Antepartum haemorrhage

This is how I remember the key points about antepartum haemorrhage:

Annie is a 25 year old lady who is 25 weeks pregnant. She doesn’t know much, but she does know she’s having twins. Her anomaly scan shows a low placenta with a clot behind it, and also some exposed vessels between the placenta and the baby.

She has had a number of STI’s in the past, and recently hurt herself falling off her bike, which caused some bleeding from the groin.

The doctor goes to examine her but Annie slaps her hand away and says, “I have a placenta praevia, so you can’t touch this”

Just at that moment, Annie starts bleeding torrentially, and goes very pale. She gets very hot, panics and collapses on the floor. She begins to urinate blood as well and the doctor sets up a transfusion to try and replace some of the blood, before she also puts on some TED stockings. The CTG shows marked foetal distress and very quickly the tiny foeti show no signs of life.

  • Affects 2-5% of pregnancies
  • Defined as haemorrhage after 24 weeks of pregnancy and before birth
  • Mainly idiopathic
  • Placenta usually the cause:
    • placenta praevia (more likely with twins)
    • placental abruption
    • vasa praevia
  • Genital causes:
    • cervicitis
    • trauma
    • vulvovaginal varicosity
  • Be sure to exclude a placenta praevia before performing a digital vaginal examination
  • Complications:
    • anaemia
    • consumptive coagulopathy (DIC)
      • can give 4 units of FFP and 10 units of cryoprecipitate
    • shock
    • psychological sequelae
    • renal tubular necrosis
    • transfusion and its complications
      • VTE risk
    • foetal hypoxia
    • iugr and sga
    • foetal death

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