech, transverse lie). The

head is high floating

Unrelated, the head may be engaged

Placentography

Placenta in lower segment

Placenta in upper segment

Tocolysis

Can be given

Never

Wait and watch

Can be done

Never

Delivery

LSCS

LSCS or vaginal delivery

DIC

Less common

More common





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